Pharmacologic management of weight regain following bariatric surgery

Abstract

While bariatric surgery restults in significant long-term weight loss for most patients with obesity, post-surgical weight gain affects a considerable percentage of patients to varying degrees of severity. Furthermore, a small but significant percentage of patients experience inadequate post-surgical weight loss. Although many studies have examined the role of anti-obesity medications to address post-operative weight regain, an evidence-based consensus has not yet been achieved because of the heterogeneity of populations studied and the studies themselves. Observational studies in the post-bariatric surgery population consistently demonstrate the benefit of medical weight management after bariatric surgery, with most evidence highlighting liraglutide, topiramate, and phentermine/topiramate. New anti-obesity medications are anticipated to be helpful for post-surgical weight optimization given their efficacy in the non-surgical population.

Outcomes of concomitant antiobesity medication use with endoscopic sleeve gastroplasty in clinical US settings

“…As seen with other chronic diseases like hypertension and diabetes, using a combination of several available therapeutic options is often necessary to obtain optimal goals. For instance, AOMs have been found to be effective adjuncts for post-bariatric weight recurrence [ 3 ]. Several different medications have been used, with data suggesting that glucagon-like-1 receptor agonists (GLP-1RA) may be most effective in these cases [ 4 ].…”

Special considerations for the adolescent with obesity: An obesity medicine association (OMA) clinical practice statement (CPS) 2024

“…Evidence for the safety and effectiveness of MBS and AOMs exists in both adults and children. There is evidence for both the need and effectiveness of using AOM's in adults who have had MBS [ [67] , [68] , [69] , [70] , [71] , [72] ], but the reports suffer from a lack of consistent methods, techniques, and definitions. Despite the variety of responses of adolescents with obesity to MBS and the obvious rationale for using AOM's in some select situations, we could find no reports discussing the use of AOMs after MBS in adolescents.…”

“…This section focuses on adolescents who are post-MBS and when they may benefit from the addition of AOM's as an adjunct therapy. The available MBS data for children [ [20] , [21] , [22] , [23] , [24] , 66 ] and adults [ [67] , [68] , [69] , [70] , [71] , [72] ] is examined for the variety of responses to MBS ( Table 2 ). This information is provided as guidance for the pediatric obesity medicine team.…”

“… -Patient population was heterogeneous: -patients with 2 or 3 MBS revisions -patients with or without T2DM. Lucas et al., 2023 [ 72 ] review which lists clinical studies that evaluated the weight loss effect of AOMs in patients who were post MBS. summarize findings in general about orlistat, phentermine, topiramate, phentermine/topiramate, liraglutide, naltrexone, bupropion, naltrexone/bupropion, semaglutide, and tirzepatide.…”

Approach to Obesity Treatment in Primary Care

“…There are several resources for long-term management of patients after MBS, including recommendations for laboratory evaluation and management of postsurgical complications . Although evidence-based strategies for assisting patients with inadequate weight loss or weight regain after MBS are few, adjunctive treatment with AOMs may provide benefit …”