Pharmacotherapies for Post‐Bariatric Weight Regain: Real‐World Comparative Outcomes

Abstract

Objective This study aimed to compare outcomes of treatment strategies for weight regain after bariatric surgery. Methods This is a retrospective analysis of 207 individuals treated for post‐bariatric weight regain at an academic center from January 1, 2014, through November 25, 2019. Percentage body weight loss was compared after 3, 6, 9, and 12 months of treatment among an intensive lifestyle modification (ILM) group, a non–glucagon‐like‐1 receptor agonist (GLP‐1‐RA)‐based weight‐loss pharmacotherapy (WLP) group, and a GLP‐1‐RA‐based WLP group (the latter two groups in conjunction with ILM). Results The percentage body weight loss was significantly different between groups after 3 months (1.4% vs. 2.2% vs. 4.5% [P < 0.001] for ILM, non–GLP‐1‐RA‐based WLP, and GLP‐1‐RA‐based WLP groups, respectively), 6 months (0.8% vs. 2.9% vs. 6.7% [P < 0.001]), and 9 months (−1.6% vs. 5.6% vs. 6.9% [P = 0.007]). There was a significant difference in the percentage of individuals achieving ≥5% weight loss after 3, 6, and 9 months, with most occurring in the GLP‐1‐RA‐based WLP group. In a multiple regression analysis including bariatric surgery type, treatment group was the only significant predictor of percentage weight change. Conclusions GLP‐1‐RA‐based WLP therapies were found to be more effective for treating post‐bariatric weight regain than non–GLP‐1‐RA‐based WLP or ILM, regardless of surgery type.

The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery—a Retrospective Analysis

“…There is limited data about the use of GLP-1 RA in postbariatric WR or IWL, which were found to be more effective for treating post-bariatric weight regain than non-GLP-1 RA-based pharmacotherapies regardless of surgery type [21]. According to a retrospective review comparing amphetamine-derived phentermine with phentermine-topiramate, phentermine and phentermine-topiramate in addition to diet and exercise in post-RYGB and LAGB patients induced weight loss of 6.35 kg (12.8% excess weight loss) and 3.81 kg (12.9% EWL) within 90 days, respectively [14].…”

Patient-centered care and the “people first” principle as a tool to prevent stigmatization of patients with obesity

“…Scientific research confirms that a constructive relationship between a doctor and a patient favors, among others: recovery, compliance with recommendations, and reduced the risk of relapse [48]. The nature of the therapeutic relationship is determined by many components, including the patient's attitude but also the attitude of the doctor.…”

Pharmacologic management of weight regain following bariatric surgery

“…There are no studies evaluating the individual efficacies of naltrexone, bupropion, or naltrexone/bupropion specifically in the post-bariatric surgery population. A few studies have investigated the effectiveness of obesity pharmacotherapy in general, in which monotherapies naltrexone or bupropion and combination naltrexone/bupropion were minimally represented ( 17 , 29 , 30 ). The strongest body of evidence for weight loss efficacy stems from phase 3 randomized controlled trials of combination naltrexone/bupropion, from which individuals with a history of bariatric surgery were excluded, but demonstrated about 5% placebo-subtracted weight loss at one year ( 31 , 32 ).…”