Gaining It Back after Bariatric Surgery: Weight Loss Drugs as an Option

Although generally the most effective intervention for morbid obesity, bariatric surgery does not result in predictable weight loss patterns.

Some patients lose weight quickly and consistently, and most lose weight more quickly than the size of their necessary calorie reduction would suggest. Between 10% and 30% struggle with weight recidivism (WR) and weight loss plateau (WLP).

Patients and their healthcare providers have several options, which to date include lifestyle modification, endoscopic treatments, and revisional surgery. These patients usually have trouble with diet and exercise approaches.

A team of experts from The Comprehensive Weight Management and Bariatric Surgery Program at The Ohio State University Wexner Medical Center discussed a new approach — the use of adjunct pharmacotherapy and standard diet and exercise programs in patients with WR or WLP after bariatric surgery.

This article appears in the February issue of Obesity Surgery.

The researchers retrospectively reviewed bariatric surgery patients who experienced WR or WLP after bariatric surgery. They calculated patients’ weight 90 days after initial surgery. Then they collected data concerning patient weights, medication side effect, and co-morbidities were collected during the first 90 days of pharmacotherapy.

The researchers noted that phentermine, approved since 1959, was the most prescribed weight loss medication in the USA and has been associated with a 5% to 10% excess weight loss (EWL) if used fewer than six months.

Phentermine—topiramate ER has been approved for long-term use since 2012, and studies demonstrated weight loss of roughly 10% at one year; this weight loss tends to be maintained at two years if the patient continues on the drug.

The researchers identified 52 patients who were prescribed phentermine and 13 who received phentermine—topiramate ER. Patients in both groups lost more weight than would be predicted using diet and exercise alone.

Among those whose weights were recorded at 90 days, patients on phentermine lost 6.35 kg (12.8% EWL). Patients taking phentermine—topiramate lost 3.81 kg (12.9% EWL).

Adjusting for baseline weight, time since surgery, and visit through 90 days, patients treated with phentermine weighed significantly less than those on phentermine—topiramate ER throughout the course of this study.

Patients reported no serious side effects reported.

The researchers indicate that adding weight loss drugs when patients experience WR or WLP after bariatric surgery may be an option to explore. They note that they only followed patients for 90 days, so these results should be considered short-term at best.