Use of Weight Loss Medications in Patients after Bariatric Surgery

Abstract

Purpose of Review

Weight regain after bariatric surgery is unfortunately a common occurrence. In this article, we have reviewed the data addressing this clinical problem focusing on pharmacological management of weight regain.

Recent Findings

Data from several small, non-randomized, retrospective, and prospective studies provide evidence that a number of pharmacological options, both FDA approved and off-label, are effective in mitigating and managing weight regain after bariatric surgery. There is a suggestion that the optimal time to initiate weight loss medications may be at the time of weight plateau, rather than after weight regain.

Summary

Adjuvant pharmacotherapy can help treat weight regain after bariatric surgery. Future studies should investigate the optimal timing for starting weight loss medications, as well as the best medication or combinations of medicines, for managing postoperative weight regain in different patient groups, including those who have undergone different types of bariatric surgeries.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    American Society for Metabolic and Bariatric Surgery. 2020. Estimate Of Bariatric Surgery Numbers, 2011–2018 | American Society For Metabolic And Bariatric Surgery. [online] Available at: <https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers>.

  2. 2.

    •• Sjostrom L. Review of the key results from results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34 The largest prospective observational study of long-term outcomes after bariatric surgery.

    CAS  Article  Google Scholar 

  3. 3.

    Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.

    Article  Google Scholar 

  4. 4.

    Courcoulas AP, King WC, Belle SH, Berk P, Flum DR, Garcia L, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153(5):427–34.

    Article  Google Scholar 

  5. 5.

    Nedelcu M, Khwaja HA, Rogula TG. Weight regain after bariatric surgery – how should it be defined? Surg Obes Relat Dis. 2016;12(5):1129–30.

    Article  Google Scholar 

  6. 6.

    Lauti M, Lemanu D, Zeng ISL, Su’a B, Hill AG, MacCormick AD. Definition determines weight regain outcomes after sleeve gastrectomy. Surg Obes Relat Dis. 2017;13(7):1123–9.

    Article  Google Scholar 

  7. 7.

    •• Karmali S, Brar B, Shi X, Sharma AM, De Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33 A thorough systematic review detailing the risk factors for weight regain.

    Article  Google Scholar 

  8. 8.

    Stanford FC. Controversial issues: a practical guide to the use of weight loss medications after bariatric surgery for weight regain or inadequate weight loss. Surg Obes Relat Dis. 2019;15(1):128–32.

    Article  Google Scholar 

  9. 9.

    Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474–81.

    Article  Google Scholar 

  10. 10.

    King WC, Hinerman AS, Belle SH, Wahed AS, Courcoulas AP. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA. 2018;320(15):1560–9.

    Article  Google Scholar 

  11. 11.

    Colles SL, Dixon JB, O'Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity. 2008;16:615–22.

    Article  Google Scholar 

  12. 12.

    Kalarchian MA, Marcus MD, Wilson GT, Labouvie EW, Brolin RE, LaMarca LB. Binge eating among gastric bypass patients at long-term follow-up. Obes Surg. 2002;12(2):270–5.

    Article  Google Scholar 

  13. 13.

    Shukla AP, He D, Saunders KH, Andrew C, Aronne LJ. Current concepts in management of weight regain following bariatric surgery. Expert Rev Endocrinol Metab. 2018;13(2):67–76.

    CAS  Article  Google Scholar 

  14. 14.

    Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.

    Article  Google Scholar 

  15. 15.

    Meguid MM, Glade MJ, Middleton FA. Weight regain after Roux-en-Y: a significant 20% complication related to PYY. Nutrition. 2008;24:832–42.

    CAS  Article  Google Scholar 

  16. 16.

    Zoss I, Piec G, Horber FF. Impact of orlistat therapy on weight reduction in morbidly obese patients after implantation of the Swedish adjustable gastric band. Obes Surg. 2002;12:113–7.

    Article  Google Scholar 

  17. 17.

    Zilberstein B, Pajecki D, Garcia de Brito AC, et al. Topiramate after adjustable gastric banding in patients with binge eating and difficulty losing weight. Obes Surg. 2004;14(6):802–5.

    Article  Google Scholar 

  18. 18.

    Ard JD, Beavers DP, Hale E, Miller G, McNatt S, Fernandez A. Use of phentermine-topiramate extended release in combination with sleeve gastrectomy in patients with BMI 50 kg/m2 or more. Surg Obes Relat Dis. 2019;15:1039–43.

    Article  Google Scholar 

  19. 19.

    Suliman M, Buckley A, Tikriti AA, et al. Routine clinical use of Liraglutide 3 mg for the treatment of obesity: outcomes in non-surgical and bariatric surgery patients. Diabetes Obes Metab. 2019;21(6):1498–501.

    CAS  Article  Google Scholar 

  20. 20.

    Schwartz J, Chaudry UI, Suzo A, et al. Pharmacotherapy in conjunction with a diet and exercise program for the treatment of weight recidivism or weight loss plateau post-bariatric surgery: a retrospective review. Obes Surg. 2016;26(2):452–8.

    Article  Google Scholar 

  21. 21.

    Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity. 2013;21(11):2163–71.

    CAS  Article  Google Scholar 

  22. 22.

    Gorgojo-Martinez JJ, Feo-Ortega G, Serrano-Moreno C. Effectiveness and tolerability of liraglutide in patients with type 2 diabetes mellitus and obesity after bariatric surgery. Surg Obes Relat Dis. 2016;12:1856–65.

    Article  Google Scholar 

  23. 23.

    Pajecki D, Halpern A, Cercato C, Mancini M, De Cleva R, Santo MA. Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery. Rev Col Bras Cir. 2012;40(3):191–5.

    Article  Google Scholar 

  24. 24.

    Wharton S, Kuk JL, Luszczynski M, Kamran E, Christensen RAG. Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery. Clin Obes. 2019;9(4):e12323.

    Article  Google Scholar 

  25. 25.

    •• Stanford FC, Alfaris N, Gomez G, et al. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Surg Obes Relat Dis. 2017;13(3):491–500 A large retrospective review of the use of weight loss medications after bariatric surgery.

    Article  Google Scholar 

  26. 26.

    Stanford FC, Toth AT, Shukla AP, Pratt JS, Cena H, Biino G, et al. Weight loss medications in older adults after bariatric surgery for weight regain or inadequate weight loss: a multicenter study. Bariatric Surg Pract Patient Care. 2018;13(4):171–8.

    Article  Google Scholar 

  27. 27.

    Toth AT, Gomez G, Shukla AP, et al. Weight loss medications in young adults after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Children. 2018;5(9):116.

    Article  Google Scholar 

  28. 28.

    Hanipah ZN, Nasr EC, Bucak E, et al. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018;14:93–8.

    Article  Google Scholar 

  29. 29.

    Srivastava G, Buffington C. A specialized medical management program to address post-operative weight regain in bariatric patients. Obes Surg. 2018;28:2241–6.

    Article  Google Scholar 

  30. 30.

    Apovian CM, Aronne LJ, Bessesen DH, McDonnell M, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62.

    CAS  Article  Google Scholar 

  31. 31.

    Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiat. 2010;71:1259–72.

    Article  Google Scholar 

  32. 32.

    Messerli FH, Bell DS, Fonseca V, Katholi RE, McGill J, Phillips RA, et al. Body weight changes with beta-blocker use: results from GEMINI. Am J Med. 2007;120:610–5.

    CAS  Article  Google Scholar 

  33. 33.

    Igel LI, Sinha A, Saunders KH, Apovian CM, Vojta D, Aronne LJ. Metformin: an old therapy that deserves a new indication for the treatment of obesity. Curr Atheroscler Rep. 2016;18(4):16.

    CAS  Article  Google Scholar 

  34. 34.

    Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016 Jul 28;375(4):311–22.

    CAS  Article  Google Scholar 

  35. 35.

    Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.

    CAS  Article  Google Scholar 

  36. 36.

    O’Neil PM, Birkenfeld AL, McGowan B, et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet. 2018;392:637–49.

    Article  Google Scholar 

  37. 37.

    https://clinicaltrials.gov/ct2/show/NCT04095104?term=bariatric+surgery&cond=obesity+pharmacotherapy&draw=2&rank=1. Accessed 6 April 2020.

  38. 38.

    https://clinicaltrials.gov/ct2/show/NCT03603080?term=bariatric+surgery&cond=obesity+pharmacotherapy&draw=2&rank=3. Accessed 6 April 2020.

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ilana P. Redmond.

Ethics declarations

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Obesity Treatment

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Redmond, I.P., Shukla, A.P. & Aronne, L.J. Use of Weight Loss Medications in Patients after Bariatric Surgery. Curr Obes Rep (2021). https://doi.org/10.1007/s13679-021-00425-1

Download citation

Keywords

  • Obesity
  • Bariatric surgery
  • Weight regain
  • Pharmacotherapy
  • Weight loss