Highlights
- •Antiobesity Medications can safely be used before and after bariatric surgery.
- •Neoadjuvant use of antiobesity medications has the greatest effect.
- •Early adjuvant antiobesity medications use can improve weight loss trajectory.
Abstract
Background
Few studies have examined the adjuvant use of antiobesity medications with surgery,
especially in the pre- and early postoperative periods.
Objective
Evaluate the impact of adjuvant pharmacotherapy on bariatric surgery outcomes.
Setting
University hospital, United States.
Methods
A retrospective chart review of patients receiving adjuvant pharmacotherapy for obesity
treatment and bariatric surgery. Patients received pharmacotherapy either preoperatively
if their body mass index was >60, or in the first or second postoperative years for
suboptimal weight loss. Outcome measures included percentage of total body weight
loss as well as comparison with the expected weight loss curve as determined by the
Metabolic and Bariatric Surgery Risk/Benefit Calculator.
Results
A total of 98 patients were included in the study, with 93 (94.9%) undergoing sleeve
gastrectomy and 5 (5.1%) undergoing Roux-en-Y gastric bypass surgery. During the study
period, patients were prescribed phentermine and/or topiramate. At postoperative year
1, patients who received pharmacotherapy preoperatively lost 31.3% of their total
body weight (TBW) compared with 25.3% TBW for patients with suboptimal weight loss
who received medication in the first postoperative year, and 20.8% TBW for patients
who did not receive any antiobesity medication in the first postoperative year. Using
the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program
(MBSAQIP) curve for comparison, patients receiving medication preoperatively weighed
2.4% less than expected, whereas patients receiving medication during the first postoperative
year weighed 4.8% higher than expected.
Conclusion
For patients having bariatric surgery who fall below the expected MBSAQIP weight loss
curve, early initiation of antiobesity medications can improve the weight loss, with
preoperative pharmacotherapy having the greatest effect.
Keywords
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Article info
Publication history
Published online: February 14, 2023
Accepted:
January 21,
2023
Received:
September 1,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Research reported in this publication was supported by the West Virginia University Clinical and Translational Science Institute through the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM104942-05. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Identification
Copyright
© 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- Comment on: Preoperative and Early Adjuvant Antiobesity Medications in Bariatric Surgery Patients with BMI over 60 or Suboptimal Initial Response to SurgerySurgery for Obesity and Related Diseases
- PreviewIn the US, currently only 1-2% of individuals who qualify for bariatric surgery or anti-obesity medications (AOMs) receive them. Of individuals that receive bariatric surgery, 20-25% experience significant weight regain or insufficient weight loss. (1) The authors are to be commended for reporting their efforts to optimize patient outcomes by combining bariatric surgery with AOMs in patients identified as high risk for not meeting post-surgical weight targets including high initial BMI and insufficient weight loss at 3 and 6 months post-op.
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