Background

Preoperative weight loss for bariatric surgery patients has been demonstrated to enhance outcomes. Anti-obesity medications (AOM) provide an opportunity to down-stage disease. Barriers to use of AOMs include the approval process and manpower. Here we describe a new paradigm of weight loss services utilizing clinical pharmacists.

Methods

Within our health system, clinical pharmacists who are integrated into our specialty disease state clinics were recognized as enhancing patient outcomes. A need in our bariatric surgery program emerged for pre-operative weight loss. Given manpower access issues and burdensome insurance approval process, clinical pharmacists emerged as ideal health care providers and a pilot program was initiated.

Results

24 patients have been enrolled to date in the Clinical Pharmacist Weight Management Pilot. There was significant variation in duration of therapy, highest dose achieved, and type of AOM used. There were 6 medications employed including Ozempic® (61%); Victoza® (9%); Wegovy , (4%); Saxenda ® (9%); Trulicity® (9%); and Monjaro®(9%). Median duration of therapy was 17 weeks (4-80 weeks). Initial BMI median was 57 (range: 37-74) and latest BMI prior to surgery was 53 (range: 37-71). No adverse effects were noted with medication use and 25% of patients successfully underwent bariatric surgery without any complications.

Conclusions

This pilot program successfully shows that clinical pharmacists can provide enhanced outcomes through combined therapies of AOMs and bariatric surgery. As previously demonstrated in anticoagulation and diabetes management, clinical pharmacists can both navigate the insurance drug approval process and provide therapy to a well-defined target with low adverse events.