Background

Although bariatric surgery is the gold standard for severe obesity, long-term weight regain remains a complication and pharmacotherapy is a common therapeutic option. This study compares trends in use of weight loss medications and their effectiveness following bariatric surgery.

Methods

Single-center retrospective chart review from January 2019 to December 2021 comparing outcomes of weight loss medication use after bariatric surgery. Demographics, procedure type, pre- and post-medication body mass index (BMI), and comorbidities recorded. Total body weight loss (TBWL) calculated and compared using ANOVA.

Results

Of 158 patients prescribed medication, 91 (57%) had prior surgery: 59 (65%) Roux-en-Y, 27 (30%) sleeve gastrectomy, and 5 (5%) gastric band. Of this cohort, 85% were women and 84% white. 19% had diabetes, 43% hypertension, 48% hyperlipidemia, and 40% obstructive sleep apnea. On average, medication was started 7.3 years post-procedure. 61 started on liraglutide, 14 on naltrexone/bupropion, 8 on phentermine, 5 on semaglutide, and 3 on phentermine/topiramate. Average weight loss was 10lbs (4% TBWL). 75% lost weight and 25% maintained/regained weight, ranging from 68lbs lost to 37lbs gained. Between medications TBWL was significantly different (p<0.05). Phentermine/topiramate had the greatest weight loss, average 30.3lbs (13% TBWL). Naltrexone/bupropion had the lowest, average 0.89lbs (0% TBWL) gained.

Conclusions

Although bariatric surgery is the gold standard for severe obesity, the substantial proportion of post-surgical patients on weight loss medication indicates it is not a permanent solution. For providers to optimize long-term outcomes, further research is necessary to determine the ideal combination and timing of medication initiation post-surgically.