Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, School of Medicine, Boston University/Boston Medical Center, Boston, Massachusetts, USA.
Section of Minimally Invasive Surgery, Department of Surgery, School of Medicine, Boston University /Boston Medical Center, Boston, Massachusetts, USA.
Obesity (Silver Spring). 2020 Jun;28(6):1023-1030. doi: 10.1002/oby.22786.
Weight regain (WR) after Roux-en-Y gastric bypass surgery (RYGB) starts to occur 2 years after surgery, ultimately affecting at least 25% of patients. A limited number of studies have evaluated the impact of antiobesity medications (AOMs) on this phenomenon.
This study reviewed the electronic medical records of 1,196 patients who underwent RYGB between 2004 and 2015. WR was evaluated by comparing each patient's weight during subsequent postoperative office visits to nadir weight (lowest weight after RYGB, n = 760), taking into consideration the interval during which WR occurred. Patients who were prescribed AOMs and came to follow-up visits were classified as adherent users, whereas those who missed their follow-up visits were considered nonadherent. This study used a linear mixed model, Cox regression, and generalized equation estimator to determine the impact of AOMs on WR trajectory, hazard ratio for time to event, and odds ratio for repeated event occurrence, respectively.
Despite the lack of a unified protocol for using AOMs, the three statistical models converged to show that phentermine and topiramate, used individually or in combination, can significantly reduce WR after RYGB.
Phentermine and topiramate are effective in mitigating WR after RYGB. Further studies are needed to help ascertain optimal use of AOMs after bariatric surgery.
减重手术（RYGB）后体重反弹（WR）始于术后 2 年，最终影响至少 25%的患者。有限数量的研究评估了抗肥胖药物（AOM）对此现象的影响。
本研究回顾了 2004 年至 2015 年间接受 RYGB 的 1196 名患者的电子病历。通过将每位患者随后的术后就诊体重与最低体重（RYGB 后最低体重，n=760）进行比较，评估 WR，考虑到 WR 发生的时间间隔。服用 AOM 并来随访的患者被归类为依从性使用者，而错过随访的患者被认为是非依从性使用者。本研究使用线性混合模型、Cox 回归和广义方程估计器分别确定 AOM 对 WR 轨迹、时间事件风险比和重复事件发生的比值比的影响。
尽管缺乏使用 AOM 的统一方案，但这三种统计模型得出的结论一致，表明单独或联合使用安非他命和托吡酯可显著减轻 RYGB 后的 WR。
安非他命和托吡酯可有效减轻 RYGB 后的 WR。需要进一步研究以确定肥胖手术后 AOM 的最佳使用方法。
