Center for Metabolic and Bariatric Surgery, Division of Gastrointestinal Surgery, Medical University of South Carolina, Charleston, SC, USA.
Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
J Gastrointest Surg. 2021 Feb;25(2):369-377. doi: 10.1007/s11605-020-04880-4. Epub 2021 Jan 8.
Bariatric surgery is the most effective treatment for obesity; however, some patients experience significant weight regain. Weight loss medications (WLM) are being increasingly used in surgery patients with limited evidence. We examine weight loss outcomes in patients using WLM after bariatric surgery.
In a retrospective study, 197 bariatric surgery patients who started WLM between 2016 and 2019 at a single center were analyzed. Patients were categorized into 3 groups based on outcomes of the initial surgery: (1) Weight regainers (WR) = achieved goal weight loss after surgery (15% total body weight loss (TBWL) for sleeve gastrectomy (SG) and 25% TBWL for Roux-en-Y gastric bypass (RYGB)) with subsequent regain of > 20% of weight lost; (2) Adequate weight loss (AWL) = achieved goal weight loss without > 20% weight regain; (3) Non-responders (NR) = never achieved goal weight loss. Weight loss and medication use patterns were analyzed.
Among the three categories, there was no significant difference in duration of medical therapy or %TBWL with medications. RYGB patients lost more weight than SG patients using WLM (p = 0.03). Of the medications used, patients treated with phentermine + topiramate had the highest likelihood of achieving 5%, 10%, and 15% weight loss. Compared to other 2 groups, AWL group initiated WLM earlier and experienced more weight loss when compared to their pre-operative weight or post-operative nadir.
RYGB patients respond better to WLM than SG patients. Those who had started WLM before regaining weight (AWL) experienced greater overall weight loss, suggesting that proactive medical therapy at the time of weight plateau can help with greater total weight loss. Phentermine + topiramate is the most effective WLM in post-bariatric surgery patients.
减重手术是治疗肥胖症最有效的方法；然而，一些患者会出现明显的体重反弹。减肥药物（WLM）在手术患者中的应用越来越多，但证据有限。我们研究了在减重手术后使用 WLM 的患者的减肥效果。
在一项回顾性研究中，分析了 2016 年至 2019 年期间在一家中心接受 WLM 的 197 名减重手术患者。根据初始手术的结果，患者分为 3 组：（1）体重反弹者（WR）=手术后达到目标体重减轻（袖状胃切除术（SG）为 15%总体体重减轻（TBWL），Roux-en-Y 胃旁路术（RYGB）为 25%TBWL），随后体重减轻超过 20%；（2）充分减重者（AWL）=达到目标体重减轻，没有超过 20%的体重反弹；（3）无应答者（NR）=从未达到目标体重减轻。分析了体重减轻和药物使用模式。
在这三个类别中，药物治疗的持续时间或体重减轻的%TBWL 没有显著差异。RYGB 患者使用 WLM 比 SG 患者体重减轻更多（p=0.03）。在所使用的药物中，接受 phentermine+topiramate 治疗的患者达到 5%、10%和 15%体重减轻的可能性最高。与其他两组相比，AWL 组更早开始 WLM，与术前体重或术后最低点相比，体重减轻更多。
RYGB 患者对 WLM 的反应优于 SG 患者。那些在体重反弹之前开始 WLM（AWL）的患者经历了更大的总体体重减轻，这表明在体重平台期积极进行药物治疗有助于实现更大的总体体重减轻。 phentermine+topiramate 是减重手术后患者最有效的 WLM。
