Abstract
Background
Bariatric surgery is an effective therapeutic option for management of obesity. However, weight recidivism (WR) and weight loss plateau (WLP) are common problems. We present our experience with the use of two pharmacotherapies in conjunction with our standard diet and exercise program in those patients who experienced WR or WLP.
Methods
From June 2010 to April 2014, bariatric surgery patients who experienced WR or WLP after undergoing Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), and who were treated with phentermine (Ph) or phentermine–topiramate (PhT), were reviewed retrospectively. Generalized estimating equations were used to compare patient weights through 90 days between initial surgery type and medication type. Patient weights, medication side effect, and co-morbidities were collected during the first 90 days of therapy.
Results
Fifty-two patients received Ph while 13 patients received PhT. Overall, patients in both groups lost weight. Among those whose weights were recorded at 90 days, patients on Ph lost 6.35 kg (12.8 % excess weight loss (EWL); 95 % confidence interval (CI) 4.25, 8.44) and those prescribed PhT lost 3.81 kg (12.9 % EWL; CI 1.08, 6.54). Adjusting for baseline weight, time since surgery, and visit through 90 days, patients treated with Ph weighed significantly less than those on PhT throughout the course of this study (1.35 kg lighter; 95 % CI 0.17, 2.53; p = 0.025). There were no serious side effects reported.
Conclusions
Phentermine and phentermine–topirimate in addition to diet and exercise appear to be viable options for weight loss in post-RYGB and LAGB patients who experience WR or WLP.
Similar content being viewed by others
References
World Health Organization. Media centre. Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/.
Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7. PMID: 18607383, Epub 2008 Jul 8.
Magro DO, Geloneze B, Delfini R, et al. Long-term weight regain after gastric bypass: a 5-years prospective study. Obes Surg. 2008;18(6):648–51. Epub 2008 Apr 8.
Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.
Carvajal R, Wadden TA, Tsai AG, et al. Managing obesity in primary care practice: a narrative review. Ann N Y Acad Sci. 2013;1281:191–206. PMID: 23323827, Epub 2013 Jan 16.
Dakin GF, Eid G, Mikami D, et al. Endoluminal revision of gastric bypass for weight regain—a systematic review. Surg Obes Relat Dis. 2013;9:335–43.
Eid GM, McCloskey CA, Eagleton JK, et al. StomaphyX vs a sham procedure for revisional surgery to reduce regained weight in roux-en-Y gastric bypass patients: a randomized clinical trial. JAMA Surg. 2014;149(4):372–9. doi:10.1001/jamasurg.2013.4051.
Spaulding L. Treatment of dilated gastrojejunostomy with sclerotherapy. Obes Surg. 2003;13(2):254–7. PMID: 12740134.
Schauer P, Chand B, Brethauer S. New applications for endoscopy: the emerging field of endoluminal and transgastric bariatric surgery. Surg Endosc. 2007;21(3):347–56.
McKenna D, Selzer D, Burchett M, et al. Revisional bariatric surgery is more effective for improving obesity related co-morbidities than it is for reinducing major weight loss. Surg Obes Relat Dis. 2014;10(4):654–9. Epub 2013 Dec 18.
Brethauer SA, Kothari S, Sudan R, et al. Systemic review on reoperative bariatric surgery American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10:952–72. Epub 2014 Feb 22.
Yanovski SZ, Yanovski JA. Long-term drug treatment of obesity: a systemic and clinical review. JAMA. 2014;311(1):74–86.
Jester L, Wittgrove AC, Clark GW. Adjunctive use of appetite suppressant medications for improved weight management in bariatric surgical patients. Obes Surg. 1996;6:412–5.
Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19:1826–34. doi:10.1038/oby.2011.172.
Kang JG, Park CY, Kang JH, et al. Randomized controlled trial to investigate the effects of a newly developed formulation of phentermine diffuse-controlled release for obesity. Diabetes Obes Metab. 2010;12(10):866–82.
Garvey WT, Ryan DH, Look M, et al. Two-years sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012;95(2):297–308. Epub 2011 Dec 7.
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341–52. Epub 2011 Apr 8.
Cosentino G, Conrad AO, Uwaifo GI. Phentermine and topiramate for the management of obesity: a review. Drug Des Dev Ther. 2011;7:267–78.
Li Z, Maglione M, Tu W, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532–46.
Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity. 2012;20(2):330–42. Epub 2011 Nov 3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of Interest
Dr. Mikami is a consultant for WL Gore, on the Advisor Board at CareFusion, and a consultant for Covidien. Allison Wehr, MS and Kathy Foreman, CNP have no relevant disclosures. Drs. Schwartz, Needleman, and Noria have no conflicts of interest or financial ties to disclose.
Informed Consent
For this type of study, formal consent is not required.
Rights and permissions
About this article
Cite this article
Schwartz, J., Suzo, A., Wehr, A.M. et al. Pharmacotherapy in Conjunction with a Diet and Exercise Program for the Treatment of Weight Recidivism or Weight Loss Plateau Post-bariatric Surgery: a Retrospective Review. OBES SURG 26, 452–458 (2016). https://doi.org/10.1007/s11695-015-1979-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-015-1979-x