title: 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.
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.
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schwartz
authors.forename: Umer I
authors.initials: UI
authors.lastname: Chaudhry
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Suzo
authors.forename: Nicholas
authors.initials: N
authors.lastname: Durkin
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Wehr
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Kathy S
authors.initials: KS
authors.lastname: Foreman
authors.forename: Kristen
authors.initials: K
authors.lastname: Tychonievich
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
authors.affiliation: The Comprehensive Weight Management and Bariatric Surgery Program, Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Room 558, Columbus, OH, 43210, USA. Sabrena.noria@osumc.edu.
authors.forename: Sabrena F
authors.initials: SF
authors.lastname: Noria
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000008:administration & dosage*; D050110:Bariatric Surgery; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery / Q000628:therapy*; D010645:Phentermine / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077236:Topiramate; D015431:Weight Loss / Q000187:drug effects
chemical_list: D019440:Anti-Obesity Agents; D000077236:Topiramate; D005632:Fructose; D010645:Phentermine
keywords: Bariatric surgery; Phentermine; Phentermine–topiramate; Weight loss plateau; Weight recidivism