title: The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study.
abstract: BACKGROUND
  Patients who undergo bariatric surgery often have inadequate weight loss or weight regain.
  
  
  OBJECTIVE
  We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000-2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy.
  
  
  RESULTS
  A total of 319 patients (RYGB = 258; sleeve gastrectomy = 61) met inclusion criteria for analysis. More than half (54%; n = 172) of all study patients lost≥5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n = 96) and 15% (n = 49) losing≥10% (16.7 to 195.2 lbs) and≥15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a statistically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio = 1.9; P = .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose≥5% of their total weight with the aid of weight loss medications.
  
  
  CONCLUSIONS
  Weight loss pharmacotherapy serves as a useful adjunct to bariatric surgery in patients with inadequate weight loss or weight regain.
authors.affiliation: MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA; Endocrine Unit, Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: fstanford@mgh.harvard.edu.
authors.forename: Fatima Cody
authors.initials: FC
authors.lastname: Stanford
authors.affiliation: MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, MA.
authors.forename: Nasreen
authors.initials: N
authors.lastname: Alfaris
authors.affiliation: Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA.
authors.forename: Gricelda
authors.initials: G
authors.lastname: Gomez
authors.affiliation: Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY; Texas Tech University- Paul L. Foster School of Medicine, El Paso, TX.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Ricks
authors.affiliation: Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Alpana P
authors.initials: AP
authors.lastname: Shukla
authors.affiliation: Harvard Medical School, Boston, MA; Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Corey
authors.affiliation: Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Janey S
authors.initials: JS
authors.lastname: Pratt
authors.affiliation: Department of GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.affiliation: Department of Metabolic and Bariatric Surgery, Kings College London and Kings College Hospital, London, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
authors.affiliation: Institute of Human Nutrition, Columbia University, New York, NY.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Aronne
mesh_terms: D000328:Adult; D000368:Aged; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D050110:Bariatric Surgery; D015992:Body Mass Index; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions; D009767:Obesity, Morbid / Q000601:surgery; D011182:Postoperative Care; D012189:Retrospective Studies; D015430:Weight Gain / Q000187:drug effects*; D015431:Weight Loss / Q000187:drug effects*; D055815:Young Adult
chemical_list: D019440:Anti-Obesity Agents
keywords: Bariatric surgery; Inadequate weight loss; Obesity; Obesity co-morbidities; Weight regain