title: Improving efficacy of the adjustable gastric band: studies of the use of adjuvant approaches in a rodent model.
abstract: BACKGROUND
  The laparoscopic adjustable gastric band (AGB) has been effective in reducing excess weight by approximately 50% for at least 16 years. However, as with all weight loss approaches, reduction in weight resulting from bariatric surgery is associated with a compensatory reduction in energy expenditure, which may confound and limit weight loss. Adjuvant therapies that reduce food intake and increase energy expenditure may be used to improve weight loss outcomes by ameliorating, or even reversing, this reduction in energy expenditure.
  
  
  METHODS
  Rats were either fitted with an AGB or were sham operated and received one of 2 adjunctive pharmacologic treatments, (1) thyroxine or (2) bupropion/naltrexone (Contrave), at a range of doses and matched with vehicle controls (n = 6-8/group) over a 4-week period of combined treatments. Metabolic parameters including food intake, weight, fat mass, and energy expenditure in brown adipose tissue (BAT), whole body calorimetry, and physical activity were assessed.
  
  
  RESULTS
  Inflation of the AGB caused a reduction in weight gain that was further enhanced by cotreatment with either thyroxine or Contrave (P<.05). Thyroxine completely ameliorated the reduction in AGB-induced BAT thermogenesis and significantly improved weight loss, particularly in fat mass. Contrave also augmented the loss of weight and fat mass associated with the AGB and increased BAT thermogenesis in banded rats even at doses below that required to change food intake.
  
  
  CONCLUSIONS
  Adjuvant therapies can improve the efficacy of the AGB, at least in part by negating the compensatory reduction in energy expenditure, but also via a combined effect on food intake.
authors.affiliation: Department of Physiology, Monash University, Melbourne, Australia.
authors.forename: Aneta
authors.initials: A
authors.lastname: Stefanidis
authors.affiliation: Department of Physiology, Monash University, Melbourne, Australia.
authors.forename: Christine Cheuk
authors.initials: CC
authors.lastname: Man Lee
authors.affiliation: Monash University Department of Surgery, Alfred Hospital, Melbourne, Australia; Centre for Obesity Research and Education, Monash University School of Public Health and Preventive Science, Melbourne, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
authors.affiliation: Department of Physiology, Monash University, Melbourne, Australia. Electronic address: brian.oldfield@monash.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Oldfield
mesh_terms: D002001:Adipose Tissue, Brown / Q000033:anatomy & histology / Q000187:drug effects / Q000502:physiology; D000818:Animals; D019440:Anti-Obesity Agents / Q000494:pharmacology; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000187:drug effects / Q000502:physiology; D050218:Body Fat Distribution; D001831:Body Temperature / Q000187:drug effects / Q000502:physiology; D016642:Bupropion / Q000008:administration & dosage / Q000494:pharmacology; D059305:Diet, High-Fat; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004435:Eating / Q000187:drug effects / Q000502:physiology; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D015391:Gastroplasty / Q000295:instrumentation*; D018149:Glucose Intolerance / Q000503:physiopathology; D007279:Injections, Subcutaneous; D007333:Insulin Resistance / Q000502:physiology; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage / Q000494:pharmacology; D009765:Obesity / Q000503:physiopathology / Q000601:surgery; D010805:Physical Conditioning, Animal; D017207:Rats, Sprague-Dawley; D022722:Thermogenesis / Q000187:drug effects / Q000502:physiology; D013974:Thyroxine / Q000008:administration & dosage / Q000494:pharmacology; D015431:Weight Loss / Q000187:drug effects / Q000502:physiology
chemical_list: D019440:Anti-Obesity Agents; D001786:Blood Glucose; D004338:Drug Combinations; C000591595:bupropion hydrochloride, naltrexone hydrochoride drug combination; D016642:Bupropion; D009271:Naltrexone; D013974:Thyroxine
keywords: Adjustable gastric band; Adjuvant therapy; Animal model; Bariatric surgery