PATTERNS OF WEIGHT LOSS MEDICATION UTILIZATION AND OUTCOMES FOLLOWING BARIATRIC SURGERY
Colston Edgerton*, Meetal Mehta, Danny Mou, Nena Pater, Lalita Khaodhiar, Ali Tavakkoli
Brigham and Women's Hospital, Boston, MA
Introduction
Bariatric surgery is the most effective treatment for obesity, with nadir weight loss occurring 12-18 months following surgery. Some patients, however, can experience significant weight regain. Weight loss medications (WLM) are being increasingly used to address weight regain, but with limited evidence guiding their use. We examine the outcomes of patients after bariatric surgery that were placed on WLM.
Methods
In a retrospective study, all patients who had undergone bariatric surgery and later seen in our referral center and started on WLM between 2016-2019 were analyzed. Patients were placed into 3 categories: (1) Weight Regainers (WR): achieved initial intended goal weight loss after surgery (15% total body weight loss (TBWL) for sleeve gastrectomy (SG), 25% TBWL for roux en y gastric bypass (RYGB)) with subsequent weight gain of >20% of the weight lost (2) Inadequate Weight Loss (IWL): achieved intended goal weight loss, did not regain >20% of the weight lost, but were started on medication to help with further weight loss (3) Non-Responders (NR): did not achieve intended goal weight loss. Time to medical therapy initiation, nadir weight on medication as well as the time to achieve that nadir were analyzed. The categories were further analyzed by index operation. Revisions were categorized according to their revised anatomy. Statistical significance between averages was calculated using students t test with significance determined to be a p value <0.05.
Results
One hundred and ninety-two patients were identified (90% female; average age 46.9 years). Among all patients, RYGB lost more weight with WLM than SG (8.3 vs 6.6 %TBWL, p=0.03). Table 1 summarizes the baseline characteristics of the three groups and primary outcomes. The IWL group had a higher percent of SG patients. Between the three groups, there was no statistically significant difference for %TBWL with medication, time to nadir weight with medication, and duration of medical therapy. There was a significant difference in time to initiation of WLM between WR and IWL groups (p<0.01), and NR and IWL groups (p=0.02).
Conclusions
Our analysis indicates that in a large cohort of bariatric patients taking WLM, RYGB patients respond better to WLM than SG patients. However when differentiating the groups based on indication for WLM, there is no difference in weight loss achieved among the WR, IWL, and NR cohorts. A proportionally higher percent of SG patients were observed in the IWL group. IWL patients initiated WLM sooner following surgery than other patients.
Table 1. Characteristics and weight loss outcomes of three cohorts receiving weight loss medication (WLM) following bariatric surgery.
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