The study reveals that anti-obesity medications such as topiramate and phentermine used in combination or individually can significantly reduce weight regain in patients who have undergone Roux-en-Y gastric bypass surgery. The findings of the retrospective study are published online in Obesity, the flagship journal of The Obesity Society.
Associate professor of medicine, Nawfal Istfan, MD, Ph.D., at Boston University School of Medicine and attending physician at Boston Medical Center is the corresponding author of the study. He said that this study provides evidence that medications can be helpful, particularly in situations where the weight gain is occurring at a quick rate. Characterization of weight regains as a rate is novel and adds to the understanding of this important medical problem.
Weight regain after gastric surgery is well recognized, ordinarily occurring two years after the procedure and eventually affecting 25 per cent of patients. It is becoming urgent to control its occurrence and preserve the medical and metabolic benefits of weight reduction surgery. The use of pharmacologic agents for dealing with this specific problem has been constrained in the medical literature.
Researchers used the electronic clinical records of almost 1,200 multi-ethnic patients who underwent Roux-en-Y gastric bypass surgery at Boston Medical Center, between 2004 and 2015. The evaluation of weight regain was done by comparing the weight of each patient during subsequent, post-operative office visits for nadir weight (minimum weight after Roux-en-Y gastric bypass surgery), taking into consideration the interim during which weight regain happened. Seven-time interims were used in the evaluation ranging from before the surgery to 6 years after the surgery. Patients were prescribed anti-obesity medications and who came for follow-up visits were considered as adherent users, whereas the individuals who missed their follow-up visits were classified as non-adherent.
Using three different statistical models, researchers found that anti-obesity medications decrease total weight regain by about 10 per cent comparative to nadir weight and lessen the chances of quick weight-regain after Roux-en-Y gastric bypass surgery. Researchers also demonstrated that of the 760 patients who got nadir weight and are at risk for weight regain, 350 of them were documented users of anti-obesity medications.
These outcomes take into account that patients usually lost their weight by taking anti-obesity medications and regained it during the intervals when no medications were prescribed. Moreover, patients started using anti-obesity drugs at different stages and used them at intermittent and variable periods.
The authors of the study observed that the full potential of topiramate and phentermine and latest anti-obesity medications for countering weight recidivism and preventing the reoccurrence of comorbidities related to obesity need to be checked in further prospective clinical trials. Guidelines also need to be made to initiate and monitor the long-term use of anti-obesity drugs after bariatric surgery.
Assistant professor at the University of Florida College Of Medicine, Crystal Johnson-Mann, M.D. said that one of the ways of addressing these limitations in future prospective clinical trials would be to follow specific protocols regarding the use of anti-obesity medications. In particular, providing education and training to providers on individual anti-obesity medications to understand its mode of action, and then separately creating a clinical work process for incorporating the use of anti-obesity medications, specifical settings of weight recidivism. She said that for ideal results in a prospective trial, individuals prescribing tendencies (or lack of prescribing) should be eliminated and be uniform over the entirety of the providers engaged in taking care of the patients post-operatively.