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
- 1.1k Downloads
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.
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.
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.
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.
KeywordsPhentermine Phentermine–topiramate Weight recidivism Weight loss plateau Bariatric surgery
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of Interest
Dr. Mikami is a consultant for WL Gore, on the Advisor Board at CareFusion, and a consultant for Covidien. Allison Wehr, MS and Kathy Foreman, CNP have no relevant disclosures. Drs. Schwartz, Needleman, and Noria have no conflicts of interest or financial ties to disclose.
For this type of study, formal consent is not required.
- 1.World Health Organization. Media centre. Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/.
- 16.Garvey WT, Ryan DH, Look M, et al. Two-years sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012;95(2):297–308. Epub 2011 Dec 7.PubMedPubMedCentralCrossRefGoogle Scholar
- 17.Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341–52. Epub 2011 Apr 8.PubMedCrossRefGoogle Scholar
- 18.Cosentino G, Conrad AO, Uwaifo GI. Phentermine and topiramate for the management of obesity: a review. Drug Des Dev Ther. 2011;7:267–78.Google Scholar