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Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database

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Abstract

Purpose

A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery.

Materials and Methods

We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations.

Results

A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35–39 years for topiramate, 40–44 years for phentermine/topiramate and naltrexone/bupropion, 45–49 years for semaglutide, and 65–69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use.

Conclusion

Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.

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Abbreviations

USPSTF:

United States Preventive Services Task Force

BMI:

Body mass index

IWL:

Insufficient weight loss

WR:

Weight regain

RYGB:

Roux-en-Y gastric bypass

AOM:

Anti-obesity medication

GABA:

Gamma aminobutyric acid

GLP-1:

Glucagon-like peptide-1

FDA:

Food and Drug Administration

SG:

Sleeve gastrectomy

SNOMED-CT:

Systematized Nomenclature of Medicine-Clinical Terms

HIPAA:

Health Insurance Portability and Accountability Act

CVA:

Cerebrovascular accident

MI:

Myocardial infarction

OR:

Odds ratio

CI:

Confidence interval

EWL:

Excess weight loss

TWL:

Total weight loss

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Author information

Authors and Affiliations

  1. Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Stephen A. Firkins, Bailey Flora & Roberto Simons-Linares

  2. Digestive Health Institute, University Hospitals, Cleveland, OH, USA

    Vibhu Chittajallu

  3. Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Heesoo Yoo

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  5. Roberto Simons-Linares
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Contributions

Study concept and design: RSL, SF, VC, BF, HY. Acquisition of data: SF, VC. Statistical analysis and data verification: SF, VC, BF, HY. Data analysis and interpretation: SF, VC, RSL. Drafting of manuscript: SF. Critical revision of manuscript for important intellectual content and review of final manuscript: SF, VC, HY, BF, RSL. Study supervision and guarantor of article: RSL. All authors have approved the final version of this manuscript.

Corresponding author

Correspondence to Roberto Simons-Linares.

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Key Points

• In this analysis, FDA-approved AOMs were only prescribed in 0.17–2.91% of patients within 5 years of bariatric surgery.

• Of the AOMs studied, topiramate was used with highest prevalence (8.0%) after bariatric surgery and is more likely to be used in younger patients.

• GLP-1 receptor agonists are more likely to be prescribed among patients with comorbid diabetes and cardiovascular risk factors.

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Firkins, S.A., Chittajallu, V., Flora, B. et al. Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database. OBES SURG 34, 1415–1424 (2024). https://doi.org/10.1007/s11695-024-07181-w

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