Long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery: pharmacological prevention and management of body weight regain

ABSTRACT

Introduction: The obesity epidemic continues to grow. Bariatric surgery is part of the arsenal to treat the disease. Surgery results in an effective option for patients with severe obesity but also when obesity is associated with significant comorbidities. Weight regain is frequent after bariatric surgery. Consequently, the addition of anti-obesity drugs to prevent and manage weight regain are commonly recommended even when the quality of the evidence supporting this recommendation is relatively weak.

Areas covered: The aim of this review is to summarize the available evidence concerning long-term pharmacotherapy of obesity in patients that have undergone bariatric surgery with a focus on pharmacological prevention and management of weight regain. The etiology and epidemiology of weight regain are summarized, as well as the available information about the benefits and risks of long-term pharmacotherapy in the prevention and management of recidivism.

Expert opinion: The available information, mainly obtained from observational studies and small trials, is encouraging but calls for a prudent approach in the selection of appropriate agents for each individual patient and a careful follow-up to detect adverse reactions or drug interactions. Results from well-designed trials are upcoming. In the meantime, a cautious, individualized approach is advisable.

KEYWORDS:

• Bariatric surgery
• weight regain
• recidivism
• pharmacotherapy
• obesity

Article highlights

• Weight regain after bariatric surgery is not uncommon.

• The etiology of body weight regain after bariatric surgery (when not associated with surgery associated factors) is poorly understood. Some risks factors for postsurgical weight regain have been identified.

• Anti-obesity drugs to prevent and manage weight regain are commonly recommended.

• Even though the quality of the evidence supporting this recommendation is relatively weak. Retrospective evaluations suggest that the initiation of medications when weight plateau is reached may result in a higher cumulative total weight loss when compared with drug interventions after body weight regain.

• Small short-term trials and, mainly, several retrospective observational studies suggest beneficial effects with the use of pharmacotherapy to prevent and management of weight regain after bariatric surgery.

• Long-term Randomized Clinical Trial results are needed to validate these preliminary data.

• In the meantime, a cautious, individualized approach is advisable in the management of pharmacotherapy to prevent/treat body weight regain after bariatric surgery.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares to having acted as a consultant for Novo Nordisk, Orexigen, Biologix and Vivus. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.