Combining Obesity Drugs With Surgery May Help You Lose More Weight: Study

May 11, 2023 – Both are popular ways to lose weight. Demand for anti-obesity drugs such as semaglutide (Wegovy) and liraglutide (Saxenda) is so high that pharmaceutical companies occasionally report shortages. And gastric sleeve surgery (a procedure that reduces the size of the stomach by up to 80%) remains the most common intervention for weight loss.

Studies show that both strategies can reduce overall weight, but little is known about what happens when they are combined.

Should I take weight loss pills first and then reduce stomach size or vice versa? How long should I wait if I do both?

Researchers are beginning to answer these and other questions that could help the 42% of Americans who suffer from obesity.

Studies have shown that adding medication can help you lose more total weight than using a gastric sleeve alone. Digestive Disease Week 2023 (DDW). DDW is an international conference of gastroenterologists, nurses and other healthcare providers, and this year he had 13,000 attendees, both virtual and in person.

In a study of 224 obese patients, 69 received a combination of drug therapy and gastric sleeve surgery. If both are given within 6 months, they are considered “combination therapy.” This approach led to the most weight loss, on average she lost 24% of her total body weight by 1 year.

The study performed gastric sleeve surgery endoscopically, a minimally invasive procedure known as gastroplasty. Instead of cutting the stomach, a specialist known as a bariatric endoscopist inserts a flexible tube down the throat and uses a special instrument at the tip to shrink the stomach.

Various anti-obesity drugs studied

The combination group received different anti-obesity drugs. About a third were taking glucagon-like peptide-1 agonists, or GLP-1 for short (such as semaglutide and liraglutide). Other medications included phentermine/topiramate extended-release capsules (Qsymia) or a combination of bupropion and naltrexone extended-release capsules for weight loss (Contrave).

Combining these other agents with gastroplasty resulted in an 18% reduction in total body weight after one year.

Another 77 participants in the study had sleeve gastroplasty alone. They lost an average of 17% of their total body weight.

A third group of 78 people received “sequential therapy”, starting medication at least 6 months before or after gastroplasty. This group lost the least amount of weight, 14% of total body weight at 1 year if gastroplasty was preceded and 12% if medication was preceded.

Waiting for weight loss after gastroplasty to start to plateau may be the ideal time to add weight-loss drugs, says Pichamol Girapiño, M.D., a bariatric endoscopist at Brigham and Women’s Hospital in Boston. said no. “Usually when I see them at 3 months old, I plot how fast they lost weight. [steadily]Anti-obesity drugs will not be offered until the patient is seen again in 6 months. ”

Girapiño, the study’s principal investigator, said not all patients offered weight-loss drugs were interested.

The incidence of serious side effects from gastroplasty was similar between groups: 2.6% for surgery alone, 1.4% for combination therapy, and 1.3% for continuous therapy. Anti-obesity drug-related side effects occurred in 1.3% of patients in the sequential therapy group and none in the other two groups.

Combo makes sense

Gregory L. Austin, M.D., a gastroenterologist at the UCHealth Digestive Health Center in Denver, said, “I believe that combination therapy should be more effective than gastroplasty alone, and probably better. There are,” he said.

However, the study did not address whether people who have been on the drug for more than six months should undergo gastroplasty. If you haven’t seen enough weight loss with improved health by that point, he said, you should probably take it.

“Whether to start now or wait three months is still an open question,” Austin said.

“Future Wave”

The study is “really exciting and interesting,” said Linda S. Lee, M.D., chief of endoscopy at Brigham and Women’s Hospital.

Starting the medication within six months of endoscopic surgery “had better outcomes than endoscopy alone,” she said.

“I think this is exactly the wave of the future when it comes to treating patients with obesity problems. It’s clear that diet and exercise alone are not enough for most people,” Lee said. “Of course we have [bariatric] However, after surgery, the weight may gradually begin to come back over time. “

“From my point of view, as long as the drugs are safe and do no harm, let’s do both together,” she said.

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