Pharmacological treatment of non-responders following bariatric surgery

Apr 1, 2021Minerva endocrinology

Drug treatments for patients who do not improve after weight-loss surgery

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Abstract

Weight loss medications could offer significant benefits for patients who do not achieve expected results after bariatric surgery.

Insufficient weight loss or weight regain can occur in patients after bariatric surgery, posing challenges in obesity management.
Evidence from various studies indicates that medications like liraglutide, naltrexone/bupropion, orlistat, topiramate, and phentermine may aid in weight management for these patients.
Data suggest that these weight loss medications may enhance the effectiveness of lifestyle and behavioral modifications.
New anti-obesity therapies expand treatment options for individuals struggling with obesity after surgery.

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Obesity is a complex chronic disease and requires a long-term multidisciplinary management. Even patients undergoing bariatric surgery, one the most effective treatments for obesity, can have insufficient weight loss (IWL) than expected (primary non responder) or weight regain (WR) after a successful primary procedure (secondary non responder). A poor response represents a challenge of bariatric surgery that can induce persistence or recurrence of obesity-related comorbidities, prejudicing benefits of surgery. Increasing evidence suggests that weight loss medications represent a useful strategy in obesity care also after bariatric surgery procedures. This narrative review summarizes the evidence concerning anti-obesity therapy in the management of no-responders to primary bariatric surgery. Available data on liraglutide (one randomized double-blind placebo-controlled trial, three prospective and three retrospective studies), naltrexone/bupropion (three retrospective studies), orlistat (one case control prospective and one retrospective studies) and topiramate and phentermine (five retrospective studies) have been considered. Available data suggest that weight loss medications could offer a significant adjunctive benefit to lifestyle and behavioral modifications in the life-long management of obesity. Newer treatment modalities including the use of anti-obesity drugs provide patients and healthcare providers with more options in the management of poor response after bariatric surgery.

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Pharmacological treatment of non-responders following bariatric surgery

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