Friday, June 19, 2015

Using Obesity Drugs in Combination with Bariatric Surgery

Over the past three years, new obesity drugs have gained FDA approval and become available for the treatment of obesity. These drugs are Qsymia, produced by Vivus, Belviq, produced by Arena, Contrave, produced by Orexigen and Saxenda (liraglutide), produced by Novo Nordisk. These drugs give bariatric service providers new tools to fight obesity. Bariatric surgery, including gastric bypass surgery, sleeve gastrectomy and the lap band, is another tool that bariatric service providers use. Now, some providers are wondering if obesity drugs and bariatric surgery can be combined to deliver optimum weight loss and weight loss maintenance.

Although not much research has yet been devoted to combining bariatric surgery with obesity drugs, the approach is a natural progression in obesity treatment. One expert indicated that "While surgery can provide tremendous benefit, we are realizing that medications may add to this benefit. Many insurers require preoperative weight-loss, and medications may aid in this effort." Further, as the expert suggests, "In addition to utilizing medications preoperatively, there may be a use for obesity medications after surgery."

One small study has shown that  weight gain after bariatric surgery was "significantly reduced after treatment with liraglutide." The investigators concluded that liraglutide may be a treatment for those persons who don't lose much weight or those who regain the weight after weight loss surgery.

One of the most popular obesity drugs is phentermine. It was approved for short term use by the FDA in 1959. Phentermine was part of the Fen-Phen obesity drug taken off the market in the 1990s because of severe side effects. Although phentermine is only FDA approved for short term use, obesity medicine specialists prescribe the drug off-label for long term weight loss -- with good results. And some physicians have suggested that phentermine should be considered for those patients who don't experience good weight loss after bariatric surgery.  

We generally view pharmacotherapy as a weight loss tool to be used in conjunction with diet and exercise. But it makes sense to consider the surgery-obesity-drug combination. This consideration could grow the obesity treatment options.


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