Suboptimal Weight Loss and Weight Regain: Is it Prime Time for Pharmacotherapy?
While bariatric surgery remains the most effective weight loss intervention in severe obesity and it leads to significant improvement of obesity and obesity associated comorbidities, suboptimal weight loss and weight regain are a new concern among surgeon
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Silvana Pannain
30.1 Introduction Bariatric surgery is undoubtfully the most effective weight loss intervention in severe obesity and leads to significant improvement of obesity associated health conditions, health-related quality of life and reduction in overall mortality and morbidity [1, 2]. However the variability in weight loss outcome and the longer-term durability of weight loss and control of comorbidity after bariatric procedures are a new concern. In this chapter we will briefly review the prevalence and possible etiology of suboptimal weight loss (SWL) and weight regain (WR) as complications of bariatric surgery. We will then discuss the evaluation and treatment of these conditions, with a more specific focus on the possible role of weight loss medications as a rescue therapy in patients who experience these complications.
30.2 Search Strategy A literature search was conducted between November 2019 and January 2020 and aimed to find published clinical trials and systematic reviews. The databases searched was PubMed (January 1921 to January 2020). The key terms used were suboptimal weight loss, weight regain, bariatric surgery, anti-obesity medication, obesity pharmacotherapy, re-operative bariatric surgery, re-operative intervention, conversional procedures, endoscopic procedures. Laparoscopic Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are the two most common weight reduction surgeries in the world, S. Pannain (*) Department of Medicine, University of Chicago, Chicago, IL, USA e-mail: [email protected] © Springer Nature Switzerland AG 2021 J. Alverdy, Y. Vigneswaran (eds.), Difficult Decisions in Bariatric Surgery, Difficult Decisions in Surgery: An Evidence-Based Approach, https://doi.org/10.1007/978-3-030-55329-6_30
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therefore most attention was given in this chapter to these two procedures. Additionally, seen that the SG has been available in the US only since 2010, a larger number of the studies available and discussed here are in RYGB patients.
30.3 Suboptimal Weight Loss after Bariatric Surgery There is consensus that some patients experience SWL after bariatric surgery [3]. SWL is often defined as never achieving more than 50% excess weight loss (EWL) [4]. Depending on the report, 5–20% of patients do not lose weight successfully, despite perceived optimal surgical technique and regular follow-up [5–7]. Interestingly a retrospective review of 375 post RYGB, showed that an early prediction of insufficient weight loss can be made at 6 months: patients who lost 50 kg/m2] puts patients at higher risk of SWL and WR after gastric bypass [17]. In 782 patients post gastric bypass weight loss was completed by 24 months and WR become significant at 48 months. Some WR was observed in approximately 50% of the patients (46% within 24 months and 63.6% within 48 months) who had received gastric bypass. Patients with WR experienced a mean gain of 8.8 kg within 60 months, which represented a 8% increase from the lowest weight after surge
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