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Firkins SA, Chittajallu V, Flora B, Yoo H, Simons-Linares R. Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database. Obes Surg 2024; 34:1415-1424. [PMID: 38512645 DOI: 10.1007/s11695-024-07181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery. MATERIALS AND METHODS We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations. RESULTS A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35-39 years for topiramate, 40-44 years for phentermine/topiramate and naltrexone/bupropion, 45-49 years for semaglutide, and 65-69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use. CONCLUSION Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.
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Affiliation(s)
- Stephen A Firkins
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Vibhu Chittajallu
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - Bailey Flora
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Heesoo Yoo
- Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Roberto Simons-Linares
- Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Gabriel-Medina P, Ferrer-Costa R, Rodriguez-Frias F, Comas M, Vilallonga R, Ciudin A, Selva DM. Plasma SHBG Levels as an Early Predictor of Response to Bariatric Surgery. Obes Surg 2024; 34:760-768. [PMID: 38183592 PMCID: PMC10899416 DOI: 10.1007/s11695-023-06981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Obesity is a growing global health problem, and currently, bariatric surgery (BS) is the best solution in terms of sustained total weight loss (TWL). However, a significant number of patients present weight regain (WR) in time. There is a lack of biomarkers predicting the response to BS and WR during the follow-up. Plasma SHBG levels, which are low in obesity, increase 1 month after BS but there is no data of plasma SHBG levels at long term. We performed the present study aimed at exploring the SHBG role in predicting TWL and WR after BS. METHODS Prospective study including 62 patients with obesity undergoing BS. Anthropometric and biochemical variables, including SHBG were analyzed at baseline, 1, 6, 12, and 24 months; TWL ≥ 25% was considered as good BS response. RESULTS Weight loss nadir was achieved at 12 months post-BS where maximum SHBG increase was reached. Greater than or equal to 25% TWL patients presented significantly higher SHBG increases at the first and sixth months of follow-up with respect to baseline (100% and 150% respectively, p = 0.025), than < 25% TWL patients (40% and 50% respectively, p = 0.03). Also, these presented 6.6% WR after 24 months. The first month SHBG increase predicted BS response at 24 months (OR = 2.71; 95%CI = [1.11-6.60]; p = 0.028) and TWL in the 12th month (r = 0.330, p = 0.012) and the WR in the 24th (r = - 0.301, p = 0.028). CONCLUSIONS Our results showed for the first time that increase in plasma SHBG levels within the first month after BS is a good predictor of TWL and WR response after 2 years.
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Affiliation(s)
- P Gabriel-Medina
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
| | - R Ferrer-Costa
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
| | - F Rodriguez-Frias
- Clinical Biochemistry Department, Vall d'Hebron University Hospital, 08035, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), 08193, Barcelona, Spain
- Biochemical Chemistry, Drug Delivery & Therapy (BC-DDT) Research Group, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - M Comas
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - R Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Diabetes and Metabolism Research Unit, Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain.
| | - D M Selva
- Diabetes and Metabolism Research Unit, Diabetes and Metabolism Department, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029, Madrid, Spain.
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McIntosh S, Hayes M, Barr-Porter ML. Positive Program Evaluation and Health Maintenance among Post-Metabolic and Bariatric Surgery Patients Following a 6-Week Pilot Program. Obes Surg 2024; 34:524-533. [PMID: 38168717 PMCID: PMC10811185 DOI: 10.1007/s11695-023-07013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Despite lifestyle changes and medication therapies, weight loss is difficult to maintain. Metabolic and bariatric surgery (MBS) is an effective route for significant weight reduction. However, post-operation there are limited opportunities to support weight loss maintenance. The following study aimed to pilot test a 6-week, 6-session nutrition and support program for post-MBS surgery patients. MATERIALS AND METHODS A 6-week post-MBS pilot nutrition and support program was developed to test feasibility and acceptability. Participants completed a baseline survey that included demographics, weight changes, success post-surgery, and self-efficacy of leading a healthy lifestyle. Weight change, percent total weight loss, self-efficacy, and program evaluation measures were assessed. RESULTS Participants (n = 18) were recruited from a local MBS clinic, predominately female (88.9%), non-Hispanic white (94.4%), received sleeve gastrectomy surgery (100%), and were 2-3 years post-operation (44.4%). Eight of the 18 participants attended the in-person sessions, serving as the intervention group. Both weight loss over and behavioral variables remained stable for both groups across the 6 weeks with no significant differences from pre to post program (p > 0.05). For program evaluation, intervention participants "agreed" or "strongly agreed" with 10 of 11 program satisfaction measures. CONCLUSION Following the program, weight loss was maintained among both intervention and control groups. Intervention feedback indicated that the program's approach to provide nutrition education and support was successful and acceptable. Future enhancement of the intervention should include a broader multidisciplinary approach, longer intervention period, and intentional recruitment of participants with a weight regain.
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Affiliation(s)
- Sydney McIntosh
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, 40506, USA
| | - Madison Hayes
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, 40506, USA
| | - Makenzie L Barr-Porter
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, 40506, USA.
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Razzak FA, Kerbage A, Brunaldi VO, Mrad R, Mahmoud T, Gala K, Vargas EJ, Storm A, Ghanem O, Dayyeh BA. Correlation Between Gastrojejunal Anastomosis Diameter, Distensibility Index, and Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:4042-4048. [PMID: 37922061 DOI: 10.1007/s11695-023-06918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Gastrojejunal anastomosis (GJA) dilation is an independent predictor of weight regain (WR) after Roux-en-Y gastric bypass (RYGB). However, the role of planimetric measurements in this context remains unknown. METHODS This is a retrospective cohort study including adult RYGB patients who underwent a diagnostic endoscopy with Endoflip assessment of the GJA. We excluded patients in the early postoperative period and those with abnormal endoscopic findings (marginal ulcers and gastro-gastric fistulas). RESULTS Thirty-four patients were initially included. Endoscopic GJA diameter had a moderate positive correlation with WR (r=+0.438, p=0.011). However, after excluding the 7 patients with GJA> 30 mm, there was no significant correlation. There was a moderate agreement between the EndoFLIP-GJA diameter at 60mL and endoscopic diameter (ICC=0.576, p=0.049). The distensibility index (DI) showed a consistent moderate negative correlation with WR. Considering the maximum DI at 40 ml, we found a cutoff of DI = 7 mm2/mmHg that split the sample in two significantly different populations in terms of WR (67.4% vs. 43.2%, p=0.04). CONCLUSION Visual estimation of the GJA diameter correlates with EndoFLIP at 60mL. In the subset of patients with GJA ≤ 30 mm, more distensible GJAs are associated with lower rates of WR. Larger studies are needed to confirm this correlation and to validate its utility for clinical management.
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Affiliation(s)
- Farah Abdul Razzak
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Anthony Kerbage
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Vitor O Brunaldi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
- Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rudy Mrad
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Andrew Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Barham Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA.
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Lind R, Hage K, Ghanem M, Shah M, Vierkant RA, Jawad M, Ghanem OM, Teixeira AF. Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders. Obes Surg 2023; 33:3028-3034. [PMID: 37464052 DOI: 10.1007/s11695-023-06730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up. METHODS We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation. RESULTS From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not. CONCLUSIONS Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.
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Affiliation(s)
- Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA.
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
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