Drug Therapy After the “Last Resort” of Bariatric Surgery

It’s 2021 and the medical world has mostly moved on from the archaic view of bariatric surgery as a treatment of last resort for obesity. For many patients, delaying bariatric surgery harms their health. The rest of the world is still struggling to catch up. But healthcare providers who care for people living with obesity have moved on. A new paper in Obesity offers a real-world perspective on outcomes with drug therapy after bariatric surgery.

The analysis in this study finds a better effect for GLP-1 agonists in treating weight regain after surgery. But the authors advise caution regarding their conclusion. It will take more rigorous studies to identify the best treatment strategies.

Addressing Important Questions

The real value of this study is not that it gives definitive answers. Rather it gives a first look at something that clinicians are only beginning to explore. Weight regain after bariatric surgery is common. Naysayers will exaggerate it, with even some doctors falsely saying that the benefits of surgery don’t last. But the truth is that, although most surgery patients regain some weight as years pass, most of them remain at a lower, healthier weight than they started with.

Nonetheless, the question of how to manage weight regain is important. Obesity care providers are addressing it and this study is a look back at what they are doing in one academic medical center.

Limitations

The finding that GLP-1 agonists yielded better outcomes might be an attention-grabber. In this study the finding was for the whole class of drugs – the researchers list six in their paper. Only one of them – liraglutide – is presently approved for obesity treatment. So it’s important to take these findings with a grain of salt. All the drugs in this class are not equally effective and this analysis doesn’t examine specific drugs and doses.

Thus, the possibility remains that these findings reflect unknown confounding features of this particular sample of patients. It is a retrospective study, after all.

Getting Beyond the “Last Resort”

More important is the fact that clinicians are getting beyond the last-resort mentality that once surrounded bariatric surgery. These procedures are but one tool for managing a chronic disease. Right now surgery is the most effective tool by far, but it’s far from perfect. Most people would prefer to avoid surgery if they can. And with obesity, delays in treatment are all too common.

So it is a good sign that clinicians are developing better approaches to managing obesity after surgery. A gastric sleeve or bypass is not the end of the road for managing the chronic disease of obesity. Patients will benefit from having options after surgery.

Click here for the new study in Obesity and here for further reporting on it. For an excellent review of the role for anti-obesity meds after bariatric surgery, click here.

Ends of Barns, painting by Georgia O’Keeffe / WikiArt

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May 8, 2021