May 11, 2023 — Both are popular methods for reducing weight. Anti-obesity drugs akin to semaglutide (Wegovy) and liraglutide (Saxenda) are in such demand that drugmakers sometimes report shortages. And sleeve gastrectomy – a procedure that shrinks the stomach by as much as 80% – stays probably the most common weight-loss procedure.
Research shows that each strategies can reduce overall body weight, but little is understood about what happens once you mix them.
Is it higher to take weight reduction medication first after which reduce your waistline – or vice versa? If you do each, how long must you wait?
Researchers are starting to reply these and other questions that might help the 42% of Americans that suffer from obesity.
Additional drug treatment appears to assist patients lose more weight than sleeve gastrectomy alone, based on a study by Digestive Disease Week (DDW) 2023DDW is a world gathering of gastrointestinal physicians, nurses, and other providers that had 13,000 virtual and in-person attendees this 12 months.
In the study of 224 individuals with obesity, 69 received a mix of medication and sleeve gastrectomy. When each were done inside 6 months of one another, it was considered “combination therapy.” This approach was related to the best weight reduction: a mean of 24% of total body weight inside a 12 months.
The sleeve gastrectomy within the study was performed endoscopically – a minimally invasive procedure often called gastroplasty. Instead of constructing cuts within the stomach, specialists often called bariatric endoscopists insert a versatile tube into the throat and use a special instrument at the top to shrink the stomach.
Various drugs against obesity investigated
The combination group took various anti-obesity medications. About a 3rd took a glucagon-like peptide-1 agonist, or GLP-1 for brief, akin to semaglutide and liraglutide. Other medications included extended-release phentermine/topiramate capsules (Qsymia) or an extended-release combination of bupropion and naltrexone for weight reduction (Contrave).
When combined with gastroplasty, these other medications resulted in a complete weight reduction of 18% inside one 12 months.
Another 77 people within the study underwent sleeve gastrectomy alone. They lost a mean of 17% of their total body weight.
A 3rd group of 78 people received “sequential therapy,” meaning they began taking medication greater than 6 months before or after gastroplasty. This group had the least weight reduction – 14% of total body weight after one 12 months if gastroplasty was done first and 12% if medication was taken first.
Waiting for weight reduction to start after gastroplasty could also be an excellent time so as to add weight-loss medications, said Dr. Pichamol Jirapinyo, a bariatric endoscopist at Brigham and Women's Hospital in Boston. “Usually, when I see them at 3 months, I record how quickly they lost weight. If it goes down, [steadily]we will not offer any anti-obesity medication until I see her again in 6 months.”
Not every patient who is offered a weight-loss drug is interested in it, says Jirapinyo, the study's lead researcher.
The rate of serious side effects from gastroplasty was similar in both groups: 2.6% in the surgery-only group, 1.4% in the combination therapy group, and 1.3% in the sequential therapy group. Side effects related to the anti-obesity medications occurred in 1.3% of the sequential therapy group – and were not reported in either of the other two groups.
Combination makes sense
“I am convinced that combination therapy is more effective and probably even better than gastroplasty alone,” says Dr. Gregory L. Austin, a gastroenterologist at UCHealth Digestive Health Center in Denver.
However, the study did not address whether patients should still undergo gastroplasty after taking medication for 6 months or more, saying they probably should if they have not lost enough weight by then that leads to improved health.
“Whether to start immediately or wait three months is a question that has yet to be answered,” Austin said.
“Wave of the Future”
The study is “really exciting and interesting,” said Linda S. Lee, MD, medical director of endoscopy at Brigham and Women's Hospital.
Drug treatment within six months of the endoscopic examination “led to better results than endoscopy alone,” she said.
“I feel this is de facto the wave of the longer term when it comes to treating patients with obesity problems. We know very clearly that weight loss program and exercise alone should not adequate for most individuals,” said Lee. “Of course, we've [bariatric] surgery, but we also know that after surgery, weight sometimes returns over time.”
“In my view, we should always do each together, so long as the drug is secure and doesn't harm patients,” she said.