May 11, 2023 – They’re some celebrated ways to suffer weight. Anti-obesity medications for illustration semaglutide (Wegovy) and liraglutide (Saxenda) are successful specified precocious request that drugmakers sometimes study shortages. And gastric sleeve room – a process that shrinks tummy size by up to 80% – remains nan astir communal involution for weight loss.
Research shows some strategies tin little full assemblage weight, but small is known astir what happens erstwhile you harvester them.
Is it amended to return weight nonaccomplishment medicine first, and past trim tummy size – aliases nan different measurement around? If you’re going to do both, really overmuch clip should you wait?
Investigators are starting to reply these and different questions that could thief nan 42% of Americans pinch obesity.
Adding medicine appears to thief group suffer much full assemblage weight than nan gastric sleeve alone, according to a study at Digestive Disease Week (DDW) 2023. DDW is an world gathering of gastrointestinal doctors, nurses, and different providers that had 13,000 virtual and in-person attendees this year.
In nan study of 224 group pinch obesity, 69 had nan operation of medicine and nan gastric sleeve procedure. Having some wrong 6 months of each different was considered “combination therapy.” This attack was linked to nan astir weight loss: an mean of 24% of full assemblage weight by 1 year.
Gastric sleeve room was done endoscopically successful nan study – a minimally invasive process known arsenic gastroplasty. Instead of cuts successful nan stomach, specialists known arsenic bariatric endoscopists insert a elastic conduit down nan pharynx and usage a typical instrumentality connected nan extremity to make nan tummy smaller.
Different Anti-Obesity Drugs Studied
The operation group took different anti-obesity medications. About one-third took a glucagon-like peptide-1 agonist, aliases a GLP-1 for short, specified arsenic semaglutide and liraglutide. Other medications included phentermine/topiramate extended-release capsules (Qsymia) aliases a operation of bupropion and naltrexone extended-release for weight nonaccomplishment (Contrave).
When mixed pinch gastroplasty, these different narcotics led to 18% full assemblage weight nonaccomplishment astatine 1 year.
Another 77 group successful nan study had sleeve gastroplasty alone. They mislaid an mean 17% of their full assemblage weight.
A 3rd group of 78 group had “sequential therapy,” which intends they started medicine much than 6 months earlier aliases aft gastroplasty. This group had nan slightest magnitude of weight nonaccomplishment – 14% of full assemblage weight astatine 1 twelvemonth if gastroplasty came first and 12% if medicine came first.
Waiting for weight nonaccomplishment to commencement to plateau aft gastroplasty mightiness beryllium an perfect clip to adhd weight nonaccomplishment medication, said Pichamol Jirapinyo, MD, a bariatric endoscopist astatine Brigham and Women’s Hospital successful Boston. “Usually erstwhile I spot them astatine 3 months, I crippled really accelerated their weight nonaccomplishment has been. If it’s been going down [steadily], we do not connection an anti-obesity medicine until I spot them again astatine 6 months.”
Not each diligent offered weight nonaccomplishment medicine is interested, said Jirapinyo, nan lead interrogator connected nan study.
The superior broadside effect complaint for gastroplasty was akin among groups: 2.6% for nan group that only sewage nan procedure, 1.4% pinch operation therapy, and 1.3% pinch sequential therapy. Side effects linked to anti-obesity medicine occurred successful 1.3% of nan sequential therapy group – and was not reported successful either of nan different 2 groups.
Combo Makes Sense
“I surely deliberation operation therapy should beryllium much effective than conscionable gastroplasty unsocial and is astir apt better," said Gregory L. Austin, MD, a gastroenterologist astatine nan UCHealth Digestive Health Center successful Denver.
But nan study did not reside whether group should still person gastroplasty aft being connected medicine for 6 months aliases longer. He said they astir apt should if they’re not seeing capable weight nonaccomplishment that comes pinch improved wellness outcomes by that time.
“Whether you commencement instantly aliases hold 3 months afterwards is simply a mobility that still needs to beryllium answered,” Austin said.
‘Wave of nan Future’
The study is “really breathtaking and interesting,” said Linda S. Lee, MD, aesculapian head of endoscopy astatine Brigham and Women’s Hospital.
Medication begun wrong 6 months of nan endoscopic process “led to superior outcomes compared to conscionable endoscopy alone,” she said.
“I deliberation that's really nan activity of nan early arsenic acold arsenic treating patients pinch obesity issues. We intelligibly cognize that fare and workout unsocial for astir group is not bully enough,” Lee said. “Of course, we person [bariatric] surgery, but we besides recognize that pinch surgery, sometimes nan weight starts to creep backmost up complete time.”
“From my constituent of view, arsenic agelong arsenic nan medicine is safe and not harming them, past let's do some of them together,” she said.