GLP-1 receptor agonists ‘superior’ for countering weight regain after bariatric surgery
Adults with obesity who regained weight after bariatric surgery saw more effective weight loss with GLP-1 receptor agonist therapy compared with other weight-loss regimens, according to data published in Obesity.
“There are several medications that are approved for weight management (phentermine, topiramate-phentermine, orlistat, bupropion-naltrexone and liraglutide); however, there are limited data to support their use to treat post-bariatric weight regain,” Chellse L. Gazda, MD, assistant professor in the department of internal medicine at University of Texas Southwestern Medical Center, and colleagues wrote in the study background. “Liraglutide is a GLP-1 receptor agonist that is approved for managing type 2 diabetes mellitus and obesity. Studies have shown that postprandial levels of endogenous GLP-1 after bariatric surgery can be 10 to 20 times higher compared with before surgery.”
In a retrospective study, Gazda and colleagues analyzed data from 207 adults treated for weight regain after bariatric surgery at an academic center from January 2014 to November 2019. Researchers compared the percentage of body weight loss after 3, 6, 9 and 12 months of treatment among adults who received intensive lifestyle modification, non-GLP-1 receptor agonist pharmacotherapy or GLP-1 receptor agonists as part of a weight-loss program, with both pharmacotherapy groups also utilizing intensive lifestyle modification.
Researchers found that the percentage of body weight loss differed by treatment type at 3, 6 and 9 months. At 3 months, adults who received lifestyle modification, non-GLP-1 receptor agonist drugs or GLP-1 receptor agonist therapy experienced mean weight loss of 1.4%, 2.2% and 4.5%, respectively (P < .001). At 6 months, mean weight-loss percentage was 0.8% for adults who received lifestyle modification, 2.9% for those who received non-GLP-1 receptor agonist drugs and 6.7% for those who received GLP-1 receptor agonist therapy, (P < .001), and 1.6%, 5.6% and 6.9% across the three treatment groups, respectively, at 9 months (P = .007).
“There was a significant difference in the percentage of individuals achieving at least 5% weight loss after 3, 6 and 9 months, with most occurring in the GLP-1 receptor agonist-based weight-loss program group,” the researchers wrote.
At 12 months, the percentage of weight loss was numerically but not statistically significant.
In multiple regression analysis, researchers found the results did not change when stratified by bariatric surgery type, adding that treatment group was the only significant predictor of percentage weight change.
“Based on our study, a GLP-1 receptor agonist-based weight-loss program appears to be superior to non-GLP-1 receptor agonist-based weight-loss programs and intensive lifestyle modification alone for treating post-bariatric surgery weight regain, regardless of surgery type,” the researchers wrote. “However, larger prospective randomized studies are needed to identify the optimal treatment strategies for post-bariatric weight regain, which is a frequent challenge in this growing population.”