Might 11, 2023 – They’re each common methods to drop pounds. Anti-obesity medicines like semaglutide (Wegovy) and liraglutide (Saxenda) are in such excessive demand that drugmakers typically report shortages. And gastric sleeve surgical procedure – a process that shrinks abdomen dimension by as much as 80% – stays the most typical intervention for weight reduction.
Analysis reveals each methods can decrease complete physique weight, however little is understood about what occurs once you mix them.
Is it higher to take weight reduction medicine first, after which scale back abdomen dimension – or the opposite method round? If you happen to’re going to do each, how a lot time do you have to wait?
Investigators are beginning to reply these and different questions that would assist the 42% of Individuals with weight problems.
Including medicine seems to assist folks lose extra complete physique weight than the gastric sleeve alone, in keeping with a examine at Digestive Illness Week (DDW) 2023. DDW is a global assembly of gastrointestinal docs, nurses, and different suppliers that had 13,000 digital and in-person attendees this 12 months.
Within the examine of 224 folks with weight problems, 69 had the mix of medicine and the gastric sleeve process. Having each inside 6 months of one another was thought of “mixture remedy.” This method was linked to probably the most weight reduction: a median of 24% of complete physique weight by 1 12 months.
Gastric sleeve surgical procedure was completed endoscopically within the examine – a minimally invasive process often called gastroplasty. As an alternative of cuts within the abdomen, specialists often called bariatric endoscopists insert a versatile tube down the throat and use a particular instrument on the top to make the abdomen smaller.
Completely different Anti-Weight problems Medicine Studied
The mixture group took totally different anti-obesity medicines. About one-third took a glucagon-like peptide-1 agonist, or a GLP-1 for brief, resembling semaglutide and liraglutide. Different medicines included phentermine/topiramate extended-release capsules (Qsymia) or a mix of bupropion and naltrexone extended-release for weight reduction (Contrave).
When mixed with gastroplasty, these different medicine led to 18% complete physique weight reduction at 1 12 months.
One other 77 folks within the examine had sleeve gastroplasty alone. They misplaced a median 17% of their complete physique weight.
A 3rd group of 78 folks had “sequential remedy,” which implies they began medicine greater than 6 months earlier than or after gastroplasty. This group had the least quantity of weight reduction – 14% of complete physique weight at 1 12 months if gastroplasty got here first and 12% if medicine got here first.
Ready for weight reduction to begin to plateau after gastroplasty may be an excellent time so as to add weight reduction medicine, stated Pichamol Jirapinyo, MD, a bariatric endoscopist at Brigham and Ladies’s Hospital in Boston. “Normally after I see them at 3 months, I plot how briskly their weight reduction has been. If it’s been happening [steadily], we don’t supply an anti-obesity medicine till I see them once more at 6 months.”
Not each affected person supplied weight reduction medicine is , stated Jirapinyo, the lead researcher on the examine.
The intense facet impact fee for gastroplasty was related amongst teams: 2.6% for the group that solely obtained the process, 1.4% with mixture remedy, and 1.3% with sequential remedy. Unwanted effects linked to anti-obesity medicine occurred in 1.3% of the sequential remedy group – and was not reported in both of the opposite two teams.
Combo Makes Sense
“I definitely assume mixture remedy must be more practical than simply gastroplasty alone and might be higher,” stated Gregory L. Austin, MD, a gastroenterologist on the UCHealth Digestive Well being Heart in Denver.
However the examine didn’t handle whether or not folks ought to nonetheless have gastroplasty after being on medicine for six months or longer. He stated they most likely ought to in the event that they’re not seeing sufficient weight reduction that comes with improved well being outcomes by that point.
“Whether or not you begin instantly or wait 3 months afterwards is a query that also must be answered,” Austin stated.
‘Wave of the Future’
The examine is “actually thrilling and attention-grabbing,” stated Linda S. Lee, MD, medical director of endoscopy at Brigham and Ladies’s Hospital.
Remedy begun inside 6 months of the endoscopic process “led to superior outcomes in comparison with simply endoscopy alone,” she stated.
“I believe that is actually the wave of the longer term so far as treating sufferers with weight problems points. We clearly know that weight-reduction plan and train alone for most individuals shouldn’t be ok,” Lee stated. “In fact, we now have [bariatric] surgical procedure, however we additionally notice that with surgical procedure, typically the burden begins to creep again up over time.”
“From my viewpoint, so long as the medication is secure and never harming them, then let’s do each of them collectively,” she stated.
