Might 11, 2023 – They’re each in style methods to shed 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 measurement by as much as 80% – stays the commonest intervention for weight reduction.
Analysis reveals each methods can decrease complete physique weight, however little is thought about what occurs while you mix them.
Is it higher to take weight reduction medicine first, after which scale back abdomen measurement – or the opposite method round? In case you’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 line with a research at Digestive Disease Week (DDW) 2023. DDW is a global assembly of gastrointestinal medical doctors, nurses, and different suppliers that had 13,000 digital and in-person attendees this yr.
Within the research of 224 folks with weight problems, 69 had the mixture of medicine and the gastric sleeve process. Having each inside 6 months of one another was thought-about “mixture remedy.” This strategy was linked to probably the most weight reduction: a median of 24% of complete physique weight by 1 yr.
Gastric sleeve surgical procedure was accomplished endoscopically within the research – a minimally invasive process generally known as gastroplasty. As a substitute of cuts within the abdomen, specialists generally known as bariatric endoscopists insert a versatile tube down the throat and use a particular instrument on the tip to make the abdomen smaller.
Completely different Anti-Weight problems Medication Studied
The mix group took totally different anti-obesity medicines. About one-third took a glucagon-like peptide-1 agonist, or a GLP-1 for brief, akin to semaglutide and liraglutide. Different medicines included phentermine/topiramate extended-release capsules (Qsymia) or a mixture 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 yr.
One other 77 folks within the research 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 yr if gastroplasty got here first and 12% if medicine got here first.
Ready for weight reduction to begin to plateau after gastroplasty could 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. “Often 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 provide 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 research.
The intense aspect impact fee for gastroplasty was related amongst teams: 2.6% for the group that solely acquired 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 ought to be simpler 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 research didn’t tackle 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 research 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 feel that is actually the wave of the long run so far as treating sufferers with weight problems points. We clearly know that weight-reduction plan and train alone for most individuals isn’t adequate,” Lee stated. “In fact, we have now [bariatric] surgical procedure, however we additionally notice that with surgical procedure, typically the load begins to creep again up over time.”
“From my viewpoint, so long as the drugs is secure and never harming them, then let’s do each of them collectively,” she stated.
