Could 11, 2023 – They’re each in style methods to drop extra pounds. Anti-obesity drugs 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 understood about what occurs whenever you mix them.
Is it higher to take weight reduction remedy first, after which cut back abdomen measurement – or the opposite manner round? Should you’re going to do each, how a lot time must you wait?
Investigators are beginning to reply these and different questions that might assist the 42% of Individuals with weight problems.
Including remedy seems to assist folks lose extra complete physique weight than the gastric sleeve alone, in line with a research at Digestive Illness 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 12 months.
Within the research of 224 folks with weight problems, 69 had the mixture of remedy and the gastric sleeve process. Having each inside 6 months of one another was thought of “mixture remedy.” This strategy was linked to probably the most weight reduction: a mean of 24% of complete physique weight by 1 12 months.
Gastric sleeve surgical procedure was carried out endoscopically within the research – a minimally invasive process referred to as gastroplasty. As an alternative of cuts within the abdomen, specialists referred to as bariatric endoscopists insert a versatile tube down the throat and use a particular instrument on the tip to make the abdomen smaller.
Totally different Anti-Weight problems Medication Studied
The mixture group took totally different anti-obesity drugs. About one-third took a glucagon-like peptide-1 agonist, or a GLP-1 for brief, similar to semaglutide and liraglutide. Different drugs 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 12 months.
One other 77 folks within the research had sleeve gastroplasty alone. They misplaced a mean 17% of their complete physique weight.
A 3rd group of 78 folks had “sequential remedy,” which implies they began remedy 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 remedy got here first.
Ready for weight reduction to begin to plateau after gastroplasty could be an excellent time so as to add weight reduction remedy, mentioned 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 supply an anti-obesity remedy till I see them once more at 6 months.”
Not each affected person supplied weight reduction remedy is , mentioned Jirapinyo, the lead researcher on the research.
The intense aspect impact price 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 side effects linked to anti-obesity remedy 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 suppose mixture remedy ought to be simpler than simply gastroplasty alone and might be higher,” mentioned Gregory L. Austin, MD, a gastroenterologist on the UCHealth Digestive Well being Middle in Denver.
However the research didn’t handle whether or not folks ought to nonetheless have gastroplasty after being on remedy for six months or longer. He mentioned 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 mentioned.
‘Wave of the Future’
The research is “actually thrilling and fascinating,” mentioned Linda S. Lee, MD, medical director of endoscopy at Brigham and Ladies’s Hospital.
Medicine begun inside 6 months of the endoscopic process “led to superior outcomes in comparison with simply endoscopy alone,” she mentioned.
“I believe that is actually the wave of the long run so far as treating sufferers with weight problems points. We clearly know that food regimen and train alone for most individuals will not be ok,” Lee mentioned. “After all, we now have [bariatric] surgical procedure, however we additionally understand that with surgical procedure, typically the burden begins to creep again up over time.”
“From my perspective, so long as the medication is secure and never harming them, then let’s do each of them collectively,” she mentioned.