Weight Loss with Combination Anti-Obesity Medications Approximates that Achieved with Bariatric Surgery

Weight loss achieved through the use of a combination of anti-obesity medications (AOMs) can approach the reduction seen in bariatric surgery, according to a paper recently published in JCEM Case Reports.

Researchers led by Priya N. Patel, MD, of the Center for Pediatric Obesity Medicine at the University of Minnesota Medical School in Minneapolis point out that obesity is a multifactorial chronic disease and treatment remains challenging. Lifestyle modification therapy remains the first line of treatment, but patients often fail to keep the weight off. “Therefore, adjunct therapy is often needed. While metabolic/bariatric surgery (MBS) provides on average the most effective and durable BMI reduction with a mean weight loss of ≥30% and significant reductions in obesity-related comorbidities, such procedures are invasive, carry risk, and may not be attractive or available to many individuals,” the authors write.

The authors go on to write that AOMs are promising adjuncts lifestyle modification therapy and that if a patient does not respond to lifestyle modification and a single AOM, then combination AOMs should be considered. Here, they detail the case of a 23-year-old male initially presenting with a body mass index of 84.3 kg/m2. In addition to lifestyle modification therapy, he was started on phentermine, topiramate, and metformin, which only resulted in weight stabilization after one year. “Subsequently, semaglutide…was added, along with a lower calorie diet, which resulted in a 32.5% total body weight reduction, approximating that which can be achieved following metabolic/bariatric surgery,” the authors write.

The authors hypothesize that this significant weight loss was the result of a combination of medications targeting multiple eating behavior pathways simultaneously, including appetite, satiety, food craving, and binge-eating tendencies. “Indeed, as body weight is regulated by a complex physiological network, combination AOM regimens may achieve weight loss by targeting multiple pathways simultaneously. It is likely that most patients will require AOM use long term; however, studies showing the impact of discontinuation are currently lacking,” the authors conclude.