A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.

Diabetes Centre Institute for Clinical and Experimental Medicine Prague Czech Republic

Tameside and Glossop Integrated Care NHS Foundation Trust Ashton under Lyne and University of Manchester Manchester United Kingdom

Zobrazit více v PubMed

Committee on Accelerating Progress in Obesity P, Food, Nutrition B, et al. In: Glickman D, Parker L, Sim LJ, Del Valle Cook H, Miller EA (eds). Accelerating progress in obesity prevention: solving the weight of the nation. Washington (DC): National Academies Press (US). Copyright 2012 by the National Academy of Sciences. All rights reserved.; 2012. PubMed

Pierce SL, Kompaniyets L, Freedman DS, et al. Children’s rates of BMI change during pre-pandemic and two COVID-19 pandemic periods, IQVIA Ambulatory Electronic Medical Record, January 2018 Through November 2021. Obesity. 2023;31(3):693–8. PubMed PMC

World Health Organization. Prevalence of obesity among adults, BMI ≥ 30 (age-standardized estimate) (%). 2023. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-). Accessed 15 Oct 2023.

World Health Organization. Prevalence of overweight among adults, BMI >= 25 (age-standardized estimate) (%). 2023. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-overweight-among-adults-bmi-=-25-(age-standardized-estimate)-(-). Accessed 15 Oct 2023.

Shariq OA, McKenzie TJ. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surg. 2020;9(1):80–93. PubMed PMC

Bays HE, Toth PP, Kris-Etherton PM, et al. Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association. J Clin Lipidol. 2013;7(4):304–83. PubMed

Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes. 2014;7:587–91. PubMed PMC

Leitner DR, Frühbeck G, Yumuk V, et al. Obesity and type 2 diabetes: two diseases with a need for combined treatment strategies—EASO can lead the way. Obes Facts. 2017;10(5):483–92. PubMed PMC

Kiran HKP, Rohin KR, Arunashis S, et al. Obesity as a risk factor for cardiac arrhythmias. BMJ Med. 2022;1(1):e000308. PubMed PMC

Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology. 2010;51(2):679–89. PubMed PMC

Romero-Corral A, Caples SM, Lopez-Jimenez F, et al. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711–9. PubMed PMC

Pati S, Irfan W, Jameel A, et al. Obesity and cancer: a current overview of epidemiology, pathogenesis, outcomes, and management. Cancers (Basel). 2023;15(2):485. PubMed PMC

Singh-Manoux A, Dugravot A, Shipley M, et al. Obesity trajectories and risk of dementia: 28 years of follow-up in the Whitehall II Study. Alzheimers Dement. 2018;14(2):178–86. PubMed PMC

Obalum DC, Fiberesima F, Eyesan SU, et al. A review of obesity and orthopaedic surgery: the critical issues. Niger Postgrad Med J. 2012;19(3):175–80. PubMed

Gkastaris K, Goulis DG, Potoupnis M, et al. Obesity, osteoporosis and bone metabolism. J Musculoskelet Neuronal Interact. 2020;20(3):372–81. PubMed PMC

Brunner KT, Henneberg CJ, Wilechansky RM, et al. Nonalcoholic fatty liver disease and obesity treatment. Curr Obes Rep. 2019;8(3):220–8. PubMed PMC

Kushner RF. Weight loss strategies for treatment of obesity. Prog Cardiovasc Dis. 2014;56(4):465–72. PubMed

Pietri L, Giorgi R, Bégu A, et al. Excess body weight is an independent risk factor for severe forms of COVID-19. Metabolism. 2021;117: 154703. PubMed PMC

Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55. PubMed PMC

Koliaki C, Liatis S, le Roux CW, et al. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17(1):50. PubMed PMC

Madsen LR, Baggesen LM, Richelsen B, et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study. Diabetologia. 2019;62(4):611–20. PubMed

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85. PubMed

Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53. PubMed PMC

Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345–56. PubMed

National Institute for Health and Care Excellence (NICE). Obesity: identification, assessment and management. 2023. https://www.ncbi.nlm.nih.gov/books/NBK588750/. Accessed 15 Oct 2023. PubMed

Billeter AT, Fischer L, Wekerle AL, et al. Malabsorption as a therapeutic approach in bariatric surgery. Viszeralmedizin. 2014;30(3):198–204. PubMed PMC

Çalık Başaran N, Dotan I, Dicker D. Post metabolic bariatric surgery weight regain: the importance of GLP-1 levels. Int J Obes (Lond). 2024. 10.1038/s41366-024-01461-2. PubMed

Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40. PubMed

Langer FB, Bohdjalian A, Shakeri-Leidenmühler S, et al. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass–indications and outcome. Obes Surg. 2010;20(7):835–40. PubMed

Cooper TC, Simmons EB, Webb K, et al. Trends in weight regain following Roux-en-Y Gastric Bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474–81. PubMed

King WC, Hinerman AS, Belle SH, et al. Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA. 2018;320(15):1560–9. PubMed PMC

Flint RS, Coulter G, Roberts R. The pattern of adjustments after laparoscopic adjustable gastric band. Obes Surg. 2015;25(11):2061–5. PubMed

Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72. PubMed

Dang JT, Vaughan T, Mocanu V, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications, prevalence, and safety. Obes Surg. 2023;33(5):1486–93. PubMed PMC

Alalwan AA, Friedman J, Park H, et al. US national trends in bariatric surgery: a decade of study. Surgery. 2021;170(1):13–7. PubMed

Seeras K, Sankararaman S, Lopez PP. Sleeve gastrectomy. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2023, StatPearls Publishing LLC.; 2023. PubMed

Rosen DJ, Dakin GF, Pomp A. Sleeve gastrectomy. Minerva Chir. 2009;64(3):285–95. PubMed

Faria GR. A brief history of bariatric surgery. Porto Biomed J. 2017;2(3):90–2. PubMed PMC

Landreneau JP, Strong AT, Rodriguez JH, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2018;28(12):3843–50. PubMed

Scott WR, Batterham RL. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: understanding weight loss and improvements in type 2 diabetes after bariatric surgery. Am J Physiol Regul Integr Comp Physiol. 2011;301(1):R15–27. PubMed

Arterburn DE, Johnson E, Coleman KJ, et al. Weight outcomes of sleeve gastrectomy and gastric bypass compared to nonsurgical treatment. Ann Surg. 2021;274(6):e1269–76. PubMed

Wu W, Widjaja J, Lu S, et al. Comparison of the outcomes of single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S), single anastomosis sleeve ileal (SASI) bypass with sleeve gastrectomy, and sleeve gastrectomy using a rodent model with diabetes. Obes Surg. 2022;32(4):1209–15. PubMed

Kersebaum J-N, Möller T, von Schönfels W, et al. Robotic Roux-en-Y gastric bypass procedure guide. JSLS. 2020;24(4):e2020.00062. PubMed PMC

Kamocka A, Chidambaram S, Erridge S, et al. Length of biliopancreatic limb in Roux-en-Y gastric bypass and its impact on post-operative outcomes in metabolic and obesity surgery—systematic review and meta-analysis. Int J Obes. 2022;46(11):1983–91. PubMed PMC

Nergaard BJ, Leifsson BG, Hedenbro J, et al. Gastric bypass with long alimentary limb or long pancreato-biliary limb–long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595–602. PubMed PMC

Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11):4331–45. PubMed

Robert L, Alec B, Dirk CJ, et al. Early and late complications of bariatric operation. Trauma Surg Acute Care Open. 2018;3(1): e000219. PubMed PMC

Chahal-Kummen M, Salte OBK, Hewitt S, et al. Health benefits and risks during 10 years after Roux-en-Y gastric bypass. Surg Endosc. 2020;34(12):5368–76. PubMed PMC

Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg. 2016;34:28–34. PubMed

Tarnowski W, Barski K, Jaworski P, et al. Single anastomosis sleeve ileal bypass (SASI): a single-center initial report. Wideochir Inne Tech Maloinwazyjne. 2022;17(2):365–71. PubMed PMC

Mercy Bariatrics. Single anastomosis stomach-ileal bypass with sleeve gastrectomy (SASI-S). 2023. https://mercybariatrics.com.au/obesity-surgery-2/surgery-options/sasi-s/. Accessed 15 Oct 2023.

Emile SH, Madyan A, Mahdy T, et al. Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study. Surg Endosc. 2021;35(2):652–60. PubMed

Aghajani E, Schou C, Gislason H, et al. Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity. Surg Endosc. 2023;37(8):6220–7. PubMed PMC

Sánchez-Pernaute A, Rubio MÁ, Pérez Aguirre E, et al. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surg Obes Relat Dis. 2013;9(5):731–5. PubMed

Shoar S, Poliakin L, Rubenstein R, et al. Single anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety. Obes Surg. 2018;28(1):104–13. PubMed

Sánchez-Pernaute A, Herrera MÁR, Ferré NP, et al. Long-term results of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Obes Surg. 2022;32(3):682–9. PubMed PMC

Andalib A, Bouchard P, Alamri H, et al. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study. Surg Obes Relat Dis. 2021;17(2):414–24. PubMed

Mahdy T, Gado W. Revisional surgery: sleeve to single anastomosis sleeve ileal (SASI) bypass. 2021. p. 579–88.

Dijkhorst PJ, Boerboom AB, Janssen IMC, et al. Failed sleeve gastrectomy: single anastomosis duodenoileal bypass or Roux-en-Y gastric bypass? A Multicenter Cohort Study. Obes Surg. 2018;28(12):3834–42. PubMed PMC

Himpens J, Cadière GB, Bazi M, et al. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146(7):802–7. PubMed

Falk V, Sheppard C, Kanji A, et al. The fate of laparoscopic adjustable gastric band removal. Can J Surg. 2019;62(5):328–33. PubMed PMC

Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450–6. PubMed

Food and Drug Administration. FDA requests the withdrawal of the weight-loss drug Belviq, Belviq XR (lorcaserin) from the market. 2022. https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market. Accessed 15 Oct 2023.

Paccosi S, Cresci B, Pala L, et al. Obesity therapy: how and why? Curr Med Chem. 2020;27(2):174–86. PubMed

Walter CP, Bleske BE, Dorsch MP. Pharmacotherapy for weight loss: the cardiovascular effects of the old and new agents. J Clin Pharm Ther. 2014;39(5):475–84. PubMed

Müller TD, Blüher M, Tschöp MH, et al. Anti-obesity drug discovery: advances and challenges. Nat Rev Drug Discov. 2022;21(3):201–23. PubMed PMC

Richard D, Ferland J, Lalonde J, et al. Influence of topiramate in the regulation of energy balance. Nutrition. 2000;16(10):961–6. PubMed

Picard F, Deshaies Y, Lalonde J, et al. Topiramate reduces energy and fat gains in lean (Fa/?) and obese (fa/fa) Zucker rats. Obes Res. 2000;8(9):656–63. PubMed

Lonneman DJ Jr, Rey JA, McKee BD. Phentermine/topiramate extended-release capsules (qsymia) for weight loss. P t. 2013;38(8):446–52. PubMed PMC

VIVUS I. VI-0521 (Qnexa®) advisory committee briefing document. Endocrinologic and Metabolic Drugs Advisory Committee MeetingEaMDA; 2012.

The European Medicines Agency. Qsiva 2013. https://www.ema.europa.eu/en/medicines/human/EPAR/qsiva. Accessed 15 Oct 2023.

VIVUS. Qsymia Full Prescribing Information. 2023. https://qsymia.com/patient/include/media/pdf/prescribing-information.pdf. Accessed 15 Oct 2023.

Lei XG, Ruan JQ, Lai C, et al. Efficacy and safety of phentermine/topiramate in adults with overweight or obesity: a systematic review and meta-analysis. Obesity (Silver Spring). 2021;29(6):985–94. PubMed

Lei X-G, Ruan J-Q, Lai C, et al. Efficacy and safety of phentermine/topiramate in adults with overweight or obesity: a systematic review and meta-analysis. Obesity. 2021;29(6):985–94. PubMed

Chintam K, Chang AR. Strategies to treat obesity in patients with CKD. Am J Kidney Dis. 2021;77(3):427–39. PubMed PMC

Sherman MM, Ungureanu S, Rey JA. Naltrexone/bupropion ER (Contrave): newly approved treatment option for chronic weight management in obese adults. P t. 2016;41(3):164–72. PubMed PMC

Billes SK, Sinnayah P, Cowley MA. Naltrexone/bupropion for obesity: an investigational combination pharmacotherapy for weight loss. Pharmacol Res. 2014;84:1–11. PubMed

Tak YJ, Lee SY. Anti-obesity drugs: long-term efficacy and safety: an updated review. World J Mens Health. 2021;39(2):208–21. PubMed PMC

The European Medicines Agency. Mysimba. 2015. https://www.ema.europa.eu/en/documents/product-information/mysimba-epar-product-information_en.pdf. Accessed 16 Oct 2023

Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–34. PubMed PMC

Wadden TA, Foreyt JP, Foster GD, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring). 2011;19(1):110–20. PubMed PMC

Christou GA, Kiortsis DN. The efficacy and safety of the naltrexone/bupropion combination for the treatment of obesity: an update. Hormones. 2015;14(3):370–5. PubMed

Ballinger A. Orlistat in the treatment of obesity. Expert Opin Pharmacother. 2000;1(4):841–7. PubMed

Halpern B, Halpern A. Safety assessment of FDA-approved (orlistat and lorcaserin) anti-obesity medications. Expert Opin Drug Saf. 2015;14(2):305–15. PubMed

Anderson JW. Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage. Expert Opin Pharmacother. 2007;8(11):1733–42. PubMed

The European Medicines Agency. Xenical. 2008. https://www.ema.europa.eu/en/documents/product-information/xenical-epar-product-information_en.pdf. Accessed 16 Oct 2023.

Torgerson JS, Hauptman J, Boldrin MN, et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27(1):155–61. PubMed

Heck AM, Yanovski JA, Calis KA. Orlistat, a new lipase inhibitor for the management of obesity. Pharmacotherapy. 2000;20(3):270–9. PubMed PMC

Zhi J, Melia AT, Guerciolini R, et al. Retrospective population-based analysis of the dose-response (fecal fat excretion) relationship of orlistat in normal and obese volunteers. Clin Pharmacol Ther. 1994;56(1):82–5. PubMed

Tak YJ, Lee SY. Long-term efficacy and safety of anti-obesity treatment: where do we stand? Curr Obes Rep. 2021;10(1):14–30. PubMed PMC

Bansal AB, Al Khalili Y. Orlistat. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2023, StatPearls Publishing LLC.; 2023.

Gentilella R, Bianchi C, Rossi A, et al. Exenatide: a review from pharmacology to clinical practice. Diabetes Obes Metab. 2009;11(6):544–56. PubMed

Apovian CM, Okemah J, O’Neil PM. Body weight considerations in the management of type 2 diabetes. Adv Ther. 2019;36(1):44–58. PubMed PMC

Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753–86. PubMed PMC

Rowlands J, Heng J, Newsholme P, et al. Pleiotropic effects of glp-1 and analogs on cell signaling, metabolism, and function. Front Endocrinol. 2018. 10.3389/fendo.2018.00672. PubMed PMC

Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221–32. PubMed

Llewellyn DC, Logan Ellis H, Aylwin SJB, et al. The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review. Obesity (Silver Spring). 2023;31(1):20–30. PubMed PMC

Iepsen EW, Torekov SS, Holst JJ. Liraglutide for type 2 diabetes and obesity: a 2015 update. Expert Rev Cardiovasc Ther. 2015;13(7):753–67. PubMed

Singh G, Krauthamer M, Bjalme-Evans M. Wegovy (semaglutide): a new weight loss drug for chronic weight management. J Investig Med. 2022;70(1):5–13. PubMed PMC

Filippatos TD, Panagiotopoulou TV, Elisaf MS. Adverse effects of GLP-1 receptor agonists. Rev Diabet Stud. 2014;11(3–4):202–30. PubMed PMC

Capehorn MS, Catarig AM, Furberg JK, et al. Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1–3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10). Diabetes Metab. 2020;46(2):100–9. PubMed

Mehta A, Marso SP, Neeland IJ. Liraglutide for weight management: a critical review of the evidence. Obes Sci Pract. 2017;3(1):3–14. PubMed PMC

Ryan PM, Hamilton JK. What do I need to know about liraglutide (Saxenda), the glucagon-like peptide 1 receptor agonist for weight management in children with obesity? Paediatr Child Health. 2022;27(4):201–2. PubMed PMC

Brady SM, Kane MP, Busch RS. GLP-1 agonist use in a patient with an explainable cause of pancreatitis. AACE Clin Case Rep. 2016;2(2):e82–5.

The European Medicines Agency. Saxenda. 2023. https://www.ema.europa.eu/en/documents/product-information/saxenda-epar-product-information_en.pdf. Accessed 16 Oct 2023.

Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22. PubMed PMC

Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11–22. PubMed

Haase CL, Serratore Achenbach MG, Lucrezi G, et al. Use of liraglutide 3.0 mg for weight management in a real-world setting in Switzerland. Obes Facts. 2021;14(5):568–76. PubMed PMC

Lundgren JR, Janus C, Jensen SBK, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med. 2021;384(18):1719–30. PubMed

Wadden TA, Tronieri JS, Sugimoto D, et al. Liraglutide 3.0 mg and intensive behavioral therapy (IBT) for obesity in primary care: the SCALE IBT randomized controlled trial. Obesity. 2020;28(3):529–36. PubMed PMC

Garvey WT, Birkenfeld AL, Dicker D, et al. Efficacy and safety of liraglutide 3.0 mg in individuals with overweight or obesity and type 2 diabetes treated with basal insulin: the SCALE insulin randomized controlled trial. Diabetes Care. 2020;43(5):1085–93. PubMed PMC

Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes. 2013;37(11):1443–51. PubMed

le Roux CW, Astrup A, Fujioka K, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389(10077):1399–409. PubMed

Park JS, Kwon J, Choi HJ, et al. Clinical effectiveness of liraglutide on weight loss in South Koreans: first real-world retrospective data on Saxenda in Asia. Medicine (Baltimore). 2021;100(2): e23780. PubMed PMC

Dhillon S. Semaglutide: first global approval. Drugs. 2018;78(2):275–84. PubMed

Lewis AL, McEntee N, Holland J, et al. Development and approval of rybelsus (oral semaglutide): ushering in a new era in peptide delivery. Drug Deliv Transl Res. 2022;12(1):1–6. PubMed

The European Medicines Agency. Wegovy. 2023. https://www.ema.europa.eu/en/documents/product-information/wegovy-epar-product-information_cs.pdf. Accessed 16 Oct 2023.

Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989–1002. PubMed

Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64. PubMed PMC

Smith I, Hardy E, Mitchell S, et al. Semaglutide 2.4 mg for the management of overweight and obesity: systematic literature review and meta-analysis. Diabetes Metab Syndr Obes. 2022;15:3961–87. PubMed PMC

Wadden TA, Bailey TS, Billings LK, et al. Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial. JAMA. 2021;325(14):1403–13. PubMed PMC

Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021;397(10278):971–84. PubMed

Farzam K, Patel P. Tirzepatide. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2023, StatPearls Publishing LLC.; 2023.

Abbasi J. FDA green-lights tirzepatide, marketed as zepbound, for chronic weight management. JAMA. 2023;330(22):2143–4. PubMed

Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–16. PubMed

The European Medicines Agency. Mounjaro. 2023. https://www.ema.europa.eu/en/documents/overview/mounjaro-epar-medicine-overview_en.pdf. Accessed 16 Oct 2023.

Garvey WT, Frias JP, Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402:613–26. PubMed

Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385(6):503–15. PubMed

Istfan NW, Anderson WA, Hess DT, et al. The mitigating effect of phentermine and topiramate on weight regain after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2020;28(6):1023–30. PubMed PMC

Shiau J, Biertho L. Canadian Adult Obesity Clinical. Practice Guidelines: Bariatric Surgery: Postoperative Management. 2020. http://obesitycanada.ca/wp-content/uploads/2021/05/14-Bariatric-Surgery-PostOperativeMgmt-v4-with-links.pdf. Accessed 16 Oct 2023.

Nor Hanipah Z, Nasr EC, Bucak E, et al. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018;14(1):93–8. PubMed

Centrum. ZM. Use of Mysimba in Patients With Weight Regain After Bariatric Surgery. 2023. https://clinicaltrials.gov/study/NCT04902625. Accessed 16 Oct 2023.

Zoss I, Piec G, Horber FF. Impact of orlistat therapy on weight reduction in morbidly obese patients after implantation of the Swedish adjustable gastric band. Obes Surg. 2002;12(1):113–7. PubMed

Miras AD, Pérez-Pevida B, Aldhwayan M, et al. Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019;7(7):549–59. PubMed

Thakur U, Bhansali A, Gupta R, et al. Liraglutide augments weight loss after laparoscopic sleeve gastrectomy: a randomised, double-blind, Placebo-Control Study. Obes Surg. 2021;31(1):84–92. PubMed

NYU Langone Health. Clinical efficacy and safety of using 3.0mg liraglutide to treat weight regain after Roux-en-Y gastric bypass surgery. 2022. https://beta.clinicaltrials.gov/study/NCT03048578?tab=results. Accessed 16 Oct 2023.

Wharton S, Kuk JL, Luszczynski M, et al. Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery. Clin Obes. 2019;9(4):e12323. PubMed PMC

Suliman M, Buckley A, Al Tikriti A, et al. Routine clinical use of liraglutide 3 mg for the treatment of obesity: outcomes in non-surgical and bariatric surgery patients. Diabetes Obes Metab. 2019;21(6):1498–501. PubMed

Muratori F, Vignati F, Di Sacco G, et al. Efficacy of liraglutide 3.0 mg treatment on weight loss in patients with weight regain after bariatric surgery. Eat Weight Disord. 2022;27(7):2775–81. PubMed PMC

Alameri M, Alnuaimi A, Fiad T. Outcomes of liraglutide as treatment for weight regain after bariatric surgery: a 2-year retrospective study. Endocr Abstr. 2019;65:416.

Pajecki D, Halpern A, Cercato C, et al. Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery. Rev Col Bras Cir. 2013;40(3):191–5. PubMed

Rye P, Modi R, Cawsey S, et al. Efficacy of high-dose liraglutide as an adjunct for weight loss in patients with prior bariatric surgery. Obes Surg. 2018;28(11):3553–8. PubMed

Colbourne JRM, Fisher OM, Mo S, et al. The role of adjuvant pharmacotherapy with liraglutide for patients with inadequate weight loss following bariatric surgery. Langenbecks Arch Surg. 2023;408(1):115. PubMed PMC

Elhag W, El Ansari W. Effectiveness and safety of liraglutide in managing inadequate weight loss and weight regain after primary and revisional bariatric surgery: anthropometric and cardiometabolic outcomes. Obes Surg. 2022;32(4):1005–15. PubMed

Lautenbach A, Wernecke M, Huber TB, et al. The potential of semaglutide once-weekly in patients without type 2 diabetes with weight regain or insufficient weight loss after bariatric surgery—a retrospective analysis. Obes Surg. 2022;32(10):3280–8. PubMed PMC

Jensen AB, Renström F, Aczél S, et al. Efficacy of the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide for the treatment of weight regain after bariatric surgery: a retrospective observational study. Obes Surg. 2023;33(4):1017–25. PubMed PMC

Murvelashvili N, Xie L, Schellinger JN, et al. Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence. Obesity. 2023;31(5):1280–9. PubMed

Lafferty RA, Flatt PR, Irwin N. GLP-1/GIP analogs: potential impact in the landscape of obesity pharmacotherapy. Expert Opin Pharmacother. 2023;24(5):587–97. PubMed

Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care of Patients with Obesity. Endocr Pract. 2016;22:1–203. PubMed

Lupoli R, Lembo E, Saldalamacchia G, et al. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464–74. PubMed PMC

McDuffie JR, Calis KA, Uwaifo GI, et al. Three-month tolerability of orlistat in adolescents with obesity-related comorbid conditions. Obes Res. 2002;10(7):642–50. PubMed

Toplak H, Woodward E, Yumuk V, et al. 2014 EASO position statement on the use of anti-obesity drugs. Obes Facts. 2015;8(3):166–74. PubMed PMC

Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6(5):449–68. PubMed PMC

Dharmaratnam VM, Lim E, Eng A, et al. Revisional surgery or pharmacotherapy for insufficient weight loss and weight regain after primary bariatric procedure: a descriptive study. Obes Surg. 2022;32(10):3298–304. PubMed

Ritchie H, Roser M. Obesity. 2017. https://ourworldindata.org/obesity. Accessed 16 Oct 2023.

Galvani C, Gorodner M, Moser F, et al. Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass—ends justify the means? Surg Endosc. 2006;20:934–41. PubMed

Schwartz J, Suzo A, Wehr AM, et al. Pharmacotherapy in conjunction with a diet and exercise program for the treatment of weight recidivism or weight loss plateau post-bariatric surgery: a retrospective review. Obes Surg. 2016;26(2):452–8. PubMed

Badurdeen D, Hoff AC, Hedjoudje A, et al. Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss. Gastrointest Endosc. 2021;93(6):1316-24.e1. PubMed