The Impact of Anti-Obesity Medications on Sleeve Gastrectomy Outcomes in Adolescents
Justine Chinn, MD, Mark Shacker, BS, Kelly Brennan, MS, Micaela Esquivel, MD, FACS, Janey Pratt, MD, FACS
Introduction: Obesity continues to rise in the pediatric population, making both metabolic and bariatric surgery (MBS) and anti-obesity medications (AOMs) important treatments. However, little is known regarding how pre-operative AOM use impacts weight loss after MBS.
Methods: A retrospective review was performed at a children’s hospital. Patients taking a GLP-1 receptor agonist (GLP1RA) or topiramate within 12 months prior to sleeve gastrectomy were compared to patients who took no AOMs. Demographics, comorbidities, and total body weight loss (%TBWL) and percent BMI reduction were compared. A matched sub-analysis was performed comparing GLP1RA to control. Analysis was performed using Kruskal-Wallis rank sum and Fisher’s exact tests.
Results: 103 control patients not on AOMs were compared to 14 patients taking pre-operative GLP1RA and 18 taking topiramate. There were no differences in age, race, ethnicity, or comorbidities. There was no significant difference in first clinic weight or BMI (average BMI 46-48, weight 125-131 kg) or day of surgery weight or BMI. At 3-, 6-, and 12-months, patients taking pre-operative GLP1RA or topiramate lost significantly less weight than controls (Figure 1). In a 4:1 matched sub-analysis controlled for age, gender, comorbidities and BMI, this trend persisted, with %TBWL of 12% vs 14.4% (p=0.1) in the GLP1RA compared to control at 3 months, 14.4% vs 19.3% at 6 months (p=0.03), and 16.9% vs 23% (p=0.11) at 12 months.
Conclusions: In this small adolescent cohort study, patients on pre-operative AOM lost less weight post-operatively. This raises questions regarding optimal timing of AOM initiation for patients undergoing MBS.