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1. Pharmacologic management of weight regain following bariatric surgery

Author

Eugene Lucas, Okeefe Simmons, Beverly Tchang, and Louis Aronne

Subjects
bariatric (weight loss) surgery, anti-obesity medications, obesity, weight regain after bariatric surgery, obesity pharmacotherapy, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

While bariatric surgery restults in significant long-term weight loss for most patients with obesity, post-surgical weight gain affects a considerable percentage of patients to varying degrees of severity. Furthermore, a small but significant percentage of patients experience inadequate post-surgical weight loss. Although many studies have examined the role of anti-obesity medications to address post-operative weight regain, an evidence-based consensus has not yet been achieved because of the heterogeneity of populations studied and the studies themselves. Observational studies in the post-bariatric surgery population consistently demonstrate the benefit of medical weight management after bariatric surgery, with most evidence highlighting liraglutide, topiramate, and phentermine/topiramate. New anti-obesity medications are anticipated to be helpful for post-surgical weight optimization given their efficacy in the non-surgical population.

Published
2023
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2. Metformin and Covid-19: Focused Review of Mechanisms and Current Literature Suggesting Benefit

Author

Sherehan Ibrahim, Jamie R. Lowe, Carolyn T. Bramante, Surbhi Shah, Nichole R. Klatt, Nancy Sherwood, Louis Aronne, Michael Puskarich, Leonardo Tamariz, Ana Palacio, Eric Bomberg, Michael Usher, Samantha King, Brad Benson, Deneen Vojta, Chris Tignanelli, and Nicholas Ingraham

Subjects
metformin, COVID-19, mechanisms of action, obesity, microbiome, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Metformin is the first-line medication for type 2 diabetes, but it also has a long history of improved outcomes in infectious diseases, such as influenza, hepatitis C, and in-vitro assays of zika. In the current Covid-19 pandemic, which has rapidly spread throughout the world, 4 observational studies have been published showing reduced mortality among individuals with home metformin use. There are several potential overlapping mechanisms by which metformin may reduce mortality from Covid-19. Metformin’s past anti-infectious benefits have been both against the infectious agent directly, as well as by improving the underlying health of the human host. It is unknown if the lower mortality suggested by observational studies in patients infected with Covid-19 who are on home metformin is due to direct activity against the virus itself, improved host substrate, or both.

Published
2021
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3. Recombinant Human Leptin Does Not Alter Gut Hormone Levels after Gastric Bypass but May Attenuate Sweet Cravings

Author

Rushika Conroy, Gerardo Febres, Donald J. McMahon, Michael O. Thorner, Bruce D. Gaylinn, Irene Conwell, Louis Aronne, and Judith Korner

Subjects
Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

Bariatric surgery improves glucose homeostasis and alters gut hormones partly independent of weight loss. Leptin plays a role in these processes; levels are decreased following bariatric surgery, creating a relative leptin insufficiency. We previously showed that leptin administration in a weight-reduced state after Roux-en-Y gastric bypass (RYGB) caused no further weight loss. Here, we discuss the impact of leptin administration on gut hormones, glucostasis, and appetite. Weight stable women after RYGB were randomized to receive placebo or recombinant human metreleptin (0.05 mg/kg twice daily). At weeks 0 and 16, a liquid meal challenge was performed. Glucose, insulin, C-peptide, GLP-1, PYY, glucagon, and ghrelin (total, acyl, and desacyl) were measured fasting and postprandially. Appetite was assessed using a visual analog scale. Mean post-op period was 53±2.3 months; mean BMI was 34.6±0.2 kg/m2. At 16 weeks, there was no significant change in weight within or between groups. Fasting PYY was significantly different between groups and the leptin group had lower sweets craving at week 16 than the placebo group (P

Published
2014
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4. OR10-3 Long-term Weight Loss Maintenance with Obesity Pharmacotherapy: a 5-Year Retrospective Study

Author

Clarissa Andre, Louis Aronne, Debra D’Angelo, Alpana Shukla, Beverly Tchang, and Michael Weintraub

Subjects
Endocrinology, Diabetes and Metabolism
Abstract

Objective To determine the association of anti-obesity medications (FDA-approved and off-label) with weight loss maintenance over 3-5 years. Methods We performed a retrospective observational study of adults 18-75 years treated for overweight/obesity at a tertiary academic weight management center with an initial visit between April 1st, 2014 and April 1st, 2016. We excluded patients who had a period of follow-up less than 2.5 years or a gap in follow-up of greater than 2 years. Patients who had bariatric surgery, pregnancy, or a medical condition predisposing them to weight loss during the study were also excluded. We extracted key demographic data, medical history, and weight at each visit. Anti-obesity medication (AOM) start date and end date was determined through chart review with attention to patient self-reporting of medication adherence to calculate total exposure to each AOM. We used the weight loss maintenance definition of weight regain ≤ 3% of the nadir weight. Results A total of 428 patients met inclusion criteria for the analysis and were followed for a mean of 4.4 years. The mean age was 50.9 years, 73% were female, and median initial BMI was 34.3 kg/m2. Weight categories were as follows: 19% overweight, 35% class 1, 25% class 2, and 20% class 3 obesity. In addition, 16% had diabetes and 36% had prediabetes. The median nadir BMI was 25.6 with a median maximum weight loss of 14.7%. The median time to achieving nadir weight was 1.9 years. Average weight change from the initial to final visit was -10.6% (-10.9 kg), with a final visit median BMI of 27.4. The proportion of patients who achieved ≥5%, ≥10%, ≥15%, and ≥20% total weight loss was 70.8%, 48.1%, 30.1%, and 16.8%, respectively. During the 4.4 years the patients were followed, weight regain following the nadir weight was 6.3%. At the last observation, 40.2% of all patients had maintained their maximum weight loss. The mean number of AOMs trialed throughout the duration of the study was 4.2. At the final visit, a mean of 2.5 AOMs were being taken. The most common medications observed at the final visit alone or in combination were metformin (76.2% of patients), phentermine (31.1%), topiramate (30.8%), bupropion (29.9%), and semaglutide (24.5%). Conclusion Long-term weight loss of 10.6% was observed over 3-5 years in adults with overweight/obesity who were managed with pharmacotherapy. This study demonstrates clinically significant long-term weight loss maintenance can be achieved with pharmacotherapy and lifestyle interventions. Presentation: Sunday, June 12, 2022 11:30 a.m. - 11:45 a.m.

Published
2022
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5. Clinical Management of Obesity

Author

Caroline M. Apovian, MD, Louis Aronne, MD, Sarah R. Barenbaum, MD, Caroline M. Apovian, MD, Louis Aronne, MD, and Sarah R. Barenbaum, MD

Abstract

Provides detailed guidance to the practicing physician on how and why to implement the new complications-centric approach to the treatment of obesity in their clinical practice. The rational for approaching obesity as a medical condition requiring intervention to reduce the risk of diabetes, CV events, and other serious diseases is presented, including the importance of understanding the pathophysiologic basis of obesity and the long list of obesity-related comorbidities. Major medical society obesity management guidelines which have recently been released are incorporated into the book. All currently available anti-obesity medications are covered, including a detailed discussion of the phase 3 clinical trial data for each agent, its mechanism of action, adverse events and contraindications, and drug prescribing information. Currently, only a PDF of the book is available.

Published
2023

6. Efficacy of Endoscopic Interventions for the Management of Obesity: a Meta-analysis to Compare Endoscopic Sleeve Gastroplasty, AspireAssist, and Primary Obesity Surgery Endolumenal

Author

Zubair, Khan, Muhammad Ali, Khan, Kaveh, Hajifathalian, Shawn, Shah, Mohamed, Abdul, Monica, Saumoy, Louis, Aronne, Wade, Lee, and Reem Z, Sharaiha

Subjects
Treatment Outcome, Gastroplasty, Weight Loss, Bariatric Surgery, Humans, Endoscopy, Obesity
Abstract

Novel endoscopic procedures (endoscopic sleeve gastroplasty (ESG), AspireAssist (AA), and primary obesity surgery endolumenal (POSE)) have been developed for treatment of obesity. We aimed to conduct a systematic review and meta-analysis to evaluate and compare the efficacy of these three endoscopic procedures.Main outcomes of interest were percent excess weight loss (%EWL) and percent total body weight loss (%TBWL). Weighted pooled means (WPMs) were calculated and analyzed using random effects model. Mean differences (MDs) were calculated to compare these procedures.Twelve studies with 1149 patients were included. WPMs for %EWL at 6 and 12 months with ESG were 49.67 (45.67, 53.66) and 52.75 (43.52, 61.98), respectively, while %TBWLs at 6 and 12 months with ESG were 16.01 (15.10, 16.92) and 17.41 (17.08, 17.74), respectively. WPMs for %EWL at 6 and 12 months with POSE were 43.79 (40.17, 47.42) and 44.91 (40.90, 48.92), respectively. WPM for %EWL at 12 months with AA was 50.85 (46.03, 55.68). While comparing ESG and POSE, at 6 months and 12 months, MD for %EWL was 6.17 (1.07, 11.26; P = 0.01) and 7.84 (- 2.05, 17.71; P = 0.06) in favor of ESG. No difference in %EWL was observed while comparing ESG with AA (P = 0.29). Likewise, MD for %EWL to compare AA and POSE was not significant (P = 0.68).During a follow-up of 6-12 months, both AA and ESG had excellent efficacy in achieving significant and sustained weight loss; however, ESG was found to be superior in terms of weight loss when compared with POSE.

Published
2019

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