Sleeve Gastrectomy and Adjuvant Pharmacological Treatment Underutilized in Americans with Obesity

While obesity remains a major concern in the United States of America, both surgical and pharmaceutical interventions have been underutilized, according to results intended to be presented at Digestive Disease Week 2020.

The following article is part of coverage from Digestive Disease Week (DDW 2020). Due to the global COVID-19 pandemic, the American Gastroenterology Association made the necessary decision to cancel the meeting originally scheduled for May 2–May 5, 2020, in Chicago. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

While obesity is a major concern in the United States, both surgical and pharmaceutical interventions have been underutilized, according to study results intended to be presented at Digestive Disease Week 2020.

Researchers collected information from patients (N=9,848,700) registered in the IBM Explorys database, which aggregates electronic health records from 26 health care networks in the United States. Only adults with body mass indices (BMI) ≥30 who underwent sleeve gastrectomy (SG) were used in the study. Any adjuvant pharmacological treatments (APT) prescribed as additional weight loss aides at least 7 days after surgery were also included.

Only a small fraction of adults with obesity underwent SG (0.25%; n=24,350). Despite the small number of procedures, SG surgeries significantly increased from 2009 to 2018 (0.003% to 0.143%; P <.0001). Supplemental pharmacotherapy for obesity was prescribed to 1630 (6.7%) individuals who had an SG operation. APT use ranged from 2.4% to 4.2% of patients for the last 5 years, and most (56%) had been prescribed an APT within 1 year of surgery. The most common APT was phentermine (65%), followed by bupropion/naltrexone (16.5%) and phentermine/topiramate (16.5%). The demographic groups most likely to be prescribed pharmacotherapy were women (OR, 1.61; 95% CI, 1.39-1.86) and African Americans (OR, 1.6; 95% CI, 1.41-1.79).

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A limitation of this study was the de-identified nature of the IBM Explorys database. The researchers were not able to discern the precise motivation of patients to have SG surgery. For example, Roux-en-Y gastric bypass (RYGB) has several non-bariatric indications, and patients with high BMI undergoing RYGB for reasons not related to obesity may have been included in the study.

The investigators concluded that despite the growing trend of SG use, surgery and pharmacotherapy remain underutilized in the United States. Less than 1% of adults with obesity had surgery, and of those only <5% were prescribed pharmacotherapy.

Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Shah R, Elangovan A, Smith Z L. Trends of sleeve gastrectomy and post-operative weight loss pharmacotherapy over 10 years: a large database study. Abstract intended to be presented at Digestive Disease Week 2020; May 2020 (canceled). Chicago, Illinois, United States of America.