Weight Loss Medications after Bariatric Surgery

Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN

Bariatric Dietitian and Board-Certified Specialist in Obesity & Weight Management.

Understanding the role of weight loss medications post-bariatric surgery can be instrumental in managing expectations and achieving long-term weight management goals. This guide explores the differences between various weight loss medications, the reasons why bariatric doctors prescribe them, and the potential side effects, particularly for bariatric patients.

1) Differences between weight loss medications.

Weight loss medications, also known as anti-obesity medications (AOMs), offer different mechanisms to aid in weight management. Here’s an overview of some commonly prescribed AOMs:

• Orlistat (Xenical, Alli): Inhibits fat absorption, reducing calorie intake from fats. It's typically taken with meals and may cause gastrointestinal side effects like oily stools.

• Phentermine-Topiramate (Qsymia): This combination drug suppresses appetite and increases feelings of fullness. Phentermine is a stimulant that reduces hunger, while Topiramate alters brain signals related to appetite.

• Naltrexone-Bupropion (Contrave): This combination affects the central nervous system to curb hunger and control cravings. Naltrexone is used for addiction treatment, while Bupropion is an antidepressant.

• GLP-1 Receptor Agonists (e.g., Liraglutide - Saxenda, Semaglutide - Wegovy, Ozempic): These drugs mimic a hormone that regulates appetite, slows gastric emptying, and boosts insulin secretion. They are typically administered via injection and can significantly reduce hunger and food intake.

• GLP-1/GIP Receptor Agonists (e.g., Tirzepatide - Mounjaro, Zepbound): These medications target both GLP-1 and GIP receptors to enhance insulin secretion, reduce appetite, and slow gastric emptying, offering robust weight loss benefits.

2) Why bariatric doctors prescribe weight loss medications.

Bariatric doctors may prescribe weight loss medications post-surgery for several reasons:

• Overcoming weight loss plateaus: Despite initial success, many patients experience weight loss plateaus. AOMs can help break through these plateaus by enhancing metabolic processes and reducing hunger.

• Improving metabolic health: Weight loss medications can enhance metabolic health by decreasing fat mass, thereby lowering the risk of obesity-related conditions such as type 2 diabetes, hypertension, and cardiovascular diseases.

• Supporting behavioral changes: AOMs can aid in reinforcing healthy eating habits and portion control, making it easier for patients to stick to their dietary plans and avoid reverting to old habits.

3) Side effects of medications for bariatric patients.

While weight loss medications can be beneficial, it’s crucial to be aware of their potential side effects, especially for bariatric patients:

• Ozempic (Semaglutide): Common side effects include nausea, vomiting, diarrhea, and constipation. For bariatric patients, these gastrointestinal side effects can be more pronounced due to their altered digestive systems.

• Liraglutide (Saxenda): Similar to Semaglutide, it can cause gastrointestinal discomfort. Long-term use may lead to pancreatitis in some patients.

• Orlistat (Xenical, Alli): May cause oily stools, flatulence, and frequent bowel movements, which can be inconvenient and affect adherence.

• Phentermine-Topiramate (Qsymia): Can lead to increased heart rate, insomnia, dry mouth, dizziness, and mood changes, necessitating careful monitoring, especially for those with cardiovascular concerns.

• Naltrexone-Bupropion (Contrave): Side effects may include nausea, headache, and increased blood pressure. It’s important to monitor for mood changes or unusual thoughts, as Bupropion can affect mental health.

• Tirzepatide (Mounjaro, Zepbound): Side effects can include gastrointestinal issues, potential pancreatitis, and increased heart rate. Monitoring by a healthcare provider is essential to manage these effects.

4) Conclusion

Weight loss medications can be a valuable tool in the post-bariatric surgery journey, helping manage weight loss plateaus and enhance overall metabolic health. However, it’s crucial to weigh the benefits against potential side effects and work closely with your healthcare provider to ensure these medications are safe and effective for your individual needs. With informed decisions and a supportive healthcare team, you can optimize your post-surgery outcomes and maintain a healthy weight long-term.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.