Drug-induced obesity is excess weight gain attributable to pharmacologic agents. When a full course of intensified obesity pharmacotherapy does not produce adequate weight reduction, clinical management advances to the next treatment line — a surgical approach for appropriate candidates.
The preceding line involves intensification with additional or alternative obesity pharmacologic agents: phentermine/topiramate ER, naltrexone/bupropion ER, orlistat, liraglutide, or phentermine.
Escalation is triggered when this regimen fails to achieve >5% total body weight loss after 3 months of use — the threshold distinguishing non-responders from those likely to benefit from continued pharmacotherapy.
For patients who are otherwise good surgical candidates, metabolic surgery is the approach indicated at this stage. The specific procedures considered and the full selection criteria are detailed in the complete protocol.
Success is defined by substantial total body weight loss — approximately 22.8% to 29.1% at one year depending on the procedure chosen — together with type 2 diabetes remission where applicable.
DOI: 10.2337/dc26-S008
Consider metabolic surgery as a weight and glycemic management approach in people with type 2 diabetes with BMI ≥30.0 kg/m² (or ≥27.5 kg/m² in Asian American individuals) who are otherwise good surgical candidates.
The overwhelming majority of procedures performed in the U.S. are vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB).
At 1 year after surgery, those who had RYGB lost on average 29.1% of their total body weight, while those who had VSG lost on average 22.8% of their total body weight.
Among the 6,141 individuals who experienced type 2 diabetes remission, the subsequent type 2 diabetes relapse rate was lower for those who had RYGB than for those who had VSG.
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