The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

Background: Patients who undergo bariatric surgery often have inadequate weight loss or weight regain. Objectives: We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. Setting: Two academic medical centers. Methods: We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000– 2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy. Results: A total of 319 patients (RYGB 1⁄4 258; sleeve gastrectomy 1⁄4 61) met inclusion criteria for analysis. More than half (54%; n 1⁄4 172) of all study patients lost Z5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n 1⁄4 96) and 15% (n 1⁄4 49) losing Z10% (16.7 to 195.2 lbs) and Z15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a stat- istically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio 1⁄4 1.9; P 1⁄4 .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose Z5% of their total weight with the aid of weight loss medications

Association between obesity and poor sleep: a review of epidemiological evidence

Sleep is a multifaceted biological process linked with biochemical pathways of growth, maturation, and energy homeostasis. Due to the growing complaints of poor sleep in the general population, there has been a significant increase in sleep research aiming to identify the determinants of poor sleep. This review aims to explore the current state of the knowledge on obesity-sleep association and evaluate the role of weight loss in sleep improvement and vice versa. Current evidence suggests three directions of association between obesity and sleep: obesity leading to poor sleep, poor sleep leading to obesity and co-occurrence of obesity and poor sleep. People with obesity often report poor sleep, and obstructive sleep apnoea (OSA), and poor sleepers are often overweight or obese. Weight gain is not only associated with poor sleep and OSA prevalence but also affects the severity of OSA. Poor sleep, specifically OSA, affects metabolic hormones and influence behavioural pathways favouring unhealthy lifestyle leading to further worsening of obesity. Weight loss has shown potential in improving the quality of sleep, reducing OSA severity and decreasing metabolic abnormalities related to obesity. However, weight management is yet to be established as a clinical intervention with a long-lasting effect in improving sleep. Evidence also suggests that improvement in sleep quality lowers the odds of future obesity. Despite, the growing evidence base, the current literature has methodological limitations and fails to establish a causal link between obesity and poor sleep. Nonetheless, it is prudent to advise that weight management should be an important component of the clinical management plans for improving sleep