Early Anti-Obesity Medication After Sleeve Gastrectomy Supports Durable Weight Loss: JAMA
USA: Researchers have found in a new study that early reinitiation of anti-obesity medication within 3 months of sleeve gastrectomy (SG) was safe and associated with more sustained weight loss and improved eating behaviours through 12 months.
Differences in weight trajectories emerged after 6 months and coincided with reductions in hunger-driven and cue-driven eating, suggesting that early pharmacotherapy may enhance postoperative appetite regulation and counteract neurohormonal adaptations that contribute to weight regain or slowing weight loss. The findings support an integrated, long-term surgical and pharmacological approach to managing obesity, including in paediatric metabolic and bariatric surgery patients.
The findings were reported in a Research Letter published in JAMA Surgery by Alaina P. Vidmar, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, and colleagues.
Pediatric obesity is a chronic, relapsing disease, and sleeve gastrectomy is an effective treatment for severe obesity. However, some youths experience early slowing or reversal of weight loss after surgery. Because anti-obesity medications are often discontinued postoperatively despite limited evidence of harm, researchers investigated whether early medication reinitiation could improve long-term outcomes.
The retrospective cohort study analyzed 99 patients aged 7–20 years who underwent sleeve gastrectomy at a tertiary children's hospital. Of these, 53 restarted anti-obesity medication within three months of surgery, while 46 received standard postoperative care. Researchers evaluated changes in BMI, excess BMI loss, safety, and eating behaviors over 12 months.
Key findings from the study include:
- The median age of participants was 17 years, and 59% were female.
- Patients who restarted anti-obesity medication resumed treatment a median of one month after surgery.
- Weight loss was similar in both groups during the first six months after surgery.
- At 12 months, the early medication group achieved greater reductions in BMI (29.3% vs 25.5%) and greater excess BMI loss than the surgery-only group.
- Improvements in eating behaviors, particularly reductions in hunger-driven eating, were significantly greater among patients who restarted medication early.
- Rates of postoperative complications, hospital readmissions, emergency department visits, biliary events requiring cholecystectomy, and reoperations were comparable between the two groups, supporting the safety of early medication reinitiation.
The researchers suggested that early medication reinitiation may improve long-term weight loss by enhancing appetite regulation and reducing hunger-driven eating after surgery. The findings support a multimodal approach to obesity management that combines bariatric surgery with pharmacotherapy.
The study was limited by its retrospective, nonrandomized, single-center design and limited ability to compare individual medication classes. However, the findings indicate that restarting anti-obesity medication within three months of sleeve gastrectomy is safe and may improve long-term weight and eating behavior outcomes. The researchers called for larger prospective multicenter studies to validate these results.
Reference:
Vidmar AP, Vu MH, Martin MJ, et al. Early Reinitiation of Obesity Medication After Sleeve Gastrectomy in Youths. JAMA Surg. Published online July 22, 2026. doi:10.1001/jamasurg.2026.2786
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