Appetite Suppressants, Magic or Myth?
October 27, 2016On occasion, I am asked about the need or use of appetite suppressants following weight loss surgery. Although a simple question, there are many variables that I would consider before providing an answer.
For Gastric Band patients - In broad terms, I am much more inclined to endorse appetite suppressants with post-surgical Gastric Band patients then others, if they are following up for the adjustments and if they are being adherent to the guidelines and behaviors required to be successful with weight loss following gastric banding, (chewing food to applesauce consistency, eating protein forward meals, not drinking with their meals, allowing adequate time for the fullness signal to be experienced, and not grazing or eating without hunger).
In these situations, the Gastric Band patient might need a little “jump start” to help them eliminate their feeling of hunger. In these cases, I think appetite suppressants are helpful.
For Roux en Y (RNY) or Sleeve patients (I don’t do the Duodenal Switch) - For these patients who are experiencing weight gain, I am much more inclined to look for an answer outside of a medication. I want to make sure that the “tool” is intact and that there is not some breakdown or reversal in place to the operation that allows the patient to regain weight. I will order an upper endoscopy for measurements as well an upper GI swallow exam to better answer this question.
If the Bypass or Sleeve is intact, then I want to make sure that the patient is working with the tool and not choosing behaviors to effectively bypass the anatomy such as eating poor food choices, eating without hunger, eating past hunger or grazing throughout the day.
Your Relationship With Food Instead of Pills
Let me share this experience that happened early in my career as an example. My wife and I were working with a young lady on a personal financial matter. One of the forms requiring our information asked our professions. As our discussion progressed, this woman inquired what type of a surgeon I was, and I told her that I was a general surgeon but 95% of my practice was weight loss surgery. She then shared with me that she had that surgery (RNY) and had gained all of her weight back. I asked what could she eat and she said that she ate “¾ of a pizza” last evening. I was convinced that she had a breakdown of her Gastric Bypass.
I encouraged her to get me copies of her records and to make an appointment with me for further evaluation. She came to see me two weeks later. I ordered the upper GI and upper endoscopy. When the results came back, everything was perfect. I saw her back in the clinic the following week to discuss these results. I again asked if she really could eat ¾ of a pizza. When she answered yes, I asked, “Does it hurt?” “Oh, yes” she replied, “I get crushing chest pain up to my throat which lasts for three to four hours.” Now the picture was clear. She was able to eat this large amount by compressing and stacking the pizza up into her esophagus and throat. It was not until the pizza could move through the small Gastric Bypass pouch and be digested that her pain would resolve.
For this woman, there is not a pill in the world that will help her to get back on track with weight loss. What was needed was behavioral counseling to relearn how to use the tool she had been given to lose weight.
This was a prime and profound example for me of a patient’s need to reevaluate her relationship with food.
That said, my standard plan of care for patients that have had either the RNY or Sleeve procedures with concern for weight regain and breakdown of their original procedure, is as follows. First, get an accurate weight history, acquire accurate accounting of their daily calorie/meals, inquire about maladaptive behaviors and evaluate the RNY or sleeve anatomy. In 9 times out of 10, the issue is not anatomical but, if it is, we proceed to revisional surgery to correct the problem. For everyone else, we work on helping the patient get back on track - to relearn the behaviors necessary for successful weight loss following weight loss surgery.
Obviously, this is why it is so important for patients to have surgery first and foremost with an experienced surgeon who can perform these operations effectively to appropriately reduce the size of the stomach to allow for significant weight loss. Just as important is that the patient’s care is with a comprehensive bariatric program to ensure that they have the expertise and the support they might need if they do begin to struggle with weight regain. I have seen some crazy foreign operations for “WEIGHT LOSS”.
What Is Your Best Approach?
Weight loss, for Band patients, may involve appetite suppressants, but for most others, most likely will involve emotional support to get them back on track for weight loss. If indicated following RNY or Sleeve, a bariatrician would best direct this part of your journey into health.
Dr. Jeffrey Baker is a board-certified physician specializing in bariatric surgery at Ridgeview Medical Center.
 | ABOUT THE AUTHOR Dr. Jeffrey Baker is a board-certified physician specializing in bariatric surgery at Riverside Medical Center. He has performed over 2,500 weight loss surgeries since specializing in bariatrics in 2003. He sits on the review boards of two international state-of-the-art medical device companies developing new technologies for bariatric innovations. Read more articles by Dr. Baker! |
