Adjunctive Use of Appetite Suppressant Medications for Improved Weight Management in Bariatric Surgical Patients

Background: Patients who undergo bariatric surgery sometimes experience late onset of weight gain, when they lapse into negative eating patterns, which adversely affect weight management. Long-term weight management is a process, with a surgical foundation, and requiring adjunctive strategies for best results. We sought to determine if appetite suppressant medications could be safely incorporated into a comprehensive program of weight management. Methods: Subjects were at least 18 months post-operative, were accessible for weekly follow-up, and weighed at least 9 kg more than their ideal body weight. Phentermine and fenfluramine were prescribed in combination, at the lowest does necessary to achieve comfortable appetite suppression. Results: Weight losses ranged from 4.5 to 22.7 kg, over a 12-week course of treatment, corresponding to 8-65% of excess body weight. Most side-effects were minor, and did not require cessation of treatment. Two patients discontinued treatment due to side-effects which were unacceptable to them. Conclusion: Phentermine and fenfluramine are a safe and useful adjunct to a comprehensive program of weight management.