Background

Limited literature exists on the management of patients with super obesity prior to bariatric surgery.

Methods

A 46 year old male with a diabetes, hypertension,and super obesity (BMI 97) presented to the clinic for preoperative weight loss consultation prior to a planned two-stage bariatric surgery, first being the sleeve gastrectomy. He was on obesogenic medications, including insulin, beta-blocker, and duloxetine.

Results

Medication adjustment(cross titration of insulin with a GLP-1 agonist and the addition of Metformin and phentermine),led to a 61 lb (9% of total body weight, TBW) weight loss which leveled off at two months when late night eating increased.Adding Topiramate 50 mg nightly minimized late night eating and led to an additional 39 lb weight loss(total = 100 lbs,14.7% TBW) by six months prior to his first surgery, rendering him a potentially safer surgical candidate and allowing him to wean off weight loss medications. Following an uneventful LSG, helost an additional 63 lbs (BMI 75) in three months.Topiramate and Phentermine was restarted postoperatively to address increasing experience of hunger and to enhance his overall weight loss following LSG.The patient continues with medical weight loss and is pending the second stage of his bariatric surgery, RYGB.

Conclusions

A multidisciplinary approach incorporating medications for medical weight loss before and after bariatric surgery may be therapeutic for individuals with super obesity.