Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Bariatric Surgery

The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study



Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures and has proven effective in providing weight loss. However, considerable variance has been noted in the degree of weight loss. Physician prescription practices may be negatively affecting weight loss post-LSG and, thus, contributing to the broad range of weight loss outcomes. The aim of our study was to determine whether commonly prescribed obesogenic medications negatively affect weight loss outcomes post-LSG.


This single center retrospective cohort study performed at a University hospital included 323 patients (≥18 years) within the University California, San Diego Healthcare System who underwent LSG between 2007 and 2016. We identified a list of 32 commonly prescribed medications that have weight gain as a side effect. We compared the percent excess weight loss (%EWL) of patients divided into two groups based on post-LSG exposure to obesogenic medications. A linear regression model was used to analyze %EWL at 12 months post-LSG while controlling for age, initial body mass index (BMI), and use of leptogenic medications.


A total of 150 patients (Meds group) were prescribed obesogenic medications within the one-year post-LSG follow up period, whereas 173 patients (Control group) were not prescribed obesogenic medications. The Meds group lost significantly less weight compared to the Control group (%EWL ± SEM at 12 months 53.8 ± 2.4 n = 78, 65.0 ± 2.6, n = 84 respectively, P = 0.002). This difference could not be attributed to differences in age, gender, initial BMI, co-morbidities, or prescription of leptogenic medications between the two groups.


The use of provider-prescribed obesogenic medications was associated with worse weight loss outcomes post-LSG. Closer scrutiny of patient medications may be necessary to help improve outcomes of weight loss treatments.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3


  1. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 2009;28:w822–31.

    Article  Google Scholar 

  2. Vossenaar M, Anderson A, Lean M, Ocke M. Perceived reasons for weight gain in adulthood. Int J Obes. 2004;28S1:S67.

  3. Domecq JP, Prutsky G, Leppin A, Sonbol MB, Altayar O, Undavalli C, et al. Clinical review: drugs commonly associated with weight change: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100:363–70.

    Article  CAS  Google Scholar 

  4. Bak M, Fransen A, Janssen J, van Os J, Drukker M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS One. 2014;9:e94112.

    Article  Google Scholar 

  5. Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000;61:863–7.

    Article  CAS  Google Scholar 

  6. Pijl H, Meinders AE. Bodyweight change as an adverse effect of drug treatment. Mechanisms and management. Drug Saf. 1996;14:329–42.

    Article  CAS  Google Scholar 

  7. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:342–62.

    Article  CAS  Google Scholar 

  8. Sharma AM, Pischon T, Hardt S, Kunz I, Luft FC. Hypothesis: Beta-adrenergic receptor blockers and weight gain: a systematic analysis. Hypertension. 2001;37:250–4.

    Article  CAS  Google Scholar 

  9. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  Google Scholar 

  10. Leslie WS, Hankey CR, Lean ME. Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review. QJM. 2007;100:395–404.

    Article  CAS  Google Scholar 

  11. El Chaar M, Hammoud N, Ezeji G, Claros L, Miletics M, Stoltzfus J. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a single center experience with 2 years follow-up. Obes Surg. 2015;25:254–62.

    Article  Google Scholar 

  12. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    Article  Google Scholar 

  13. Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27:2279–89.

    Article  CAS  Google Scholar 

  14. Ponce J, DeMaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American society for metabolic and bariatric surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12:1637–9.

    Article  Google Scholar 

  15. Alvarenga ES, Lo Menzo E, Szomstein S, Rosenthal RJ. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc. 2016;30:2673–8.

    Article  Google Scholar 

  16. Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.

    Article  Google Scholar 

  17. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.

    Article  Google Scholar 

  18. De Hollanda A, Ruiz T, Jimenez A, Flores L, Lacy A, Vidal J. Patterns of weight loss response following gastric bypass and sleeve gastrectomy. Obes Surg. 2015;25:1177–83.

    Article  Google Scholar 

  19. Nor Hanipah Z, Nasr EC, Bucak E, Schauer PR, Aminian A, Brethauer SA, et al. Efficacy of adjuvant weight loss medication after bariatric surgery. Surg Obes Relat Dis. 2018;14:93–98.

    Article  Google Scholar 

  20. Larsen JR, Vedtofte L, Jakobsen MSL, Jespersen HR, Jakobsen MI, Svensson CK, et al. Effect of liraglutide treatment on prediabetes and overweight or obesity in clozapine- or olanzapine-treated patients with schizophrenia spectrum disorder: a randomized clinical trial. JAMA Psychiatry. 2017;74:719–28.

    Article  Google Scholar 

  21. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens. 2014;16:14–26.

    Article  Google Scholar 

  22. Kovell LC, Ahmed HM, Misra S, Whelton SP, Prokopowicz GP, Blumenthal RS, et al. US hypertension management guidelines: a review of the recent past and recommendations for the future. J Am Heart Assoc. 2015;4:e002315.

    Article  Google Scholar 

  23. Aitken M, Kleinrock M. Medicines Use and Spending in the U.S. A Review of 2016 and Outlook to 2021. IQVIA Institute for Human Data Science. 2017.

  24. Carter CS, Onder G, Kritchevsky SB, Pahor M. Angiotensin-converting enzyme inhibition intervention in elderly persons: effects on body composition and physical performance. J Gerontol A Biol Sci Med Sci. 2005;60:1437–46.

    Article  Google Scholar 

  25. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017;71:1269–1324.

  26. Cascade E, Kalali AH, Weisler RH. Varying uses of anticonvulsant medications. Psychiatry. 2008;5:31–3.

    Google Scholar 

  27. Malin SK, Kashyap SR. Effects of metformin on weight loss: potential mechanisms. Curr Opin Endocrinol Diabetes Obes. 2014;21:323–9.

    Article  CAS  Google Scholar 

  28. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. AACE/ACE comprehensive diabetes management algorithm 2015. Endocr Pract. 2015;21:438–47.

    Article  Google Scholar 

  29. Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm--2016 Executive Summary. Endocr Pract. 2016;22:84–113.

    Article  Google Scholar 

  30. Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922–33.

    Article  Google Scholar 

  31. Bohdjalian A, Langer FB, Shakeri-Leidenmuhler S, Gfrerer L, Ludvik B, Zacherl J, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    Article  Google Scholar 

  32. Nikolic M, Kruljac I, Kirigin L, Mirosevic G, Ljubicic N, Nikolic BP, et al. Initial weight loss after restrictive bariatric procedures may predict mid-term weight maintenance: results from a 12-month pilot trial. Bariatr Surg Pract Patient Care. 2015;10:68–73.

    Article  Google Scholar 

  33. Frood S, Johnston LM, Matteson CL, Finegood DT. Obesity, complexity, and the role of the health system. Curr Obes Rep. 2013;2:320–6.

    Article  Google Scholar 

  34. Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ. 2018;361:k1951.

    Article  Google Scholar 

  35. Gourash WF, Ebel F, Lancaster K, Adeniji A, Koozer Iacono L, Eagleton JK, et al. Longitudinal Assessment of Bariatric Surgery (LABS): retention strategy and results at 24 months. Surg Obes Relat Dis. 2013;9:514–9.

    Article  Google Scholar 

  36. Xu J, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2015. NCHS Data Brief 2016;1–8.

Download references


Grant Support: C.B.L. received support from UCSD Summer Research Training Program. A.D. received support from NIH T32 DK007202. S.B. received support from NIH F32 DK113721. A.Z. received support from NIH K08 DK102902 and AASLD Liver Scholar Award. The project described was partially supported by the NIH UL1 TR001442.

Author contributions

CBL, AD, SBH, EG, and AZ conceptualized and designed the study. CBL acquired the data. CBL, AD, and AZ analyzed and interpreted the data. EL and JAP verified statistical results. SBH, SH, SG, SB, and EG provided valuable intellectual input. CBL and AD wrote the manuscript. AZ supervised the entire study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Amir Zarrinpar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leggett, C.B., Desalermos, A., Brown, S.D. et al. The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study. Int J Obes 43, 1154–1163 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links