Title: Early Re-Initiation of Anti-Obesity Medications Post Laparoscopic Sleeve Gastrectomy in Youth: Proof of Concept Trial

Title: Early Re-Initiation of Anti-Obesity Medications Post Laparoscopic Sleeve Gastrectomy in Youth: Proof of Concept Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Title: Early Re-Initiation of Anti-Obesity Medications Post Laparoscopic Sleeve Gastrectomy in Youth: Proof of Concept Trial Alaina P. Vidmar, My H. Vu, Matthew J. Martin, Aimee G. Kim, Stuart Abel, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5363643/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Jan, 2025 Read the published version in Obesity Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background Bariatric surgery is the most effective intervention for severe pediatric obesity, but 25% of youth experience suboptimal weight loss and/or weight regain. A multi-pronged postoperative approach, including early re-initiation of anti-obesity medications (AOM), may improve outcomes, though this has not been evaluated in pediatric populations. Methods This pilot study assessed the safety, tolerability, and efficacy of early AOM re-initiation after laparoscopic sleeve gastrectomy (LSG) in youth. A retrospective analysis compared youth undergoing LSG at a large children's hospital from November 2023 to July 2024, comparing those who chose early AOM re-initiation (n = 25) versus standard care (n = 21). Primary outcomes included changes in weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions. Results The study involved 46 adolescents (mean age 16.5 years, mean BMI 50 kg/m², predominantly female (70%), Hispanic (80%), and publicly insured (87%); 93% had used AOM preoperatively). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, revealed that early AOM re-initiation (5.1 weeks [IQR 3.7,8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6 months postoperatively compared to standard care, with no significant differences in complications or readmissions. At 6 months, the mean differences were: %BMI: -6.5% (95%CI: -9.13, -3.86), p < 0.001; %TWL: -5.9% (95%CI: -8.52, -3.25), p < 0.001; %EWL: -8.2 (95%CI: -14.69, -1.63), p < 0.001. Early re-initiators reported a 4-fold reduction in emotional overeating (p = 0.001) compared to standard care. Conclusion Early AOM re-initiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates. Pediatric Obesity Metabolic and Bariatric Surgery Figures Figure 1 Figure 2 Figure 3 Key Points Early medication re-initiation after sleeve gastrectomy was safe and well tolerated. No significant differences in complication, readmission, or reoperation rates were observed. Early re-initiation led to greater reductions in body mass index. Youth who restarted medications reported a four-fold decrease in emotional overeating. Introduction Recent projections indicate that by 2050, over half of youth will be affected by obesity, with severe obesity impacting about 7.6% of youth in the U.S.[1–3] Current treatment approaches for pediatric obesity encompass lifestyle modifications, obesity pharmacotherapy, and metabolic and bariatric surgery (MBS).[4] Intensive health and behavior modification therapy, involving extensive counseling, yields only modest reductions in body mass index (~3% over 1 year).[3,5] Anti-obesity medication (AOM) combined with lifestyle modification, can achieve more significant body mass index (BMI) reductions (~5-17% over 1 year), while MBS, options like Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (LSG) offer substantial weight loss (~30% over 1 year.).[6,7] Given the chronic nature of pediatric obesity, sustained and multifaced approaches are necessary to maintain health benefits over time.[4,8] Despite its effectiveness, MBS does not guarantee uniform outcomes, with up to 25% of individuals experiencing suboptimal weight loss and recurrent weight gain above their postoperative nadir. [9–12] Emerging evidence suggests that variations in post-surgical glucagon-like-peptide-1 (GLP-1) levels and increased emotional overeating are linked to suboptimal weight loss outcomes or recurrent weight gain which can reduce or negate any positive impacts on weight-related comorbidities.[13–15] GLP-1 receptor agonists, such as those approved for pediatric use (liraglutide and semaglutide), and/or other AOMs, might offer a promising solution as an adjunct to surgery to mitigate these challenges.[8,16–18] AOMs work through multiple mechanisms, to reduce appetite; enhance satiety; and beneficially alter various metabolites to inhibit the reward pathways associated with hedonic eating behaviors which could potentially counteract the counter-regulatory metabolic adaptations that often lead to obesity relapse.[19–21] It is currently common practice to discontinue AOMs in the perioperative period, and particularly in the early postoperative phase due to concerns about complications related to delayed gastric emptying and gastrointestinal motility. However, there is currently little available evidence to support these theoretical concerns. The traditional approach of discontinuing AOMs post-surgery may need re-evaluation given the evolving landscape of pediatric obesity treatment.[8,16–18] Specifically, current protocols generally recommend resuming AOM only if initial weight loss is insufficient or if recurrent weight gain occurs within 1-2 years after surgery.[16,17] However, with increasing use of these medications in youth undergoing bariatric surgery, there is a growing need to explore their optimal use both pre- and post-operatively.[3] There is a critical gap in evidence regarding the use of AOM immediately after metabolic and bariatric surgery in pediatric populations.[8,22,23] Despite the growing number of pediatric bariatric surgery procedures and the preoperative use of these agents, no standardized protocols exist for their early postoperative use.[24–26] AOM remain underutilized post-surgery, indicating a need to reassess their role and address barriers to their use. To date, no research has examined the efficacy of anti-obesity medication immediately post-surgery in pediatric populations. At our large tertiary care, safety-net, children’s hospital 570 out of the 1900 youth followed in the comprehensive obesity care program have at least one obesity associated medical problem, and 40% were prescribed an AOM. Notably, out of the 50 youth who underwent LSG in the inaugural year of the pediatric bariatric surgery program, 93% were on one or multiple AOMs at the time of surgery but had stopped postoperatively per standard of care recommendations. However, 62% of these patients reported cravings and increased emotional overeating, despite reduced hunger, prompting many to seek early AOM re-initiation. Using a shared medical decision-making framework, the multi-disciplinary MBS team, along with patient and caregiver input, developed the PEDIATRIC-RAMP (Pediatric Reinitiation And Management Protocol) to facilitate early AOMs re-initiation after LSG). This study aims to evaluate the safety, tolerability, and efficacy of the early anti-obesity pharmacotherapy re-initiation protocol in youth with severe obesity who underwent LSG from November 2023 to July of 2024. We hypothesize that early re-initiation of AOM, compared to standard care, will be safe, well tolerated, and result in greater weight loss and less self-reported emotional overeating, without negatively affecting nutritional intake or tolerance. These preliminary findings could help bridge the evidence gaps regarding postoperative AOM use, potentially guiding future research to improve treatment protocols, enhance weight loss, prevent recurrent weight gain, and optimize long-term cardiometabolic outcomes and eating behaviors in youth. Methods Study Design: We conducted a retrospective analysis of data from a repository to evaluate outcomes in youth who underwent laparoscopic sleeve gastrectomy at a large tertiary care children’s hospital between November 2023 and July 2024. The study adhered to ethical guidelines for research involving human subjects, with approval from the hospital’s Institutional Review Board. Informed consent was obtained from the youth and one caregiver, and all data were anonymized to ensure participant confidentiality. Participants: The study included youth aged 10-21 years who underwent laparoscopic sleeve gastrectomy during the study period. Participants were identified from the hospital’s electronic health record and internal program database. Eligibility criteria included: 1) ages 7 to 21 years; 2) severe obesity (BMI > 120% of the 95th percentile); 3) primary surgical weight loss through the pediatric pathway at a tertiary care, safety-net children’s hospital; 4) consent to the clinical data repository. Exclusions applied to those with type 1 diabetes, medications influencing body composition (e.g., prednisone), or syndromes affecting the postoperative course (e.g., Prader Willi Syndrome). Group Assignment – Early Anti-Obesity Medication Re-Initiation vs. Standard Care: At the two-week post-operative visit, all participants completed the Pediatric RAMP checklist. If meeting hydration, protein, and caloric intake goals without gastrointestinal symptoms, they had the opportunity to restart AOM, guided by a shared decision-making approach. Participants who opted for standard care did not restart any medications. Data Collection: Data were extracted from the hospital's obesity-management data repository (REDCap), including electronic health records, surgical logs, follow-up documentation, and self-reported surveys. Collected data encompassed demographic information (age, sex, race, ethnicity, insurance, income), clinical characteristics (BMI, comorbidities, type of surgery, medications, family history), eating behaviors, and post-operative outcomes (weight trajectory, complications, readmissions, reoperations). Additional data on AOM use and adherence were retrieved from the electronic health record. Measurements: Primary Outcome: Anthropometric measures were collected at each clinical visit. Height was measured using a Quick Medical stadiometer (accuracy: 0.1 cm), and weight using the TANITA MC-58030 scale [27] (accuracy: 0.1 kg). BMI was calculated using CDC growth charts. [28] Postoperative outcomes included changes in percent BMI, percent total body weight, and percent excess weight (using BMI 25 to define ideal weight) at time of surgical consult, day of surgery, 3-, and 6-months post-surgery. Secondary Outcomes: Safety and Tolerability: Postoperative outcomes were monitored for readmissions and complications documented at 30-, 60-, and 90-days post-surgery. Reoperations and reasons for admissions were systematically recorded by the multidisciplinary bariatric team. Side effects were tracked through weekly phone calls to identify and address issues promptly. Self-Reported Eating Behaviors : The Adult Eating Behavior Questionnaire (AEBQ) [29] assessed various eating behaviors. The AEBQ comprises five subscales: Food Responsiveness, Emotional Eating, Satiety Responsiveness, Enjoyment of Food, and Lack of Food Control, evaluated on a 5-point Likert scale. Participants completed the questionnaire online via REDCap, which took approximately 15 minutes. Higher scores indicated a greater tendency toward specific eating behaviors. The AEBQ demonstrated robust psychometric properties, with Cronbach's alpha values ranging from 0.80 to 0.92. [29] Statistical Analysis: Baseline demographics and characteristics were summarized descriptively across arms using mean and standard deviation (SD) or median and interquartile range as appropriate for the distribution of continuous variables. Categorical variables are described as a frequency and percentage. Differences in patient characteristics and outcomes between groups were examined using Wilcoxon rank sum test and Fisher's exact test. Additionally, mixed-effects longitudinal regression models (lmerTest package in RStudio)[30,31] with fixed study arm, study visit, study arm*study visit, and covariates (baseline BMI, age, and sex) were utilized to assess whether there were between-group differences in mean change (from baseline) in clinical outcomes at 3-months and 6-months post-operatively. Models included random intercepts to account for within-subject correlation between repeated outcomes over time. All participants with data at baseline were included in analyses (n= 46). Mixed-effects analyses are generally robust for unbalanced data across study time points where information from the observed data is used to provide information about the missing data without explicitly imputing the missing outcome values using the likelihood-based approach.[32] All results were reported with 95% confidence interval and p -value. The statistical significance level was set at .05 with two-sided throughout the analyses. All statistical computations were done in RStudio 4.4.1.[33,34] Results Participant Characteristics From the time of protocol implementation, 46 youth underwent LSG (mean age [SD] 16.5 [1.9] years, mean BMI [SD] 53 [9.7] kg/m²), predominantly female (70%), Hispanic (80%), and publicly insured (87%), 93% had used AOM preoperatively.; Table 1 ). Over half of the participants (54%, 25/46) self-selected early re-initiation of an AOM (median [IQR] time to re-initiation 5.1 weeks [3.7, 8.4]). Of those who re-initiated AOM, 56% (14/25) resumed their pre-surgery regimen, with 52% (13/25) starting more than one agent. The medications re-initiated postoperatively included semaglutide (17/25), phentermine (11/25), topiramate (7/25), metformin (7/25), and tirzepatide (4/25). Change in Weight Trajector Figure 1 demonstrates the within subject change in percent BMI from surgical consult to last anthropometric point available to highlight individual response across the cohort between groups. At 3 months postoperatively, the mean (SD) change from surgical consult in absolute BMI (kg/m²) was -10.5 (2.0) kg/m² for early re-initiators and -7.3 (2.3) kg/m² for standard care, representing a difference of -3.2 kg/m² (p 0.001, Table 2 ). The correlating mean (SD) percentage change in BMI at this time was -19.4% (4.8%) for early re-initiators and -14.7% (4.4%) for standard care, with a difference of -3 percentage points (p <0.001). At 6 months postoperatively, the mean change in absolute BMI was -13.5 (1.7) kg/m 2 for early re-initiators and -8.9 (1.7) kg/m 2 for standard care, showing a difference of -4.6 points (p <0.001). The mean (SD) percentage change in BMI at 6 months was -24.3% (4.7%) for early re-initiators and -18.4% (4.3%) for standard care, with a difference of -5.9% (p = 0.004). Additionally, at 3 months postoperatively, youth in the early re-initiation group demonstrated a greater reduction in %TWL and %EWL compared to standard care, representing a difference of -4.4% and 6% respectively ( Table 2 ). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, was conducted for each arthrometric measure and revealed that early re-initiation significantly reduced absolute weight (kg), BMI (kg/m 2 ), percent BMI, percent TWL, and percent EWL at 3 and 6 months postoperatively compared to standard care ( Table 3 ). At 6 months, mean differences between groups with 95% confidence intervals included: BMI: -4.6 (-5.94, -3.25), p < 0.001; %BMI: -6.5 (-9.13, -3.86), p < 0.001; %TWL: -5.9 (-8.52, -3.25), p < 0.001; %EWL: -8.2 (-14.69, -1.63), p < 0.001; Table 3 ). Semaglutide Sub-Analysis A sub-analysis was conducted on youth who were taking semaglutide 2.4 mg weekly (n=18) for at least 3 months prior to LSG and then re-initiated the medication immediately postoperatively (median [IQR] time to re-initiation 5.0 weeks [3.7, 8.4]. Early re-initiators (n=17) experienced greater reduction in both absolute BMI and %BMI change at 3 months (median [SD[ BMI [kg/m²]: -10.7 [2.1] vs. -7.3 [2.3]; p 0.001; %BMI: -20 [5.4] vs. -14.7% [4.4]; p < 0.001) and mo. 6 (BMI [kg/m²]: -13.3 [1.7] vs. -8.9 [1.7]; p <0.001; %BMI: -24% [5.1] vs. -18.4% [4.3]; p=0.02) compared to the standard care (n=21; Figure 2 ). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, was conducted for each arthrometric measure and revealed that early re-initiation significantly reduced absolute weight (kg), BMI (kg/m 2 ), percent BMI, percent TWL, and percent EWL at 3 and 6 months postoperatively compared to standard care ( Table 3 ). Eating Behaviors While all youth reported a 50% reduction in hunger on the AEBQ [35] completed 2 and 4 weeks postoperatively, scores for food responsiveness and emotional overeating remained elevated. Compared to standard care, re-initiators demonstrated a significant four-fold reduction in emotional overeating, food avoidance, hunger, food responsiveness and an increase in slowness in eating on the self-reported AEBQ at 3 and 6 months postoperatively ( Table 4 and Figure 3 ). No negative compensatory eating behaviors (restricting, purging, binge episodes,) were reported during monthly visits with a registered dietitian. Additionally, 24-hour dietary recalls showed that post-operative nutritional intake was adequate for age and weight, meeting all micro- and macronutrient requirements. Safety and Tolerability No significant differences were observed in rates of complications (n = 4 vs. 3), unplanned readmissions (n = 3 vs. 2), or reoperations (n = 0 vs. 0) within 30, 60, or 90 days of surgery between early re-initiators and standard care groups, respectively. Discussion This study explores a novel approach to enhancing post-surgical outcomes by evaluating the safety, tolerability, and efficacy of early re-initiation of AOM following LSG in youth with severe obesity. Current guidelines recommend discontinuing AOM postoperatively, but these protocols may not address the complexities of pediatric obesity treatment. Our findings indicate that early re-initiation of AOMs post-LSG is both safe and well-tolerated, with no significant differences in complication rates compared to standard care. Importantly, this approach resulted in a greater reduction in absolute BMI and percent BMI at both 3 and 6 months postoperatively. Additionally, we observed a significant reduction in emotional overeating and other maladaptive eating behaviors in the early re-initiation group, further supporting the potential benefits of this strategy. These results align with emerging evidence in adult populations supporting the integration of AOMs into the postoperative care to enhance weight loss and prevent recurrent weight gain.[36–39] Our sub-analysis of semaglutide demonstrated even greater reductions in both absolute BMI and percent BMI compared to standard care. GLP-1 receptor agonists and MBS both modify brain responses to food cues by altering neural connectivity and GLP-1 levels.[40–43] Research indicates that GLP-1 receptor agonists can reduce brain activity in response to food cues, particularly in the insula, and decrease caloric intake and emotional eating even before significant weight loss occurs.[42–45] MBS also improves brain connectivity related to reward based eating drives and reduces cravings for high-calorie foods, effects often observed before substantial weight loss and associated with changes in ghrelin and GLP-1 levels. Incorporating GLP-1 receptor agonists into postoperative protocols could address key factors contributing to suboptimal surgical outcomes.[44–46] These medications may help patients overcome challenges related to weight loss by targeting appetite and satiety mechanisms, thereby potentially enhancing surgical outcomes, and improving long-term health and weight optimization.[16,47] However, there remains significant variability in the use of GLP-1 receptor agonists across pediatric bariatric programs. A review by Pratt et al. found that only 55% of programs occasionally restarted these medications postoperatively.[47] This inconsistency is likely due to evolving postoperative practices, access barriers, and limited data available in pediatric populations.[47] In the state of California, we were able to conduct this study due to the generally robust public and private insurance coverage for obesity treatment, which is not the case across the country.[48,49] Social inequities in access to obesity care, including medication treatment, remain a significant barrier, further contributing to the variability in care.[3] Limitations: This study has several limitations. First, the retrospective design restricts our ability to establish causal relationships between early re-initiation of AOMs and improved postoperative outcomes. Reliance on historical data means that while associations can be observed, the absence of randomization and control for confounding variables limits definitive conclusions regarding the efficacy and safety of the early re-initiation protocol. Second, the sample size, while providing preliminary data, may not represent the broader pediatric population undergoing LSG. The limited number of participants, particularly those on specific agents like semaglutide, could affect the generalizability of the findings. Additionally, the demographic characteristics of the sample—predominantly Hispanic and publicly insured youth—may introduce selection bias, limiting applicability to more diverse socioeconomic groups. Finally, the short follow-up period of 6 months is a key limitation; the efficacy and safety of early medication re-initiation may evolve over time, highlighting the need for extended follow-up to understand its long-term impact. Conclusion This study underscores the potential benefits of reevaluating post-surgical pharmacotherapy protocols in pediatric obesity management. By addressing the gap in evidence regarding early AOM use, our findings may inform future research and clinical practices. Early re-initiation of AOM after LSG may improve weight management, reduce recurrent weight gain, enhance long-term cardiometabolic outcomes, and improve eating behaviors. Further research is needed to explore the long-term impacts of early AOM re-initiation on weight maintenance and comorbidities. We recommend larger multicenter trials to validate these results and investigate how different AOMs might influence postoperative outcomes. This will aid in refining post-surgical pharmacotherapy protocols for pediatric obesity management. Abbreviations Anti-obesity medication (AOM), Body mass index (BMI), Body mass index Z-score (zBMI), Laparoscopic Sleeve Gastrectomy (LSG), Percent Total Weight Loss (%TWL), Percent Excess Weight Loss (%EWL) Declarations Statement of Ethics: The study protocol was reviewed and approved by the Institutional Review board and written informed consent was obtained from each participant and their caregiver or guardian. Funding Source: This work was supported by grants 1) NIH NIDDK, 2) Sacchi Foundation Research Scientist, 3) Supported by American Diabetes Association grant, 4) The Southern California Center for Latino Health Pilot Award 2022, 5) the National Center for Advancing Translational Science of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 6) Dexcom incorporated for product support. Financial Disclosure: The authors have no financial relationships or conflict of interest relevant to this article to disclose. Conflict of Interest: The authors have no financial relationships or conflict of interest relevant to this article to disclose. Consent for Publication: Study procedures were approved by the Institutional Review Board and was in accordance with the Helsinki Declaration of 1975, as revised in 2008. Written informed consent was obtained from the youth and one caregiver. Contributors' Statements: Authors 1-9 made a significant contribution to the work reported. Authors 1,2,5, and 9 participated in the conception, study design, execution, acquisition of data, analysis and interpretation; took part in drafting, revising or critically reviewing the article; Authors 1-9 gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Author 5 participated in the conception, acquisition of data, analysis and interpretation; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Availability of Data and Material: The datasets from this study will be available from the corresponding author on written request. The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author upon reasonable request. References Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. 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Clinical and safety outcomes between early anti-obesity pharmacotherapy re-initiators and standard care in a clinical cohort. Patient Characteristic Total N = 46 Early Re-Initiators N = 25 Standard Care N = 21 P 1 Demographics Age (years), mean (SD) 16.5 (1.9) 16.8 (2.1) 16.1 (1.7) 0.2 Sex, n (%) 0.2 Male 14 (30%) 10 (40%) 4 (19%) Female 32 (70%) 15 (60%) 17 (81%) Ethnicity, n (%) 0.3 Hispanic 37 (80%) 22 (88%) 15 (71%) Race, n (%) 0.05 American Indian 0 (0%) 0 (0%) 0 (0%) Asian 0 (0%) 0 (0%) 0 (0%) Black or African 2 (4%) 2 (8%) 0 (0%) White 6 (13%) 1 (4.0%) 5 (24%) Other 38 (83%) 22 (88%) 16 (76%) Insurance, n (%) 0.4 Private 6 (13%) 2 (8%) 4 (19%) Public 40 (87%) 23 (92%) 17 (81%) BMI, (kg/m 2 ), mean (SD) 53 (9.7) 55.4 (9.6) 50.2 (9.3) 0.03 Obesity Related Complication, n (%) Dyslipidemia 39 (89%) 23 (92%) 16 (84%) 0.6 Anxiety 18 (39%) 11 (44%) 7 (33%) 0.6 Depression 36 (78%) 18 (72%) 18 (86%) 0.3 Obstructive Sleep Apnea 31 (67%) 18 (72%) 13 (62%) 0.5 Pre-Diabetes (HbA1c 5.7-6.4%) 23 (50%) 14 (56%) 9 (43%) 0.6 ALT > 80 9 (43%) 12 (48%) 7 (37%) 0.5 Type 2 Diabetes 14 (30%) 6 (24%) 8 (38%) 0.3 Polycystic Ovarian Syndrome 3 (7%) 0 (0%) 3 (14%) 0.09 Family History 0.4 Family History of Obesity 46 (100%) 25 (100%) 21(100%) Caregiver Bariatric Surgery 2 43 (98%) 24 (96%) 21 (100%) >0.9 Pre-Op Anti-Obesity Medication, n (%) Phentermine 14 (30%) 11 (44%) 3 (11%) 0.05 Topiramate 13 (28%) 9 (36%) 4 (19%) 0.3 Semaglutide 29 (63%) 17 (68%) 12 (57%) 0.5 Tirzepatide 4 (9%) 2 (7%) 2 (11%) 0.4 Liraglutide 1 (2.2%) 1 (4%) 0 (0%) 0.4 Vyvanse 1 (2.2%) 0 (0%) 1 (4.8%) 0.5 Metformin 12 (26%) 7 (28%) 5 (24%) 0.9 Treatment timing (months) Start of medical weight management program to surgery consult 5.2 (2.4, 32.4) 10.7 (3.7, 38.9) 4.2 (1.5, 26.2) 0.12 Start of anti-obesity medication to surgery 10.1 (5.1, 25.1) 10.1 (5.2, 31.8) 9.4 (5.2, 17.1) 0.5 Surgical consult to surgery 3.3 (2.7, 4.9) 2.9 (2.7, 3.9) 3.9 (2.9, 5.7) 0.14 1 Wilcoxon rank sum test; Fisher’s Exact test 2 Participants with missing data ( N = 2) Table 2. Change in weight trajectory overtime between early anti-obesity pharmacotherapy re-initiators and standard of care in a clinical cohort from surgery consult dates. Weight Metric 1 Total N = 46 Early Re-Initiators N = 25 Standard Care N = 21 P 2 Weight (kg) Surgery Date 3 -4.8 (6.3) -6.9 (7.3) -2.3 (3.8) 0.03 1 month 3 -14.3 (7.2) -16.4 (8.4) -11.7 (4.4) 0.04 2 months 3 -20.1 (7.8) -23.4 (8.0) -16.2 (5.0) <0.001 3 months 3 -25.0 (8.5) -29.1 (7.9) -20.1 (6.3) <0.001 6 months 4 -32.8 (9.3) -37.5 (8.0) -25.3 (5.5) <0.001 BMI (kg/m 2 ) Surgery Date 3 -1.8 (2.0) -2.5 (2.3) -0.9 (1.3) 0.02 1 month 3 -5.2 (2.4) -5.8 (2.7) -4.3 (1.6) 0.03 2 months 3 -7.3 (2.4) -8.4 (2.1) -5.9 (2.0) <0.001 3 months 3 -9.0 (2.7)) -10.5 (2.0) -7.3 (2.3) <0.001 6 months 4 -11.8 (2.9) -13.5 (1.7) -8.9 (1.7) <0.001 Percent BMI (%) Surgery Date 3 -3.5 (4.3) -4.9 (4.8) -1.8 (3.0) 0.046 1 month 3 -10.0 (4.8) -11.2 (5.7) -8.5 (2.9) 0.14 2 months 3 -13.8 (4.6) -15.6 (4.8) -11.7 (3.3) 0.005 3 months 3 -17.2 (5.2) -19.4 (4.8) -14.7 (4.4) <0.001 6 months 4 -22.0 (5.3) -24.3 (4.7) -18.4 (4.3) 0.004 Percent Total Weight Loss (%) Surgery Date 3 -3.3 (9.8) -4.7 (4.8) -1.7 (3.1) 0.06 1 month 3 -9.8 (4.8) -11.0 (5.8) -8.5 (2.9) 0.2 2 months 3 -13.6 (4.6) -15.3 (4.9) -11.6 (3.4) 0.008 3 months 3 -17.0 (5.1) -19.0 (4.8) -14.6 (4.4) <0.001 6 months 4 -21.5 (5.3) -23.6 (4.8) -18.2 (4.4) 0.02 Percent Excess Weight Loss (%) Surgery Date 3 -7.0 (9.8) -9.9 (10.6) -3.7 (7.6) 0.067 1 month 3 -20.1 (11.1) -21.9 (13.3) -18.0 (7.4) 0.4 2 months 3 -27.7 (11.3) -30.1 (12.5) -24.7 (9.2) 0.1 3 months 3 -34.6 (13.6) -37.3 (13.4) -31.3 (13.3) 0.02 6 months 4 -43.2 (13.0) -45.5 (12.4) -39.4 (13.6) 0.2 1 Mean (SD) 2 Wilcoxon rank sum test 3 There are no missing data points for the following time points: surgical consult, 1-,2-, and 3-months post-operatively. 4 At 6-months postoperatively the following youth have not reached the time point postoperatively at time of publication: Total = 20; Early Re-Initiation = 9; Standard Care = 11. Table 3. Change in weight trajectory overtime between early anti-obesity pharmacotherapy re-initiators and standard of care assessed utilizing a multivariate mixed-effects linear regression model controlling for baseline body mass index, age at time of consult, and sex in a clinical cohort. Early Re-initiator (n=25) p Standard care (n=21) p Between-group differences p Change in Weight (kg) from Surgical Consult 3-months -29.1 (-31.3, -26.9) <0.001 -20.1 (-22.5, -17.6) <0.001 -9 (-12.3, -5.7) <0.001 6-months -37.6 (-40.1, -34.5) <0.001 -25.4 (-28.5, -22.2) <0.001 -12.2 (-16.2, -8.1) <0.001 Change in %TWL from Surgical Consult 3-months -19 (-20.4, -17.5) <0.001 -14.6 (-16.1, -13) <0.001 -4.4 (-6.5, -2.2) <0.001 6-months -24.1 (-25.8, -22.4) <0.001 -18.2 (-20.2, -16.2) <0.001 -5.9 (-8.5, -3.2) <0.001 Change in BMI (kg/m 2 ) from Surgical Consult 3-months -10.5 (-11.2, -9.7) <0.001 -7.3 (-8.12, -6.5) <0.001 -3.2 (-4.2, -2.0) <0.001 6-months -13.6 (-14.5, -12.7) <0.001 -9 (-10.0, -8.0) <0.001 -4.6 (-5.9, -3.2) <0.001 Change in %BMI from Surgical Consult 3- months -19.4 (-20.8, -17.9) <0.001 -14.7 (-16.2, -13.0) <0.001 -4.7 (-6.8, -2.5) <0.001 6-months -24.9 (-26.5, -23.1) <0.001 -18.4 (-20.4, -16.3) <0.001 -6.5 (-9.1, -3.8) <0.001 Change in %EWL from Surgical Consult 3-months -37.3 (-40.9, -33.7) <0.001 -31.3 (-35.2, -27.4) <0.001 -6 (-11.2, -0.6) 0.03 6-months -47.3 (-51.4, -43.1) <0.001 -39.2 (-44.2, -34.1) <0.001 -8.2 (-14.6, -1.6) 0.01 Sub-Analysis: Semaglutide Re-Initiators Early Semaglutide Re-initiator (n=17) p Standard care (n=21) p Between-group differences p Change in Weight (kg) from Surgical Consult 3-months -30.3 (-32.9, -27.6) <0.001 -20.1 (-22.5, -17.6) <0.001 -10.2 (-12.3, -5.7) <0.001 6-months -37.6 (-40.6, -34.5) <0.001 -25.4 (-28.5, -22.2) <0.001 -12.2 (-16.2, -8.1) <0.001 Change in %TWL from Surgical Consult 3-months -19.7 (-21.5, -17.9) <0.001 -14.6 (-16.1, -13) <0.001 -5.1 (-7.5, -2.8) <0.001 6-months -24.1 (-26.0, -22.1) <0.001 -18.2 (-20.2, -16.2) <0.001 -5.8 (-8.6, -3.0) <0.001 Change in BMI (kg/m 2 ) from Surgical Consult 3-months -10.7 (-11.5, -9.7) <0.001 -7.3 (-8.12, -6.5) <0.001 -3.3(-4.5, -2.2) <0.001 6-months -13.5 (-14.5, -12.7) <0.001 -9 (-10.0, -8.0) <0.001 -4.5(-5.9, -3.2) <0.001 Change in %BMI from Surgical Consult 3- months -20 (-21.7, -18.2) <0.001 -14.7 (-16.3, -13.0) <0.001 -5.3 (-7.7, -2.9) <0.001 6-months -24.9 (-26.5, -23.1) <0.001 -18.4 (-20.4, -16.3) <0.001 -6.5 (-9.4, -3.7) <0.001 Change in %EWL from Surgical Consult 3-months -39.5 (-44.5, -34.9) <0.001 -31.3 (-35.2, -27.4) <0.001 -8.2 (-14.3, -2.1) 0.01 6-months -48.4 (-53.4, -43.3) <0.001 -39.2 (-44.2, -34.1) <0.001 -9.2 (-14.6, -1.6) 0.02 Values are the mean (95% confidence interval) Table 4. Change in self-reported adult eating behavior questionnaire from baseline at 3 and 6 months postoperatively between early anti-obesity pharmacotherapy re-initiators and standard of care in a clinical cohort. Category of Eating Behavior Overall, N = 46 1 Early re-initiation N = 25 Standard care N = 21 p 2 Enjoyment in eating 3 months -1.0 (-1.0, 0.0) -1.0 (-1.0, 0.0) -0.7 (-1.0, 0.0) 0.4 6 months 0.0 (-1.0, 0.0) -0.8 (-1.0, 0.0) 0.0 (-0.7, 0.0) 0.2 Emotional overeating 3 months -3.0 (-3.5, -0.3) -3.2 (-3.9, -3.0) -0.04 (-1.0, 0.0) <0.001 6 months -4.0 (-4.0, -0.2) -4.0 (-4.0, -3.9) 0.0 (-0.4, 0.8) <0.001 Food responsiveness 3 months -2.4 (-3.0, -0.8) -3.0 (-3.4, -2.4) -0.8 (-2.0, 0.0) <0.001 6 months -3.0 (-4.0, -0.8) -3.9 (-4.0, -2.9) -0.5 (-1.3, 0.0) <0.001 Satiety responsiveness 3 months 1.1 (0.5, 2.0) 1.0 (0.5, 2.1) 1.3 (0.3, 2.0) 0.8 6 months 1.3 (0.0, 2.3) 1.5 (1.0, 2.6) 0.0 (-0.3, 1.3) 0.05 Hunger 3 months -2.4 (-3.0, -1.0) -3.0 (-3.4, -2.4) -1.2 (-2.0, 0.0) <0.001 6 months -3.0 (-4.0, -0.8) -3.6 (-4.0, -3.0) -0.6 (-0.8, 0.2) <0.001 Slowness in eating 3 months 2.1 (0.7, 2.8) 2.5 (1.8, 3.0) 0.8 (-0.1, 2.3) 0.005 6 months 1.5 (0.8, 3.5) 3.3 (2.1, 4.0) 0.3 (-0.5, 1.0) <0.001 1 Median (IQR) 2 Wilcoxon rank sum test Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Jan, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 18 Nov, 2024 Reviews received at journal 18 Nov, 2024 Reviews received at journal 07 Nov, 2024 Reviewers agreed at journal 07 Nov, 2024 Reviewers agreed at journal 07 Nov, 2024 Reviewers invited by journal 07 Nov, 2024 Editor assigned by journal 02 Nov, 2024 Submission checks completed at journal 01 Nov, 2024 First submitted to journal 30 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5363643","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":375560706,"identity":"cbbade96-596a-4485-bd61-918e2849c7f4","order_by":0,"name":"Alaina P. 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Kim","email":"","orcid":"","institution":"Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Surgery, Division of Pediatric Surgery","correspondingAuthor":false,"prefix":"","firstName":"Aimee","middleName":"G.","lastName":"Kim","suffix":""},{"id":375560710,"identity":"8a4f06c9-9296-4978-98ce-cc91d7d13b87","order_by":4,"name":"Stuart Abel","email":"","orcid":"","institution":"Division of Upper Gastrointestinal and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California","correspondingAuthor":false,"prefix":"","firstName":"Stuart","middleName":"","lastName":"Abel","suffix":""},{"id":375560711,"identity":"809df42f-1fba-437d-a961-4cb6b6abc6b0","order_by":5,"name":"Madeleine Weitzner","email":"","orcid":"","institution":"Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism","correspondingAuthor":false,"prefix":"","firstName":"Madeleine","middleName":"","lastName":"Weitzner","suffix":""},{"id":375560712,"identity":"cd63548b-aa12-4de2-a39c-1a66db5e3b9c","order_by":6,"name":"Cynthia E. Munoz","email":"","orcid":"","institution":"Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism","correspondingAuthor":false,"prefix":"","firstName":"Cynthia","middleName":"E.","lastName":"Munoz","suffix":""},{"id":375560713,"identity":"1433e23b-c527-40a4-95c3-3b325a1ac4da","order_by":7,"name":"Ahlee Kim","email":"","orcid":"","institution":"Children's Hospital Los Angeles and Keck School of Medicine of USC, Department of Pediatrics, Center for Endocrinology, Diabetes and Metabolism","correspondingAuthor":false,"prefix":"","firstName":"Ahlee","middleName":"","lastName":"Kim","suffix":""},{"id":375560714,"identity":"e1055d93-35d0-46d7-bd28-d17907ef5c3e","order_by":8,"name":"Kamran Samakar","email":"","orcid":"","institution":"Division of Upper Gastrointestinal and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California","correspondingAuthor":false,"prefix":"","firstName":"Kamran","middleName":"","lastName":"Samakar","suffix":""}],"badges":[],"createdAt":"2024-10-30 22:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5363643/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5363643/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-024-07658-8","type":"published","date":"2025-01-11T15:57:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69449264,"identity":"e961d1ec-5126-4476-b62e-20366700c4bf","added_by":"auto","created_at":"2024-11-20 12:30:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80082,"visible":true,"origin":"","legend":"\u003cp\u003eWaterfall plot demonstrating the individual change in percent BMI postoperatively compared to baseline between early anti-obesity medication re-initiators (n=25) compared to standard care (n=21) from a clinical sample.\u003c/p\u003e","description":"","filename":"PediatricRAMPFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5363643/v1/7fc46922749bff73db3e70dd.jpg"},{"id":69449263,"identity":"63d8e210-9036-448f-b7a9-784f293bdec3","added_by":"auto","created_at":"2024-11-20 12:30:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65756,"visible":true,"origin":"","legend":"\u003cp\u003eChange in percent body mass index between early semaglutide re-initiators (n=18) vs. standard care (anti-obesity medication, n = 21) from a clinical sample.\u003c/p\u003e","description":"","filename":"PediatricRAMPFigure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5363643/v1/2a3734fc982c707d9a10b10a.jpg"},{"id":69449265,"identity":"126ae3e0-2013-46e0-9be0-7404200051c0","added_by":"auto","created_at":"2024-11-20 12:30:16","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":126848,"visible":true,"origin":"","legend":"\u003cp\u003eChange in self-reported Adult Eating Behavior Questionnaire scores, completed by the youth participants between early anti-obesity medication re-initiators (n=25) vs. standard care (anti-obesity medication, n = 21) from a clinical sample.\u003c/p\u003e","description":"","filename":"PediatricRAMPFigure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5363643/v1/eda272076087800b085621ec.jpg"},{"id":73693833,"identity":"57127ee7-858e-44ed-8066-960ce0095d6e","added_by":"auto","created_at":"2025-01-13 16:08:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2188712,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5363643/v1/c613349f-8419-4730-92b2-827ac5d168c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Title: Early Re-Initiation of Anti-Obesity Medications Post Laparoscopic Sleeve Gastrectomy in Youth: Proof of Concept Trial","fulltext":[{"header":"Key Points","content":"\u003cul\u003e\n \u003cli\u003eEarly medication re-initiation after sleeve gastrectomy was safe and well tolerated.\u003c/li\u003e\n \u003cli\u003eNo significant differences in complication, readmission, or reoperation rates were observed.\u003c/li\u003e\n \u003cli\u003eEarly re-initiation led to greater reductions in body mass index.\u003c/li\u003e\n \u003cli\u003eYouth who restarted medications reported a four-fold decrease in emotional overeating.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eRecent projections indicate that by 2050, over half of youth will be affected by obesity, with severe obesity impacting about 7.6% of youth in the U.S.[1\u0026ndash;3]\u0026nbsp;Current treatment approaches for pediatric obesity encompass lifestyle modifications, obesity pharmacotherapy, and metabolic and bariatric surgery (MBS).[4]\u0026nbsp;Intensive health and behavior modification therapy, involving extensive counseling, yields only modest reductions in body mass index (~3% over 1 year).[3,5]\u0026nbsp;Anti-obesity medication (AOM) combined with lifestyle modification, can achieve more significant body mass index (BMI) reductions (~5-17% over 1 year), while MBS, options like Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (LSG) offer substantial weight loss (~30% over 1 year.).[6,7]\u0026nbsp;Given the chronic nature of pediatric obesity, sustained and multifaced approaches are necessary to maintain health benefits over time.[4,8]\u003c/p\u003e\n\u003cp\u003eDespite its effectiveness, MBS does not guarantee uniform outcomes, with up to 25% of individuals experiencing suboptimal weight loss and recurrent weight gain above their postoperative nadir.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[9\u0026ndash;12]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEmerging evidence suggests that variations in post-surgical glucagon-like-peptide-1 (GLP-1) levels and increased emotional overeating are linked to suboptimal weight loss outcomes or recurrent weight gain which can reduce or negate any positive impacts on weight-related comorbidities.[13\u0026ndash;15]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eGLP-1 receptor agonists, such as those approved for pediatric use (liraglutide and semaglutide), and/or other AOMs, might offer a promising solution as an adjunct to surgery to mitigate these challenges.[8,16\u0026ndash;18]\u0026nbsp;AOMs work through multiple mechanisms,\u0026nbsp;to reduce appetite; enhance satiety; and beneficially alter various metabolites to inhibit the reward pathways associated with hedonic eating behaviors\u0026nbsp;which could potentially counteract the counter-regulatory metabolic adaptations that often lead to obesity relapse.[19\u0026ndash;21]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is currently common practice to discontinue AOMs in the perioperative period, and particularly in the early postoperative phase due to concerns about complications related to delayed gastric emptying and gastrointestinal motility. However, there is currently little available evidence to support these theoretical concerns. The traditional approach of discontinuing AOMs post-surgery may need re-evaluation given the evolving landscape of pediatric obesity treatment.[8,16\u0026ndash;18]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSpecifically,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecurrent protocols generally recommend resuming AOM only if initial weight loss is insufficient or if recurrent weight gain occurs within 1-2 years after surgery.[16,17]\u0026nbsp;However, with increasing use of these medications in youth undergoing bariatric surgery, there is a growing need to explore their optimal use both pre- and post-operatively.[3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is a critical gap in evidence regarding the use of AOM immediately after metabolic and bariatric surgery in pediatric populations.[8,22,23]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDespite the growing number of pediatric bariatric surgery procedures and the preoperative use of these agents, no standardized protocols exist for their early postoperative use.[24\u0026ndash;26]\u0026nbsp;AOM remain underutilized post-surgery, indicating a need to reassess their role and address barriers to their use. To date, no research has examined the efficacy of anti-obesity medication immediately post-surgery in pediatric populations.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAt our\u0026nbsp;large tertiary care, safety-net, children\u0026rsquo;s hospital\u0026nbsp;570 out of the 1900 youth followed in the comprehensive obesity care program have at least one obesity associated medical problem, and 40% were prescribed an AOM. Notably, out of the 50 youth who underwent LSG in the inaugural year of the pediatric bariatric surgery program, 93% were on one or multiple AOMs at the time of surgery but had stopped postoperatively per standard of care recommendations. However, 62% of these patients reported cravings and increased emotional overeating, despite reduced hunger, prompting many to seek early\u0026nbsp;AOM\u0026nbsp;re-initiation.\u003c/p\u003e\n\u003cp\u003eUsing a shared medical decision-making framework, the multi-disciplinary MBS team, along with patient and caregiver input, developed the PEDIATRIC-RAMP (Pediatric Reinitiation And Management Protocol) to facilitate early AOMs re-initiation after LSG). This study aims to evaluate the safety, tolerability, and efficacy of the early anti-obesity pharmacotherapy re-initiation protocol in youth with severe obesity who underwent LSG from November 2023 to July of 2024. We hypothesize that early re-initiation of AOM, compared to standard care, will be safe, well tolerated, and result in greater weight loss and less self-reported emotional overeating, without negatively affecting nutritional intake or tolerance. These preliminary findings could help bridge the evidence gaps regarding postoperative AOM use, potentially guiding future research to improve treatment protocols, enhance weight loss, prevent recurrent weight gain, and optimize long-term cardiometabolic outcomes and eating behaviors in youth.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective analysis of data from a repository to evaluate outcomes in youth who underwent laparoscopic sleeve gastrectomy at a large tertiary care children\u0026rsquo;s hospital between November 2023 and July 2024. The study adhered to ethical guidelines for research involving human subjects, with approval from the hospital\u0026rsquo;s Institutional Review Board. Informed consent was obtained from the youth and one caregiver, and all data were anonymized to ensure participant confidentiality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included youth aged 10-21 years who underwent laparoscopic sleeve gastrectomy during the study period. Participants were identified from the hospital\u0026rsquo;s electronic health record and internal program database. Eligibility criteria included: 1) ages 7 to 21 years; 2) severe obesity (BMI \u0026gt; 120% of the 95th percentile); 3) primary surgical weight loss through the pediatric pathway at a tertiary care, safety-net children\u0026rsquo;s hospital; 4) consent to the clinical data repository. Exclusions applied to those with type 1 diabetes, medications influencing body composition (e.g., prednisone), or syndromes affecting the postoperative course (e.g., Prader Willi Syndrome).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGroup Assignment \u0026ndash; Early Anti-Obesity Medication Re-Initiation vs. Standard Care:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the two-week post-operative visit, all participants completed the Pediatric RAMP checklist. If meeting hydration, protein, and caloric intake goals without gastrointestinal symptoms, they had the opportunity to restart AOM, guided by a shared decision-making approach. Participants who opted for standard care did not restart any medications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were extracted from the hospital\u0026apos;s obesity-management data repository (REDCap), including electronic health records, surgical logs, follow-up documentation, and self-reported surveys. Collected data encompassed demographic information (age, sex, race, ethnicity, insurance, income), clinical characteristics (BMI, comorbidities, type of surgery, medications, family history), eating behaviors, and post-operative outcomes (weight trajectory, complications, readmissions, reoperations). Additional data on AOM use and adherence were retrieved from the electronic health record.\u003cstrong\u003e\u0026nbsp;Measurements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Outcome:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnthropometric measures were collected at each clinical visit. Height was measured using a Quick Medical stadiometer (accuracy: 0.1 cm), and weight using the TANITA MC-58030 scale\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[27] (accuracy: 0.1 kg). BMI was calculated using CDC growth charts.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[28] Postoperative outcomes included changes in percent BMI, percent total body weight, and percent excess weight (using BMI 25 to define ideal weight)\u0026nbsp;at time of surgical consult, day of surgery, 3-, and 6-months post-surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Outcomes:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSafety and Tolerability:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePostoperative outcomes were monitored for readmissions and complications documented at 30-, 60-, and 90-days post-surgery. Reoperations and reasons for admissions were systematically recorded by the multidisciplinary bariatric team. Side effects were tracked through weekly phone calls to identify and address issues promptly.\u003cstrong\u003e\u0026nbsp;Self-Reported Eating Behaviors\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Adult Eating Behavior Questionnaire (AEBQ)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[29]\u0026nbsp;assessed various eating behaviors. The AEBQ comprises five subscales: Food Responsiveness, Emotional Eating, Satiety Responsiveness, Enjoyment of Food, and Lack of Food Control, evaluated on a 5-point Likert scale. Participants completed the questionnaire online via REDCap, which took approximately 15 minutes. Higher scores indicated a greater tendency toward specific eating behaviors. The AEBQ demonstrated robust psychometric properties, with Cronbach\u0026apos;s alpha values ranging from 0.80 to 0.92.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e[29]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBaseline demographics and characteristics were summarized descriptively across arms using mean and standard deviation (SD) or median and interquartile range as appropriate for the distribution of continuous variables. Categorical variables are described as a frequency and percentage. Differences in patient characteristics and outcomes between groups were examined using Wilcoxon rank sum test and Fisher\u0026apos;s exact test. Additionally, mixed-effects longitudinal regression models (lmerTest package in RStudio)[30,31] \u0026nbsp;with fixed study arm, study visit, study arm*study visit, and covariates (baseline BMI, age, and sex) were utilized to assess whether there were between-group differences in mean change (from baseline) in clinical outcomes at 3-months and 6-months post-operatively. Models included random intercepts to account for within-subject correlation between repeated outcomes over time. All participants with data at baseline were included in analyses (n= 46). Mixed-effects analyses are generally robust for unbalanced data across study time points where information from the observed data is used to provide information about the missing data without explicitly imputing the missing outcome values using the likelihood-based approach.[32] \u0026nbsp;All results were reported with 95% confidence interval and \u003cem\u003ep\u003c/em\u003e-value. The statistical significance level was set at .05 with two-sided throughout the analyses. All statistical computations were done in RStudio 4.4.1.[33,34]\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eParticipant Characteristics \u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom the time of protocol implementation, 46 youth underwent LSG (mean age [SD] 16.5 [1.9] years, mean BMI [SD] 53 [9.7] kg/m\u0026sup2;), predominantly female (70%), Hispanic (80%), and publicly insured (87%), 93% had used AOM preoperatively.; \u003cstrong\u003eTable 1\u003c/strong\u003e). Over half of the participants (54%, 25/46) self-selected early re-initiation of an\u0026nbsp;AOM\u0026nbsp;(median [IQR] time to re-initiation 5.1 weeks [3.7, 8.4]). Of those who re-initiated\u0026nbsp;AOM, 56% (14/25) resumed their pre-surgery regimen, with 52% (13/25) starting more than one agent. The medications re-initiated postoperatively included semaglutide (17/25), phentermine (11/25), topiramate (7/25), metformin (7/25), and tirzepatide (4/25).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eChange in Weight Trajector\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e demonstrates the within subject change in percent BMI from surgical consult to last anthropometric point available to highlight individual response across the cohort between groups. At 3 months postoperatively, the mean (SD) change from surgical consult in absolute BMI (kg/m\u0026sup2;) was -10.5 (2.0) kg/m\u0026sup2; for early re-initiators and -7.3 (2.3) kg/m\u0026sup2; for standard care, representing a difference of -3.2 kg/m\u0026sup2; (p\u0026nbsp;\u0026nbsp;0.001, \u003cstrong\u003eTable 2\u003c/strong\u003e). The correlating mean (SD) percentage change in BMI at this time was -19.4% (4.8%) for early re-initiators and -14.7% (4.4%) for standard care, with a difference of -3 percentage points (p \u0026lt;0.001). At 6 months postoperatively, the mean change in absolute BMI was -13.5 (1.7) kg/m\u003csup\u003e2\u003c/sup\u003e for early re-initiators and -8.9 (1.7) kg/m\u003csup\u003e2\u003c/sup\u003e for standard care, showing a difference of -4.6 points (p \u0026lt;0.001). The mean (SD) percentage change in BMI at 6 months was -24.3% (4.7%) for early re-initiators and -18.4% (4.3%) for standard care, with a difference of -5.9% (p = 0.004). Additionally, at 3 months postoperatively, youth in the early re-initiation group demonstrated a greater reduction in %TWL and %EWL compared to standard care, representing a difference of -4.4% and 6% respectively (\u003cstrong\u003eTable 2\u003c/strong\u003e). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, was conducted for each arthrometric measure and revealed that early re-initiation significantly reduced absolute weight (kg), BMI (kg/m\u003csup\u003e2\u003c/sup\u003e), percent BMI, percent TWL, and percent EWL at 3 and 6 months postoperatively compared to standard care (\u003cstrong\u003eTable 3\u003c/strong\u003e). At 6 months, mean differences between groups with 95%\u003csup\u003e\u0026nbsp;\u003c/sup\u003econfidence intervals included: BMI: -4.6 (-5.94, -3.25), p \u0026lt; 0.001; %BMI: -6.5 (-9.13, -3.86), p \u0026lt; 0.001; %TWL: -5.9 (-8.52, -3.25), p \u0026lt; 0.001; %EWL: -8.2 (-14.69, -1.63), p \u0026lt; 0.001; \u003cstrong\u003eTable 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSemaglutide Sub-Analysis\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA sub-analysis was conducted on youth who were taking semaglutide 2.4 mg weekly (n=18) for at least 3 months prior to LSG and then re-initiated the medication immediately postoperatively (median [IQR] time to re-initiation 5.0 weeks [3.7, 8.4]. \u0026nbsp; Early re-initiators (n=17) experienced greater reduction in both absolute BMI and %BMI change at 3 months (median [SD[ BMI [kg/m\u0026sup2;]:\u0026nbsp;-10.7 [2.1] \u0026nbsp;vs. -7.3 [2.3]; p\u0026nbsp;\u0026nbsp;0.001; %BMI:\u0026nbsp;-20 [5.4] vs. -14.7% [4.4]; p \u0026lt; 0.001) and mo. 6 (BMI [kg/m\u0026sup2;]:\u0026nbsp;-13.3 [1.7] \u0026nbsp;vs. -8.9 [1.7]; p \u0026lt;0.001; %BMI:\u0026nbsp;-24% [5.1]\u0026nbsp;\u0026nbsp;vs.\u0026nbsp;-18.4% [4.3]; p=0.02) compared to the standard care (n=21; \u003cstrong\u003eFigure 2\u003c/strong\u003e). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, was conducted for each arthrometric measure and revealed that early re-initiation significantly reduced absolute weight (kg), BMI (kg/m\u003csup\u003e2\u003c/sup\u003e), percent BMI, percent TWL, and percent EWL at 3 and 6 months postoperatively compared to standard care (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEating Behaviors\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhile all youth reported a 50% reduction in hunger on the AEBQ\u0026nbsp;\u003cem\u003e[35]\u003c/em\u003e completed 2 and 4 weeks postoperatively, scores for food responsiveness and emotional overeating remained elevated. Compared to standard care, re-initiators demonstrated a significant four-fold reduction in emotional overeating, food avoidance, hunger, food responsiveness and an increase in slowness in eating on the self-reported AEBQ at 3 and 6 months postoperatively (\u003cstrong\u003eTable 4 and\u003c/strong\u003e \u003cstrong\u003eFigure 3\u003c/strong\u003e). No negative compensatory eating behaviors (restricting, purging, binge episodes,) were reported during monthly visits with a registered dietitian. Additionally, 24-hour dietary recalls showed that post-operative nutritional intake was adequate for age and weight, meeting all micro- and macronutrient requirements.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSafety and Tolerability\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences were observed in rates of complications (n = 4 vs. 3), unplanned readmissions (n = 3 vs. 2), or reoperations (n = 0 vs. 0) within 30, 60, or 90 days of surgery between early re-initiators and standard care groups, respectively.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explores a novel approach to enhancing post-surgical outcomes by evaluating the safety, tolerability, and efficacy of early re-initiation of AOM following LSG in youth with severe obesity. Current guidelines recommend discontinuing AOM postoperatively, but these protocols may not address the complexities of pediatric obesity treatment. Our findings indicate that early re-initiation of AOMs post-LSG is both safe and well-tolerated, with no significant differences in complication rates compared to standard care. Importantly, this approach resulted in a greater reduction in absolute BMI and percent BMI at both 3 and 6 months postoperatively. \u0026nbsp;Additionally, we observed a significant reduction in emotional overeating and other maladaptive eating behaviors in the early re-initiation group, further supporting the potential benefits of this strategy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese results align with emerging evidence in adult populations supporting the integration of AOMs into the postoperative care to enhance weight loss and prevent recurrent weight gain.[36\u0026ndash;39]\u003csup\u003e\u0026nbsp;\u003c/sup\u003eOur sub-analysis of semaglutide demonstrated even greater reductions in both absolute BMI and percent BMI compared to standard care. GLP-1 receptor agonists and MBS both modify brain responses to food cues by altering neural connectivity and GLP-1 levels.[40\u0026ndash;43] Research indicates that GLP-1 receptor agonists can reduce brain activity in response to food cues, particularly in the insula, and decrease caloric intake and emotional eating even before significant weight loss occurs.[42\u0026ndash;45] MBS also improves brain connectivity related to reward based eating drives and reduces cravings for high-calorie foods, effects often observed before substantial weight loss and associated with changes in ghrelin and GLP-1 levels. Incorporating GLP-1 receptor agonists into postoperative protocols could address key factors contributing to suboptimal surgical outcomes.[44\u0026ndash;46] These medications may help patients overcome challenges related to weight loss by targeting appetite and satiety mechanisms, thereby potentially enhancing surgical outcomes, and improving long-term health and weight optimization.[16,47]\u003c/p\u003e\n\u003cp\u003eHowever, there remains significant variability in the use of GLP-1 receptor agonists across pediatric bariatric programs. \u0026nbsp;A review by Pratt et al. found that only 55% of programs occasionally restarted these medications postoperatively.[47] This inconsistency is likely due to evolving postoperative practices, access barriers, and limited data available in pediatric populations.[47] In the state of California, we were able to conduct this study due to the generally robust public and private insurance coverage for obesity treatment, which is not the case across the country.[48,49] Social inequities in access to obesity care, including medication treatment, remain a significant barrier, further contributing to the variability in care.[3] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the retrospective design restricts our ability to establish causal relationships between early re-initiation of AOMs and improved postoperative outcomes. Reliance on historical data means that while associations can be observed, the absence of randomization and control for confounding variables limits definitive conclusions regarding the efficacy and safety of the early re-initiation protocol. Second, the sample size, while providing preliminary data, may not represent the broader pediatric population undergoing LSG. The limited number of participants, particularly those on specific agents like semaglutide, could affect the generalizability of the findings. Additionally, the demographic characteristics of the sample\u0026mdash;predominantly Hispanic and publicly insured youth\u0026mdash;may introduce selection bias, limiting applicability to more diverse socioeconomic groups. Finally, the short follow-up period of 6 months is a key limitation; the efficacy and safety of early medication re-initiation may evolve over time, highlighting the need for extended follow-up to understand its long-term impact.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study underscores the potential benefits of reevaluating post-surgical pharmacotherapy protocols in pediatric obesity management. By addressing the gap in evidence regarding early AOM use, our findings may inform future research and clinical practices. Early re-initiation of AOM after LSG may improve weight management, reduce recurrent weight gain, enhance long-term cardiometabolic outcomes, and improve eating behaviors. Further research is needed to explore the long-term impacts of early AOM re-initiation on weight maintenance and comorbidities. We recommend larger multicenter trials to validate these results and investigate how different AOMs might influence postoperative outcomes. This will aid in refining post-surgical pharmacotherapy protocols for pediatric obesity management.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAnti-obesity medication (AOM), Body mass index (BMI), Body mass index Z-score (zBMI), Laparoscopic Sleeve Gastrectomy (LSG), Percent Total Weight Loss (%TWL), Percent Excess Weight Loss (%EWL)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatement of Ethics:\u003c/strong\u003e The study protocol was reviewed and approved by the Institutional Review board and written informed consent was obtained from each participant and their caregiver or guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Source:\u0026nbsp;\u003c/strong\u003eThis work was supported by grants\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e1) NIH NIDDK, 2) Sacchi Foundation Research Scientist, 3)\u0026nbsp;Supported by American Diabetes Association grant, 4) The Southern California Center for Latino Health Pilot Award 2022, 5) the National Center for Advancing Translational Science of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 6) Dexcom incorporated for product support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure:\u0026nbsp;\u003c/strong\u003eThe authors have no financial relationships or conflict of interest relevant to this article to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors have no financial relationships or conflict of interest relevant to this article to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eStudy procedures were approved by the Institutional Review Board and was in accordance with the Helsinki Declaration of 1975, as revised in 2008. Written informed consent was obtained from the youth and one caregiver.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u0026apos; Statements:\u003c/strong\u003e Authors 1-9 made a significant contribution to the work reported. Authors 1,2,5, and 9 participated in the conception, study design, execution, acquisition of data, analysis and interpretation; took part in drafting, revising or critically reviewing the article; Authors 1-9 gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Author 5 participated in the conception, acquisition of data, analysis and interpretation; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u0026nbsp;All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material:\u0026nbsp;\u003c/strong\u003eThe datasets from this study will be available from the corresponding author on written request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. 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Available from: https://stop.publichealth.gwu.edu/coverage/medicaid-2024\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eClinical and safety outcomes between early anti-obesity pharmacotherapy re-initiators and standard care in a clinical cohort.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly Re-Initiators\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Care\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years), mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.5 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.8\u0026nbsp;(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.1 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEthnicity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRace, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;American Indian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Black or African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInsurance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Public\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 (87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, (kg/m\u003csup\u003e2\u003c/sup\u003e), mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.4 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.2 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eObesity Related Complication, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39 (89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eObstructive Sleep Apnea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31 (67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePre-Diabetes (HbA1c 5.7-6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eALT \u0026gt; 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType 2 Diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePolycystic Ovarian Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily History of Obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCaregiver Bariatric Surgery\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43 (98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Op Anti-Obesity Medication, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhentermine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTopiramate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSemaglutide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29 (63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTirzepatide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLiraglutide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVyvanse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMetformin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment timing (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStart of medical weight management program to surgery consult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.2 (2.4, 32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.7 (3.7, 38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2 (1.5, 26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStart of anti-obesity medication to surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.1 (5.1, 25.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.1 (5.2, 31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.4 (5.2, 17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSurgical consult to surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.3 (2.7, 4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.9 (2.7, 3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.9 (2.9, 5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e Wilcoxon rank sum test; Fisher\u0026rsquo;s Exact test\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e Participants with missing data (\u003cem\u003eN\u003c/em\u003e = 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eChange in weight trajectory overtime between early anti-obesity pharmacotherapy re-initiators and standard of care in a clinical cohort from surgery consult dates.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight Metric\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly Re-Initiators\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Care\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery Date\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.8 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-6.9 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.3 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 month\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-14.3 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-16.4 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.7 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-20.1 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-23.4 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-16.2 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-25.0 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-29.1 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-20.1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-32.8 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-37.5 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-25.3 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery Date\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.8 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.5 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.9 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 month\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.8 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.3 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-7.3 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.4 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.9 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-9.0 (2.7))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-10.5 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-7.3 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.8 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-13.5 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.9 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent BMI (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery Date\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.5 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.9 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.8 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 month\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-10.0 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.2 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.5 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-13.8 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-15.6 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.7 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-17.2 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-19.4 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-14.7 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-22.0 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-24.3 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-18.4 (4.3) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent Total Weight Loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery Date\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.3 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-4.7 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.7 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 month\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-9.8 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.0 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.5 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-13.6 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-15.3 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-11.6 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-17.0 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-19.0 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-14.6 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-21.5 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-23.6 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-18.2 (4.4) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent Excess Weight Loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery Date\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-7.0 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-9.9 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.7 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 month\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-20.1 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-21.9 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-18.0 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-27.7 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-30.1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-24.7 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-34.6 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-37.3 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-31.3 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-43.2 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-45.5 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-39.4 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e Mean (SD)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e Wilcoxon rank sum test\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e3\u0026nbsp;\u003c/sup\u003eThere are no missing data points for the following time points: surgical consult, 1-,2-, and 3-months post-operatively.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e4\u0026nbsp;\u003c/sup\u003eAt 6-months\u003csup\u003e\u0026nbsp;\u003c/sup\u003epostoperatively the following youth have not reached the time point postoperatively at time of publication: Total = 20; Early Re-Initiation = 9; Standard Care = 11.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eChange in weight trajectory overtime between early anti-obesity pharmacotherapy re-initiators and standard of care assessed utilizing a multivariate mixed-effects linear regression model controlling for baseline body mass index, age at time of consult, and sex in a clinical cohort.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly Re-initiator (n=25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard care (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween-group differences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in Weight (kg) from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-29.1 (-31.3, -26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-20.1 (-22.5, -17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-9 (-12.3, -5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-37.6 (-40.1, -34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-25.4 (-28.5, -22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-12.2 (-16.2, -8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %TWL from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-19 (-20.4, -17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-14.6 (-16.1, -13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-4.4 (-6.5, -2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-24.1 (-25.8, -22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-18.2 (-20.2, -16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-5.9 (-8.5, -3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-10.5 (-11.2, -9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-7.3 (-8.12, -6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-3.2 (-4.2, -2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-13.6 (-14.5, -12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-9 (-10.0, -8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-4.6 (-5.9, -3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %BMI from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3- months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-19.4 (-20.8, -17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-14.7 (-16.2, -13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-4.7 (-6.8, -2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-24.9 (-26.5, -23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-18.4 (-20.4, -16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-6.5 (-9.1, -3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %EWL from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-37.3 (-40.9, -33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-31.3 (-35.2, -27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-6 (-11.2, -0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-47.3 (-51.4, -43.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-39.2 (-44.2, -34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-8.2 (-14.6, -1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-Analysis: Semaglutide Re-Initiators\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly Semaglutide Re-initiator (n=17)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard care (n=21)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBetween-group differences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in Weight (kg) from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-30.3 (-32.9, -27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-20.1 (-22.5, -17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-10.2 (-12.3, -5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-37.6 (-40.6, -34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-25.4 (-28.5, -22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-12.2 (-16.2, -8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %TWL from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-19.7 (-21.5, -17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-14.6 (-16.1, -13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-5.1 (-7.5, -2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-24.1 (-26.0, -22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-18.2 (-20.2, -16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-5.8 (-8.6, -3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-10.7 (-11.5, -9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-7.3 (-8.12, -6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-3.3(-4.5, -2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-13.5 (-14.5, -12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-9 (-10.0, -8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-4.5(-5.9, -3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %BMI from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3- months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-20 (-21.7, -18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-14.7 (-16.3, -13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-5.3 (-7.7, -2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-24.9 (-26.5, -23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-18.4 (-20.4, -16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-6.5 (-9.4, -3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in %EWL from Surgical Consult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-39.5 (-44.5, -34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-31.3 (-35.2, -27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-8.2 (-14.3, -2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-48.4 (-53.4, -43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-39.2 (-44.2, -34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-9.2 (-14.6, -1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eValues are the mean (95% confidence interval)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eChange in self-reported adult eating behavior questionnaire from baseline at 3 and 6 months postoperatively between early anti-obesity pharmacotherapy re-initiators and standard of care in a clinical cohort.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory of Eating Behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall, N = 46\u003cem\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly re-initiation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard care\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnjoyment in eating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-1.0 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-1.0 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e-0.7 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e0.0 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-0.8 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e0.0 (-0.7, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmotional overeating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.0 (-3.5, -0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.2 (-3.9, -3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e-0.04 (-1.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-4.0 (-4.0, -0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19%;\"\u003e\n \u003cp\u003e-4.0 (-4.0, -3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17%;\"\u003e\n \u003cp\u003e0.0 (-0.4, 0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood responsiveness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-2.4 (-3.0, -0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.0 (-3.4, -2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e-0.8 (-2.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.0 (-4.0, -0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.9 (-4.0, -2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e-0.5 (-1.3, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 46%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatiety responsiveness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e1.1 (0.5, 2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e1.0 (0.5, 2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.3 (0.3, 2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e1.3 (0.0, 2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e1.5 (1.0, 2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e0.0 (-0.3, 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHunger\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-2.4 (-3.0, -1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.0 (-3.4, -2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e-1.2 (-2.0, 0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.0 (-4.0, -0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19%;\"\u003e\n \u003cp\u003e-3.6 (-4.0, -3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e-0.6 (-0.8, 0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlowness in 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\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Wilcoxon rank sum test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Pediatric Obesity, Metabolic and Bariatric Surgery","lastPublishedDoi":"10.21203/rs.3.rs-5363643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5363643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBariatric surgery is the most effective intervention for severe pediatric obesity, but 25% of youth experience suboptimal weight loss and/or weight regain. A multi-pronged postoperative approach, including early re-initiation of anti-obesity medications (AOM), may improve outcomes, though this has not been evaluated in pediatric populations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis pilot study assessed the safety, tolerability, and efficacy of early AOM re-initiation after laparoscopic sleeve gastrectomy (LSG) in youth. A retrospective analysis compared youth undergoing LSG at a large children's hospital from November 2023 to July 2024, comparing those who chose early AOM re-initiation (n\u0026thinsp;=\u0026thinsp;25) versus standard care (n\u0026thinsp;=\u0026thinsp;21). Primary outcomes included changes in weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study involved 46 adolescents (mean age 16.5 years, mean BMI 50 kg/m\u0026sup2;, predominantly female (70%), Hispanic (80%), and publicly insured (87%); 93% had used AOM preoperatively). Mixed effect multivariate regression analysis, adjusting for baseline BMI, age, and sex, revealed that early AOM re-initiation (5.1 weeks [IQR 3.7,8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6 months postoperatively compared to standard care, with no significant differences in complications or readmissions. At 6 months, the mean differences were: %BMI: -6.5% (95%CI: -9.13, -3.86), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; %TWL: -5.9% (95%CI: -8.52, -3.25), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; %EWL: -8.2 (95%CI: -14.69, -1.63), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Early re-initiators reported a 4-fold reduction in emotional overeating (p\u0026thinsp;=\u0026thinsp;0.001) compared to standard care.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEarly AOM re-initiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates.\u003c/p\u003e","manuscriptTitle":"Title: Early Re-Initiation of Anti-Obesity Medications Post Laparoscopic Sleeve Gastrectomy in Youth: Proof of Concept Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-20 12:30:11","doi":"10.21203/rs.3.rs-5363643/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-19T01:39:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-18T09:58:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-08T01:18:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290773223135233675231598767500563493073","date":"2024-11-07T22:43:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39069714382828744870553018752319875610","date":"2024-11-07T22:07:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-07T21:55:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-02T20:48:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T04:16:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2024-10-30T22:23:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cbd56d12-4cea-46ae-8fb6-91b7d5b4c0f0","owner":[],"postedDate":"November 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:00:04+00:00","versionOfRecord":{"articleIdentity":"rs-5363643","link":"https://doi.org/10.1007/s11695-024-07658-8","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-01-11 15:57:09","publishedOnDateReadable":"January 11th, 2025"},"versionCreatedAt":"2024-11-20 12:30:11","video":"","vorDoi":"10.1007/s11695-024-07658-8","vorDoiUrl":"https://doi.org/10.1007/s11695-024-07658-8","workflowStages":[]},"version":"v1","identity":"rs-5363643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5363643","identity":"rs-5363643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}