Table 3.
Effects of anti-obesity medications (AOM) and bariatric surgery on lipid levels. These reported effects are not intended to reflect efficacy in patients with specific dyslipidemias. Also, because these are independent studies, of varying duration, with different protocol designs (i.e., some including patients with diabetes mellitus, others not), different baseline lipid levels, different dose ranges, and at different points in active weight reduction, the reported lipid effects of these interventions are not intended to reflect direct comparisons. See references for more information about the interventions, doses of AOMs, drug formulations, duration of studies, and other details of each study. While somewhat variable depending on the analysis, the overall message is that AOMs generally have the greatest effect on lowering blood triglyceride levels, with neutral to increases in HDL-C levels, and marginal decreases in blood LDL-C levels. The exception may be orlistat, that may have greater reductions in blood LDL-C levels due to mechanisms beyond weight reduction alone [201]. Bariatric surgery generally results in greater weight reduction and greater improvements in lipid profiles than current monotherapy AOMs.
| Intervention | Change TGa | Change HDL-Ca | Change LDL-Ca | Change weighta | Ref. |
|---|---|---|---|---|---|
| Anti-obesity medications | |||||
| Orlistat | −0.09 mmol (−8 mg/dL) |
−0.034 mmol/L (−1.3 mg/dL) |
−0.27 mmol/L (−10.44 mg/dL) |
−2.12 kg | [193] |
| Phentermine/topiramate | −13.38% | +4.62% | −0.96% | −7.73 kg | [194] |
| Naltrexone/bupropion | −11 to −15 mg/dL | +3 to +5 mg/dL | −1 to −4 mg/dL | [195,196] | |
| Liraglutide | −23 mg/dL | −0.4 mg/dL | −4.6 mg/dL | −2.38 kg | [195,196] |
| Semaglutide | −15.64% | +4.24% | −2.18% | −8.51% | [197] |
| Tirzepatide | −20.3 mg/dL | +8.8 mg/dL | −4.2% | −17.8% with 15-mg dose | [198] |
| Pharmacotherapy in general | −1.25 mg/dL per one kg weight reduction | +0.37 mg/dL per one kg weight reduction | −1.67 mg/dL per one kg weight reduction | NA | [192] |
| Bariatric surgery | |||||
| Gastric bypass | −36 to −63% | +23 to +39% | −17 to −31% | −35% | [199,200] |
| Sleeve gastrectomy | −35 to −42% | +19 to +28% | −12 to −23% | −34% | [199] [200] |
| Bariatric surgery in general | −2.47 mg/dL per one kg weight reduction | +0.42 mg/dL per one kg weight reduction | −0.33 mg/dL per one kg weight reduction | NA | [192] |
HDL-C: High-density lipoprotein cholesterol
LDL-C: Low-density lipoprotein cholesterol
NA: Not applicable
TG: Triglycerides
Some of the chosen cited references were sentinel clinical trials, while others were meta-analyses. The reported data reflect variances in how the data were reported (i.e., percent versus mean reductions). Also, while the bariatric literature mostly reports “excessive weight loss,” this is a different calculation than total weight loss, and makes it challenging to compare the bariatric literature to the medical literature (i.e., publications regarding AOMs [202]). The values given here are “total weight loss” and not “excessive weight loss.”