The impact of medical management in the treatment of patients with super obesity (body mass index [BMI] >50 kg/m2) is poorly studied.In patients with obesity, highest dosage combination of Phentermine and Topiramate for weight loss therapy can provide average 15% of total body weight loss (TBW).This case study describes an off-label approach for the treatment of super obesity with Topiramate in the work up to bariatric surgery.


A 38 year old female with super obesity (BMI 55.5, 344 lbs) was evaluated for weight gain during the work up for bariatric surgery. The patient reported overeating, carbohydrate cravings triggered by sadness, and nightly snacking after dinner.Financial limitations precluded behavioral therapy and the acquisition of FDA-approved weight loss medications.Therefore, to provide dual therapy for weight loss and mood improvement, Topiramate 50 mg was prescribed in an off-label approach.


In 8 months, the patient lost 30.23% TBW , 51.7 % EWL (-104 lbs , BMI=39), similar to weight loss following gastric bypass, with significant reductions in portion size and cravings and improvement in mood. Patient eventually chose not to pursue surgical weight loss.


Limited research is available to demonstrate the efficacy of Topiramate as a monotherapy for treatment of patients with super obesity. This case study could represent a new approach to the management of eating behaviors and mood before bariatric surgery in this subset of bariatric patients.