Metabolic Bariatric Surgery Research Articles

369-OR: Continued Weight Loss with Semaglutide Once-Weekly in Patients without Type 2 Diabetes and Postbariatric Treatment Failure

Purpose: Recently, we published promising retrospective 6-months follow-up data on the effectiveness of semaglutide 0.5mg once-weekly in patients with weight regain (WR) or insufficient weight loss (IWL) following bariatric metabolic surgery (BS). Therefore, we aimed to investigate whether weight loss was sustained over a 12-months period with semaglutide in patients without type 2 diabetes (T2D) with WR or IWL. Materials and Methods: Postbariatric patients without T2D with WR or IWL (n=29) were included in the analysis. The primary endpoint was weight loss 12 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP and liver enzymes. Results: Total weight loss during semaglutide treatment added up to 14.7±8.9% (mean±SD, p<0.001) after 12 months. Categorical weight loss was >5% in 89.7% of patients, >10% in 62.1% of patients, >15% in 34.5% of patients, >20% in 24.1% of patients and >25% in 17.2% of patients. Among patients with prediabetes at baseline (n=6), 12-months treatment led to normoglycemia in all patients (p<0.05). Conclusion: Treatment options to manage postbariatric treatment failure are scarce, weight loss medications are not approved for use in the postbariatric patient population. Our results imply a clear benefit of adjunct treatment with semaglutide in postbariatric patients. Disclosure A.Lautenbach: Other Relationship; Novo Nordisk, Lilly. J.Wagner: None. F.D.Stoll: None. J.Aberle: Advisory Panel; Novo Nordisk, Speaker's Bureau; Novo Nordisk.

Pouch Resizing for Weight Regain after Roux-En-Y Gastric Bypass: Results from a High-Volume Single Center

Abstract Background The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, weight regain is reported in 10-30% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Pouch resizing (PR), the resizing of an enlarged gastric pouch, is commonly performed as a low-risk secondary surgery to stabilize or even reduce the regained weight. However, the effectiveness of PR lacks scientific evidence. Aims To analyze the effect of PR after RYGB on long-term weight loss, course of comorbidities, complication rates and patient satisfaction. Methods Forty-eight patients undergoing PR between January 2016 and December 2020 were included. Data were collected retrospectively from a prospective database. PR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, thirty-seven patients participated in a survey evaluating postoperative patient satisfaction. Results Nadir-weight after RYGB was reached after 26.3 ± 19.4 months; PR was performed after a mean time of 106.2 ± 45.5 months. Mean follow-up after PR was 55.9 ± 18.5 months. Mean BMI before PR was 39 ± 5.4 kg/m2. Mean BMI at 1, 3 and 5 years after PR was 37 ± 5.5 kg/m2, 35 ± 7.6 kg/m2 and 35 ± 7.5 kg/m2 respectively. Obesity-associated comorbidities were resolved in 53% of patients five years after PR. Postoperative complications analog grade ≤2 of the Clavien-Dindo classification occurred in 12.5% while complications grade ≥3 occurred in 10.4% of patients. There was no mortality. The postoperative survey showed high levels of satisfaction after PR. Conclusions PR for weight regain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. PR is thus a valuable option to at least stop weight regain after primary RYGB in well-selected patients leading to high levels of patient satisfaction.

How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery

BackgroundMultidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients’ needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored. MethodsA qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis. ResultsPatients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact. ConclusionPatients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.

Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta-analysis and network meta-analysis of randomized controlled trials.

To compare different types of metabolic surgery with non-surgical therapy for the treatment of type 2 diabetes (T2D). The present network meta-analysis (NMA) includes randomized clinical trials (duration ≥ 52 weeks) comparing different surgery techniques with non-surgical therapy in diabetes patients. The primary endpoints were endpoint HbA1c, body mass index (BMI) and diabetes remission. The secondary endpoints included fasting plasma glucose, lipid profile, blood pressure, arterial hypertension and dyslipidaemia remission, quality of life and surgical adverse events. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and the Mantel-Haenzel odds ratio for categorial variables, were calculated. The types of surgical procedure included laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD), greater curvature plication (GCP), one-anastomosis gastric bypass (OAGB) and Duodeno-Jejunal bypass. Thirty-six trials were included. Metabolic bariatric surgery (MBS) was associated with a significantly higher reduction of HbA1c, diabetes remission and BMI compared with medical therapy. In the NMA, a significant reduction of HbA1c was observed with OAGB and SG. Complete diabetes remission significantly increased with all surgical procedures in comparison with non-surgical therapy, except for GCP. In addition, only BPD, RYGB and OAGB were associated with a significant reduction of BMI. MBS is an effective option for the treatment of T2D in patients with obesity. Further long-term trials of appropriate quality are needed for assessing the risk-benefit ratio in some patient cohorts, such as those with a BMI of less than 35 kg/m2 and aged older than 65 years.

Defining Physiological Ketosis Following Very-Low-Calorie Diets

IntroductionVery low-calorie diets (VLCDs) are used preoperatively in bariatric-metabolic surgery; however, this can lead to physiological ketosis. Euglycemic ketoacidosis is an increasingly recognized complication in diabetic patients on sodium-glucose-cotransporter-2 inhibitors (SGLT2i) undergoing surgery and requires assessment of ketones for diagnosis and monitoring. VLCD induced ketosis may confound monitoring in this group. We aimed to evaluate the influence of VLCD, compared to standard fasting, on perioperative ketone levels and acid-base balance. Materials and methodsTwenty-seven patients were prospectively recruited to the intervention group and 26 to the control group from two tertiary referral centres in Melbourne, Australia. Intervention group patients were severely obese (body mass index) (BMI) (≥35), undergoing bariatric-metabolic surgery, and prescribed 2 wk of VLCD preoperatively. Control group patients underwent general surgical procedures and prescribed standard procedural fasting only. Patients were excluded if diabetic or prescribed SGLT2i. Ketone and acid-base measurements were taken at regular intervals. Univariate and multivariate regression was utilised with significance defined as P < 0.005. ClinicalTrials.gov ID: NCT05442918. ResultsPatients on VLCD, compared to standard fasting, had an increased median preoperative (0.60 versus 0.21 mmol/L), immediate postoperative (0.99 versus 0.34 mmol/L) and day 1 postoperative (0.69 versus 0.21 mmol/L) ketone level (P < 0.001). Preoperative acid-base balance was normal in both groups, however VLCD patients were found to have a metabolic acidosis immediately postoperatively (pH 7.29 versus pH 7.35) (P = 0.019). Acid-base balance had normalized in VLCD patients on postoperative day 1. ConclusionsPreoperative VLCD resulted in increased pre- and postoperative ketone levels with immediate postoperative values consistent with metabolic ketoacidosis. This should be considered particularly when monitoring diabetic patients prescribed SGLT2i.

A119 Predictors of Opioid Needs Following Metabolic Bariatric Surgery

A119 Predictors of Opioid Needs Following Metabolic Bariatric Surgery

Safety and Effect of Bariatric Metabolic Surgeries for Psychiatric Patients with Obesity: A Retrospective Matched Case–control Trial

IntroductionPatients living with psychiatric illnesses (PIs) have a high prevalence of obesity. In a 2006 survey, 91.2% of professionals in the bariatric field identified “psychiatric issues” as clear contraindications to weight-loss surgery.MethodsThis retrospective matched case–control study investigated the impact, safety, and possible relapse after bariatric metabolic surgery (BMS) in patients with PIs. Also, we tested the incidence of patients who developed PI after BMS and compared the post-procedural weight loss with that in a matched control group without PIs. The cases were matched in a ratio of 1:4 to the control patients standardized for age, sex, preoperative BMI, and type of BMS.ResultsOf 5987 patients, 2.82% had a preoperative PI; postoperative de novo PI was present in 0.45%. Postoperative BMI was significantly different between the groups when compared to preoperative BMI (p < 0.001). Percentage of total weight loss (%TWL) after six months was not significantly different between the case (24.6% ± 8.9) and control groups (24.0% ± 8.4, p = 1.000). Early and late complications were not significantly different between the groups. The psychiatric drug use and dosage changes did not differ significantly pre- and postoperatively. Of the psychiatric patients, 5.1% were postoperatively admitted to a psychiatric hospital (p = 0.06) unrelated to BMS, and 3.4% had a prolonged absence from work after surgery.ConclusionBMS is an effective weight loss treatment and a safe procedure for patients with psychiatric disorders. We found no change in the patients’ psychiatric status outside the usual disease course. Postoperative de novo PI was rare in the present study. Furthermore, patients with severe psychiatric illness were excluded from undergoing surgery and, therefore, from the study. Careful follow-up is necessary to guide and protect patients with PI.Graphical

Metabolic bariatric surgery and combined multilevel surgery as a treatment for obstructive sleep apnea patient with obesity

&#x0D; &#x0D; &#x0D; Body mass index (BMI) and the degree of obstructive sleep apnea (OSA) are strongly correlated. Managing obesity is an important strategy for preventing and treating OSA. Bariatric surgery can lead to significant weight loss and improvements in metabolic function, which can have beneficial effects on OSA symptoms within obese population. There is a relative lack of data directly comparing the different types of bariatric surgery and multilevel upper airway surgery for the treatment of obstructive sleep apnea (OSA). While there is some evidence to suggest that bariatric surgery can improve OSA symptoms in obese individuals, and multilevel upper airway surgery can improve OSA symptoms in some cases of anatomical obstruction, there is limited research directly comparing these treatment options. Therefore, this review provides an update on the relationship between OSA, MBS and MLS for demonstrating the significance of multidisciplinary surgery approach for obese patients with OSA.&#x0D; &#x0D; &#x0D;

Side-to-side duodeno-ileal magnetic compression anastomosis: design and feasibility of a novel device in a porcine model.

Minimally invasive metabolic/bariatric surgery (MBS) may be further advanced by magnetic compression anastomosis (MCA) technology. The study aimed to develop a magnet sized to create a patent duodeno-ileostomy (DI) and verify its effectiveness in a porcine model. Developmental study phase: magnets with 4 different flange-offset dimensions were tested to identify a design that would successfully form a compression anastomosis. Verification phase: evaluation of the selected design's efficacy. In each 6-week phase (4 pigs/phase), one magnet was inserted laparoscopically in the jejunum, one placed gastroscopically in the duodenum. Magnets were aligned, gradually fused, formed an anastomosis, and then detached and were expelled. At necropsy, MCA sites and sutured enterotomy sites were collected and compared. Developmental phase: the linear BC42 magnet with a 2.3-mm flange offset design was selected. Verification phase: in 4 swine magnets were mated at the target location, confirmed radiographically. Mean time to magnet detachment 16.0days (12-22), to expulsion 24.5days (17-33). MCA was achieved in all animals at time of sacrifice. Animals gained a mean 9.5kg (3.9-11.8). Specimens revealed patent anastomoses of ≥ 20mm with smooth mucosa and minimal inflammation and fibrosis compared to sutured enterotomies. One pig underwent corrective surgery for a mesenteric hernia without sequelae. In a large-animal model, gross and histopathologic examination confirmed that the linear MCA device created a patent, well-vascularized, duodeno-ileal anastomosis. The novel MCA device may be appropriate for use in human MBS procedures.

Obesity, Preserved Ejection Fraction Heart Failure, and Left Ventricular Remodeling.

Owing to the overwhelming obesity epidemic, preserved ejection fraction heart failure commonly ensues in patients with severe obesity and the obese phenotype of preserved ejection fraction heart failure is now commonplace in clinical practice. Severe obesity and preserved ejection fraction heart failure share congruent cardiovascular, immune, and renal derangements that make it difficult to ascertain whether the obese phenotype of preserved ejection fraction heart failure is the convergence of two highly prevalent conditions or severe obesity enables the development and progression of the syndrome of preserved ejection fraction heart failure. Nevertheless, the obese phenotype of preserved ejection fraction heart failure provides a unique opportunity to assess whether sustained and sizeable loss of excess body weight via metabolic bariatric surgery reverses the concentric left ventricular remodeling that patients with preserved ejection fraction heart failure commonly display.

Status of Body Contouring Following Metabolic Bariatric Surgery in a Tertiary Hospital of Greece-Still a Long Way to Go.

Obesity is a disease rather than a state, and metabolic bariatric surgery (MBS) is its most effective treatment. Body contouring surgery (BCS) is an integral part of the continuum of care following MBS, provided that the body mass index (BMI) has stabilized for an adequate period. This study is an attempt to capture the current status of BCS following MBS in Greece, based on data from one of the country's highest-volume hospitals. We recruited patients from the Bariatric and Plastic-Reconstructive Surgery registries who had undergone both MBS and BCS and invited them to answer a structured questionnaire with components on demographics, safety and effectiveness of previous operations, quality of life (QoL), body image, social activity, sexual activity, and doctor-patient communication. Twenty-four patients participated in the survey (response rate 88.1%). The mean BMI pre-MBS was 43.8 kg/m2 and that pre-BCS was 28.6 kg/m2. Based on the Bariatric sub-cohort, only 2.5% of post-bariatric patients underwent BCS. The mean interval between MBS and BCS was 2.9 years. The distribution of patients by MBS was as follows: sleeve gastrectomy 8 (33.3%), gastric band 7 (29.2%), gastric bypass 5 (20.8%), and gastric plication 2 (8.3%). The distribution of patients by BCS was as follows: abdominoplasty 23 (94.7%), breast contouring 8 (33.3%), thigh contouring 3 (12.5%), and arm contouring 5 (20.8%). Most positive components (70.6%) regarding QoL were appraised by >80% of the participants, indicating overall satisfaction after BCS. Conversely, only 12.5% of negative components were endorsed by >20% of patients. In conclusion, BCS has a low prevalence after MBS, although it is related to an improved quality of life and body image.

Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines.

The rise of childhood obesity is a growing concern due to its negative impact on health.Metabolic bariatric surgery (MBS) has gained popularity as an effective and adequate intervention for children and adolescent patients living with severe obesity. Nonetheless, access to MBS for this population is still limited. The objective of this paper is to conduct a comprehensive review of the latest national and international practice guidelines and improve access to MBS for children and adolescents. The paper focuses on the recommendations from the 2023 American Academy of Pediatrics (AAP) and 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Recently updated guidelines from the ASMBS and IFSO aim to improve access to MBS for children and adolescents and recommend patient selection, preoperative evaluation, and postoperative care. While lifestyle changes, medication, and behavioral therapy are commonly prescribed, they often fail to achieve permanent weight loss and its maintenance. Weight-loss surgeries like sleeve gastrectomy (SG) and gastric bypass (RYGB) show promising results in managing severe obesity in adolescents. SG has become the preferred method for treating severe obesity in adolescents, surpassing RYGB. Weight stigma is also explored in this review, revealing its negative effects on individuals who are overweight and underweight. Furthermore, telehealth is identified as an increasingly valuable tool for managing pediatric obesity, as it can improve access to care, particularly for those in remote areas where physicians trained to treat childhood obesity and the shortage of bariatric surgeons experienced in treating younger adolescents and pediatricians with advanced training are major obstacles.

Bariatric–metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial

Observational studies suggest that bariatric-metabolic surgery might greatly improve non-alcoholic steatohepatitis (NASH). However, the efficacy of surgery on NASH has not yet been compared with the effects of lifestyle interventions and medical therapy in a randomised trial. We did a multicentre, open-label, randomised trial at three major hospitals in Rome, Italy. We included participants aged 25-70 years with obesity (BMI 30-55 kg/m2), with or without type 2 diabetes, with histologically confirmed NASH. We randomly assigned (1:1:1) participants to lifestyle modification plus best medical care, Roux-en-Y gastric bypass, or sleeve gastrectomy. The primary endpoint of the study was histological resolution of NASH without worsening of fibrosis at 1-year follow-up. This study is registered at ClinicalTrials.gov, NCT03524365. Between April 15, 2019, and June 21, 2021, we biopsy screened 431 participants; of these, 103 (24%) did not have histological NASH and 40 (9%) declined to participate. We randomly assigned 288 (67%) participants with biopsy-proven NASH to lifestyle modification plus best medical care (n=96 [33%]), Roux-en-Y gastric bypass (n=96 [33%]), or sleeve gastrectomy (n=96 [33%]). In the intention-to-treat analysis, the percentage of participants who met the primary endpoint was significantly higher in the Roux-en-Y gastric bypass group (54 [56%]) and sleeve gastrectomy group (55 [57%]) compared with lifestyle modification (15 [16%]; p<0·0001). The calculated probability of NASH resolution was 3·60 times greater (95% CI 2·19-5·92; p<0·0001) in the Roux-en-Y gastric bypass group and 3·67 times greater (2·23-6·02; p<0·0001) in the sleeve gastrectomy group compared with in the lifestyle modification group. In the per protocol analysis (236 [82%] participants who completed the trial), the primary endpoint was met in 54 (70%) of 77 participants in the Roux-en-Y gastric bypass group and 55 (70%) of 79 participants in the sleeve gastrectomy group, compared with 15 (19%) of 80 in the lifestyle modification group (p<0·0001). No deaths or life-threatening complications were reported in this study. Severe adverse events occurred in ten (6%) participants who had bariatric-metabolic surgery, but these participants did not require re-operations and severe adverse events were resolved with medical or endoscopic management. Bariatric-metabolic surgery is more effective than lifestyle interventions and optimised medical therapy in the treatment of NASH. Fondazione Policlinico Universitario A Gemelli, Policlinico Universitario Umberto I and S Camillo Hospital, Rome, Italy.

Bariatric–metabolic surgery versus lifestyle intervention in non-alcoholic steatohepatitis

Bariatric–metabolic surgery versus lifestyle intervention in non-alcoholic steatohepatitis

Bariatric metabolic surgery eliminates body mass index as a risk factor for unemployment.

The effects of bariatric metabolic surgery (BMS) on health and comorbidities are well-known. Socioeconomic factors have been increasingly in focus in recent investigations. The aim of this study was to analyze the effects of BMS on predictive variables for unemployment. This study as performed in one reference center for BMS. Patients were treated between 2011 and 2017. The study design was a retrospective cohort study. Inclusion criteria were Roux-en-Y gastric bypass surgery, follow-up of 60 months, and complete data on employment rate. Exclusion criteria were secondary BMS, secondary referral, loss of follow-up, or patients aged 60 years and above. Patients were stratified as employed independent of part-time work and as unemployed if the patient had no current employment at the time of the visit. Follow-up visits were performed after 6, 12, 24, 48, and 60 months. This study included 623 patients; prior to BMS, 239 (38.36%) patients were employed and 384 (61.64%) unemployed. Risk factors for baseline unemployment included increased body mass index (BMI) (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.05; P = .010) and increased American Society of Anesthesiology (ASA) score (OR, 3.55; 95% CI, 2.56 to 4.90; P < .001). Unemployment rate dropped to 32.4% after 24 months (P < .001) and increased to 62.8% after 60 months. The BMI continuously decreased. Following BMS, the unemployment rate was no longer associated with BMI (24 months: OR, 0.97; 95% CI, 0.95 to 1.01; P = .220; 60 months: 1.04; 95% CI, 0.97 to 1.11; P = .269). The initial ASA status remained associated with unemployment (OR, 2.20; 95% CI, 1.60 to 3.01; P < .001). BMI showed some association with the unemployment rate prior to BMI. The unemployment rate significantly decreased 24 months after BMS but increased to baseline values after 60 months. Following BMS, BMI was no longer associated with unemployment.

Timing of Bariatric Surgery and COVID-19 Vaccination: Experience From a High-volume Single Center.

During the last year, there was a large COVID-19 vaccination campaign in Italy. Concurrently, metabolic bariatric surgery (MBS) restarted after a long period of discontinuity. No data are currently available on the best timing of COVID-19 vaccination for MBS candidates. The aim of this study was to report MBS outcomes in relation to the timing of COVID-19 vaccine administration. A prospectively maintained database was utilized to locate patients undergoing MBS between January 1 and December 31, 2021. Patients were divided into 2 groups: patients receiving a vaccine dose within 30 days before or after surgery (Group±30); and patients with a longer time interval of vaccine dose before or after surgery (Group>±30). Postoperative outcomes were recorded and compared. A total of 108 patients were included: 33 (30.6%) of whom were in Group±30 and 74(69.4%) in Group>30. Baseline characteristics were comparable between the 2 groups. Findings revealed that postoperative outcomes (ie, 30-d complications and length of stay postoperatively) were comparable between groups. Two patients in the ±30 group had mesenteric vein thrombosis after sleeve gastrectomy (SG); however, the rate of thrombosis events was comparable between groups (P=0.09). Thrombosis between SG patients were not significantly different between the 2 groups. COVID-19 vaccination within 30 days of MBS does not impact complication rates and length of stay. COVID-19 vaccination may have a negative impact on venous thrombosis after SG, but this study is underpowered to draw this conclusion. Larger studies should be conducted to replicate current study findings.

Using Positive Psychology to Address Emotional Barriers to Physical Activity After Bariatric Surgery: Proof-of-Concept Trial of the Gaining Optimism After Weight Loss Surgery (GOALS) Project

Physical activity promotes health and longevity after metabolic/bariatric surgery (MBS), but most patients do not meet recommended levels. The Gaining Optimism After weight Loss Surgery (GOALS) Project was a positive psychological intervention designed to address common emotional barriers to physical activity in patients who have recently undergone MBS (e.g., low confidence around exercise, internalized weight bias, fear of injury) and use motivational interviewing and standard behavior change techniques (e.g., self-monitoring) to increase physical activity. This single-arm proof-of-concept trial was designed to refine the intervention, test feasibility and acceptability, and explore pre-post changes in behavioral and psychological outcomes. Participants were 12 adults 6–12 months post-MBS (M age of 46, 58% female, 67% non-Hispanic white). GOALS was a 10-week telephone counseling program that introduced new positive psychological skills and physical activity topics each week. Participants tracked physical activity with a Fitbit and set weekly goals. Results showed that the intervention was feasible (85% of sessions completed) and acceptable (average participant ratings of session ease and utility above 8.0 on a 0–10 scale). There were medium-to-large effect size improvements in physical activity and psychological well-being (e.g., depressive symptoms). The GOALS intervention will next be tested in a pilot randomized controlled trial with longer-term follow-up to assess its effect more robustly.

Parental Obesity Predisposition and Age of Onset Associate with Poor Response to Bariatric and Metabolic Surgery

IntroductionParental predisposition and age of onset may be independently associated with 1-year total weight loss (TWL) failure (< 20%) after metabolic–bariatric surgery (MBS).MethodsThis cohort study includes all cases of the German StuDoQ|MBE register (2015–2019) with data on parental predisposition, obesity onset, and at least 1-year follow up after primary MBS procedures (n = 14,404). We provide descriptive statistics of the cohort in terms of the main outcome and 1-year TWL failure, and provide characteristics of surgery type subgroups. Finally, we provide a multivariate logistic regression model of 1-year TWL failure.Results58.8% and 45.7% of patients reported maternal and paternal predisposition for obesity, respectively. Average onset of obesity was 15.5 years and duration of disease 28.3 years prior to MBS. SG is the most frequently performed procedure (47.2%) followed by RYGB (39.7%) and OAGB (13.1%). Mean 1-year TWL is 32.7 ± 9.3%, and 7.8% (n = 1,119) of patients show TWL failure (< 20%). Multivariate analysis shows independent association of early onset of obesity (< 18 years), male sex, age at operation, pre-operative BMI, pre-operative weight loss, sleeve gastrectomy (SG), and type 2 diabetes (T2D) with 1-year TWL failure (p < 0.001).ConclusionThe proportions of MBS patients that report on paternal and maternal predisposition for obesity are 45.7% and 58.8% respectively, and average age at onset is 15.5 years. 7.8% of patients do not meet current target criteria of successful response to surgery at 1 year. Early onset, male sex, age at operation, pre-operative BMI, pre-operative weight loss, SG, and T2D are independently associated with weight loss failure.Graphical abstract

Abstract MP70: Proof-of-Concept Trial of a Positive Psychology-Based Physical Activity Intervention After Bariatric Surgery: The Gaining Optimism After Weight Loss Surgery (GOALS) Project

Metabolic/bariatric surgery (MBS) is the most effective treatment available for severe obesity, but weight regain is common, increasing risk for cardiometabolic disease. Physical activity (PA) reduces these risks and aids with weight loss maintenance; however, over 90% of adults after MBS do not achieve at least 150 minutes/week of moderate-to-vigorous physical activity (MVPA) when measured objectively. Negative emotional associations with PA are common in this population (e.g., physical pain or injury, weight stigma). Positive psychological interventions are simple exercises shown to increase psychological well-being. The Gaining Optimism After weight Loss Surgery (GOALS) Project aims to target the emotional barriers to PA in adults with recent MBS using a positive psychological approach combined with motivational interviewing and goal-setting for PA. We tested feasibility, acceptability, and pre-post change in PA and psychological, behavioral, and physiological outcomes in a single-arm proof-of-concept trial to refine GOALS and prepare for a future RCT. GOALS included 10 weekly phone calls plus a written manual and a Fitbit to track PA. Each session included a positive psychology exercise, a PA-related topic, and setting a weekly PA goal. Participants were adults with MBS in the past 6-12 months who reported low physical activity. Primary outcomes were feasibility (session completion rates) and acceptability (participant ratings of session ease and utility). Pre-post assessments included physical activity measured with Actigraph GT3X-BT, a 6-minute walk test, BMI, percent body fat and waist circumference, and self-report measures of depression, anxiety, optimism, internalized weight bias, attitudes around physical activity, and post-MBS behavioral adherence. Mixed effects regression models with a random intercept measured change in outcomes including participants with missing data. Effect sizes (Cohen’s d) estimated magnitude of change given low study power. We enrolled 12 participants (58% female, M age 46 years, 67% non-Hispanic white). They completed 8.5/10 intervention sessions on average and gave high ratings ( M between 8.3 and 8.8/10) of ease and utility. There were increases in MVPA equivalent to an additional 17 minutes/day (d=0.61, p=0.09), 6-minute walk test distance (d=1.06, p=0.01) and reductions in BMI (d=0.81, p=0.04), depression (d=1.22, p&lt;0.01), anxiety (d=0.51, p=0.16), and internalized weight bias (d=0.98, p=0.03), and increases in post-MBS adherence (d=1.44, p&lt;0.01). The GOALS intervention demonstrated feasibility, acceptability, and pre-post improvements in PA and psychological well-being in a small proof-of-concept trial. The intervention is now being tested in a pilot RCT compared to a PA education control. If it continues to show similar effects, the intervention could be integrated into post-MBS clinical care to improve outcomes.

Single-anastomosis Sleeve Jejunal: a Mid-term Follow-up Report of a New Surgical Technique.

Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. We aim to report our mid-term follow-up of SASJ from a high-volume center for bariatric metabolic surgery in the Middle East region. For the current study, the 18-month follow-up data of 43 patients with severe obesity who underwent SASJ was collected. The primary outcome measures were demographic data, weight change variables according to ideal body mass index (BMI) of 25kg/m2 at 6, 12, and 18months, laboratory assessments, remission of obesity-associated medical problems, and other potential bariatric metabolic complications after the surgery. No patient was lost due to follow-up. After 18months, patients lost 43.4 ± 11kg of their weight and 68 ± 14% of their excess weight, and their BMI decreased from 44.9 ± 4.7 to 28.6 ± 3.8kg/m2 (p < 0.001). The percentage of total weight loss till 18months was 36.3%. The T2D remission rate at 18months was 100%. Patients neither faced deficiency in significant markers for nutrition state nor represented major bariatric metabolic surgery complications. SASJ bypass achieved satisfactory weight loss and remissions in obesity-associated medical problems within 18months after surgery without major complications and malnutrition.