Eligibility For Bariatric Surgery Research Articles

Eligibility for obesity management in Peru: Analysis of National Health Surveys from 2014 to 2022

Background: The prevalence of overweight and obesity has increased fastest in low- and middle-income countries in the last decades. Together with this rising prevalence, pharmacological and surgical interventions for obesity have emerged. How many people need these treatments is unknown. We quantified the prevalence of people in need of pharmacological and surgical treatment for obesity in Peru between 2014 and 2022. Methods: Repeated cross-sectional analysis of national health surveys in Peru was conducted. Eligibility for pharmacological treatment for obesity was: body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 alongside type 2 diabetes or hypertension (self-reported). Eligibility for bariatric surgery were BMI ≥40 kg/m2 or BMI between 35 to 39.9 kg/m2 linked to weight-related health problems. We used Poisson regressions to identify associated factors with eligibility for obesity management. Results: Across years, 260,131 people (mean age 44.0 and 54.5% were women) were studied, 66,629 (27.7%; 95% CI: 27.4% - 28.1%) were eligible for obesity medication, and 5,263 (2.5%; 95% CI: 2.4% - 2.6%) were eligible for bariatric surgery. Female sex, older age, higher socioeconomic level and study year were associated with higher probability of eligibility for both obesity medication and bariatric surgery. Conclusions: Eligibility for obesity management has increased over time in Peru. There is a need to strengthen policies to tackle overweight and obesity in Peru, acknowledging that some individuals may benefit from pharmacological and surgical interventions.

Eligibility for obesity management in Peru: Analysis of National Health Surveys from 2014 to 2022

Background: The prevalence of overweight and obesity has increased fastest in low- and middle-income countries in the last decades. Together with this rising prevalence, pharmacological and surgical interventions for obesity have emerged. How many people need these treatments is unknown. We quantified the prevalence of people in need of pharmacological and surgical treatment for obesity in Peru between 2014 and 2022. Methods: Repeated cross-sectional analysis of national health surveys in Peru was conducted. Eligibility for pharmacological treatment for obesity was: body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 alongside type 2 diabetes or hypertension (self-reported). Eligibility for bariatric surgery were BMI ≥40 kg/m2 or BMI between 35 to 39.9 kg/m2 linked to weight-related health problems. We used Poisson regressions to identify associated factors with eligibility for obesity management. Results: Across years, 260,131 people (mean age 44.0 and 54.5% were women) were studied, 66,629 (27.7%; 95% CI: 27.4% - 28.1%) were eligible for obesity medication, and 5,263 (2.5%; 95% CI: 2.4% - 2.6%) were eligible for bariatric surgery. Female sex, older age, higher socioeconomic level and study year were associated with higher probability of eligibility for both obesity medication and bariatric surgery. Conclusions: Eligibility for obesity management has increased over time in Peru. There is a need to strengthen policies to tackle overweight and obesity in Peru, acknowledging that some individuals may benefit from pharmacological and surgical interventions.

Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S.

Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability. This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care. From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy. Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.

Genetic predisposition to obesity and inflammation in a tri-racial/ethnic breast cancer population

Aim: Multiple genes and genetic variants may contribute to racial/ethnic disparities in obesity-associated breast cancer diagnosis and prognosis. Therefore, we evaluate whether racial/ethnic differences in polygenic risk score (PRS) contribute to obesity and inflammatory biomarker in breast cancer patients. Methods: In a tri-racial/ethnic population of 403 breast cancer patients, 21% African American (AA), 65% Hispanic White (HW), and 14% non-Hispanic White (NHW), we evaluated racial/ethnic differences in obesity PRS, the association between PRS and an inflammatory biomarker C-reactive protein (CRP), and its implication in bariatric surgery eligibility. The obesity PRS was constructed via a weighted risk allele model using 35 obesity-related single nucleotide polymorphisms (SNPs). SAS version 9.3 for Windows (SAS Institute, Cary, NC, USA) was used to perform the logistic regression analysis. Results: About 74% of our study population were overweight or obese. The mean ± SD of obesity PRS was 45.03 ± 10.66 for obese patients and 39.36 ± 8.81 for non-obese patients (P < 0.0001). AA patients had a significantly higher obesity PRS than HW and NHW (P < 0.0001). The obesity PRS significantly correlated with body mass index and CRP levels (P < 0.0001) and was associated with bariatric surgery eligibility (OR = 4.32, 95%CI: 1.89-9.87). Conclusion: In summary, multiple obesity-associated SNPs contribute to racial/ethnic disparities in obesity of breast cancer patients; the obesity PRS has application in identifying breast cancer patients with higher genetic risk for obesity who may benefit from more aggressive weight management, such as bariatric surgery to improve breast cancer clinical outcomes.

Estimation of body fatness in obesity and partial lipodystrophy in relation to eligibility for bariatric surgery: What should be measured?

Estimation of body fatness in obesity and partial lipodystrophy in relation to eligibility for bariatric surgery: What should be measured?

Assessment of factors influencing consultations after bariatric surgery

Background. Bariatric surgery programs are recognized as the best alternative for patients with severe obesity. Many studies conclude that bariatric surgery programs that include these pre- and postoperative consultations (PPC) by the multidisciplinary team have better overall outcome. The purpose of the present study was to evaluate factors that affect PPC during a bariatric surgery program in Mexico and assess the possible impact on the patients’ post-operative course. Materials and methods. In accordance with the the International Federation for the Surgery of Obesity and Metabolic Disorders guidelines, all patients included were between 18 and 65 age when bariatric surgery was performed. Preoperative assessment of patient eligibility for bariatric surgery included consultation with the main surgeon, a dietician, an internist, and a psychologist. If non-eligible cases were detected, these issues were addressed and fully treated before surgery was considered. Results. A total of 110 patients were included in this study. Eighty-one (74 %) patients were women and 29 (26 %) were men. We observed that women had significantly more consultation attendance than men (54.3 % versus 24.1 %, p = 0.005). Patients with higher initial BMI had significantly more consultation attendance than those with lower BMI (42.9 kg/m2 versus 38.6 kg/m2, p = 0.007). When consultation attendance was evaluated according to occupation, teaching workers had significantly (p = 0.003) more consultation attendance (71.4 %) while the students group had less consultation attendance (0). Patients who had higher percentage of excess of weight loss (EWL) had significantly more general, medical, nutritional and psychological consultation attendance than those with lower percentage of EWL (p = 0.04, p = 0.032, p = 0.039 and p < 0.001). Conclusions. Consultation attendance with the multidisciplinary team is associated with better outcomes after bariatric surgery. “Nonattending” patients are at least partly responsible for any suboptimal results observed. Although this is certainly a factor for some patients, many other non-dependent reasons, such as cultural, social, economic or motivational reasons can also affect the loss of consultations in other patients.

An Examination of Who Is Eligible and Who Is Receiving Bariatric Surgery in England: Secondary Analysis of the Health Survey for England Dataset

BackgroundOver 2 million people in England were estimated to be eligible for bariatric surgery in 2006. In 2014, clinical guidelines were updated, widening potential eligibility, meanwhile, obesity prevalence rose. However, numbers receiving surgery decreased, and concerns exist of inequalities in access between population groups. This study is aimed at estimating the number of adults eligible for surgery in England and to compare demographics with those that receive surgery.MethodsBMI and comorbidity status were used to determine eligibility for bariatric surgery within participants of the 2014 Health Survey for England dataset (6938 adults), based on the National Institute of Health and Care Excellence guidelines. Results were scaled up using national population estimates. The demographics of eligible participants were compared against 2014/2015 hospital episode statistics for sex and age group using a chi-squared analysis.ResultsOf the total population of England, 7.78% (95% CI 7.1–8.6%), or 3,623,505 people, could have been eligible for bariatric surgery in 2014; nearly a million more than if previous guidelines applied. Eligibility peaked at ages 45–54, with most in the 35–64 age group (58.9%). 58.4% of those eligible were women. Patients receiving surgery were far more likely to be female than male (76.1%) and the distribution skewed towards younger ages when compared with those eligible.ConclusionBariatric surgery may benefit many people in England; significant investment is required so that service provision is adequate for demand. Differences between demographics of those eligible and receiving surgery may be explainable; however, the potential health inequality should be investigated.

Effects of bariatric surgery on telomere length and T-cell aging

BackgroundObesity adversely affects health and is associated with subclinical systemic inflammation and features of accelerated aging, including the T-cell immune system. The presence of metabolic syndrome (MetS) may accelerate, while bariatric surgery might reverse these phenomena. To examine the effects of MetS and bariatric surgery on T-cell aging, we measured relative telomere length (RTL) and T-cell differentiation status in obese patients before and after bariatric surgery.MethodsWHO II/III classified obese patients scheduled for bariatric surgery were included: 41 without MetS and 67 with MetS. RTL and T-cell differentiation status were measured in circulating CD4+ and CD8+ T cells via flow cytometry. T-cell characteristics were compared between patients with and without MetS prior to and at 3, 6, and 12 months after surgery considering effects of age, cytomegalovirus-serostatus, and weight loss.ResultsThymic output, represented by numbers of CD31-expressing naive T cells, showed an age-related decline in patients with MetS. MetS significantly enhanced CD8+ T-cell differentiation. Patients with MetS had significant lower CD4+ RTL than patients without MetS. Within the first 6 months after bariatric surgery, RTL increased in CD4+ T cells after which it decreased at month 12. A decline in both thymic output and more differentiated T cells was seen following bariatric surgery, more pronounced in the MetS group and showing an association with percentage of body weight loss.ConclusionsIn obese patients, MetS results in attrition of RTL and accelerated T-cell differentiation. Bariatric surgery temporarily reverses these effects. These data suggest that MetS is a risk factor for accelerated aging of T cells and that MetS should be a more prominent factor in the decision making for eligibility for bariatric surgery.

Abstract 1767: Racial/ethnic disparities of obesity in a breast clinic population: Consideration for weight loss program in improving clinical outcomes

Abstract Introduction: Accumulating evidence suggest that obesity is associated with breast cancer diagnosis, recurrence, and mortality. Obese subjects with genetic predisposition may need more aggressive weight loss management, such as bariatric surgery. Therefore, the primary aim of this study was to assess the racial/ethnic disparities in obesity and the prevalence of breast cancer study participants who may be eligible for bariatric surgery. Methods: In three clinic-based studies conducted at University of Miami during 2008 to 2015, we evaluated 462 healthy controls and 975 breast cancer patients. Genotyping data of two obesity-related genes (FTO and MC4R) were also evaluated. Race/ethnicity and obesity-related comorbidities were self- reported. Body Mass Index (BMI) was calculated as kg/m2. The classification of BMI was: (1) < 18.5, underweight; (2) 18.5-24.9, normal weight; (3) 25.0-29.9, overweight; (4) 30.0-34.9, class I obesity; (5) 35.0-39.9, class II obesity; and (6) ≥ 40.0, class III obesity. The NIH eligibility for bariatric surgery was for class II obese subjects with obesity-related comorbidities and class III obese subjects. Results: The study consists of 70.0% Hispanic whites (HW), 21.7% black or African American (AA), and 6.4% non-Hispanic whites (NHW). Mean and SD of age was 54.1± 9.9 years and mean BMI was 29.0±6.1 kg/m2. Overall, about 11.1% of study participants met criteria for bariatric surgery and there were significant racial/ethnic disparities (19.7% AA, 8.5% HW, 8.8% NHW, and 17.2% others; p<0.0001). Subgroup analysis observed increased BMI at follow up (29.60 vs. 29.16 kg/m2, p = 0.00229). Women with the AA risk genotype of rs1121980 (FTO gene) had 3.6-fold higher risk of obesity class II or III compared to those with the GG genotype (p = 0.00393). Conclusion: In addition to cancer risk, obesity is a major risk factor for cancer treatment-related side effects and worse survival. Our results suggest that at least 11% of breast cancer patients may be eligible for bariatric surgery. Considering some other beneficial effects of bariatric surgery on physical quality of life, metabolic syndrome, diabetes, and microbiome, future studies will consider weight loss and bariatric surgery programs in breast cancer patients, particularly in underserved minorities with higher obesity rate and worse survival. Citation Format: Carolina Puyana Barcha, Eunkyung Lee, Cristiane Takita, Jean L. Wright, Wei Zhao, Isildinha M. Reis, Jennifer J. Hu. Racial/ethnic disparities of obesity in a breast clinic population: Consideration for weight loss program in improving clinical outcomes. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1767.

The Effectiveness of a Worksite Lifestyle Intervention Program on High-Risk Individuals as Potential Candidates for Bariatric Surgery: My Unlimited Potential (MyUP).

This is a single-arm, pre and post effectiveness study that evaluated the impact of a comprehensive workplace lifestyle program on severe obesity among high cardiovascular disease risk individuals in a large, diverse employee population. Employees of Baptist Health South Florida were considered eligible to participate if they had 2 or more of the following cardiometabolic risk factors: total cholesterol ≥200 mg/dL, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, hemoglobin A1c ≥6.5%, body mass index ≥30kg/m(2). Participants received a personalized diet plan and physical activity intervention, and were followed for 1 year. Data on anthropometric measurements, blood pressure, blood glucose, and other biochemical measures were collected. Participants' body mass index was calculated and their eligibility for bariatric surgery (BS) also assessed. A total of 297 persons participated in the program; 160 participants completed all procedures through 12 months of follow-up. At baseline, 34% (n = 100) of all participants were eligible for BS. In an intention-to-treat analysis, 27% (n = 27) of BS eligible participants at baseline became ineligible after 12 months. Considering program completers only, 46% of BS eligible participants at baseline became ineligible. Irrespective of BS eligibility at 12 months, mean values of cardiometabolic risk factors among program completers improved after the follow-up period. Workplace wellness programs provide an important option for weight loss that can obviate the need for BS, reduce cardiovascular disease risk, and potentially reduce costs. However, in designing future worksite lifestyle interventions, measures should be taken to improve participation and retention rates in such programs.

Usefulness of Upper Endoscopy for Pre-bariatric Surgery Clearance: A Look at a Predominantly Minority Population

Introduction: Obesity has reached epidemic proportions in the US. More than third the U.S population is estimated to have a BMI of > 30. As per CDC, the prevalence of obesity is highest in African Americans. The annual medical cost of obesity in the U.S. was estimated at $147 billion in 2008 U.S. dollars. In recent years, bariatric surgery is garnering increasing attention as a modality of weight reduction. From 1994 to 2005, there was a tenfold increase in the number of bariatric surgeries performed in the United States and it is expected to be one of the most common procedures in the next twenty years. Many physicians perform pre-operative esophagogastroduodenoscopy (EGD) before performing a bariatric surgery. Finding significant pathology on endoscopy could potentially alter the course of management and the patient's eligibility for bariatric surgery. However, due to a lack of studies the true efficacy of performing an endoscopy in this case remains unknown. Methods: In this retrospective study, we reviewed all upper endoscopies done for pre-operative evaluation of bariatric surgery over a period of two years from December 2012 to December 2014. Outcome data of endoscopic and pathological finding were analyzed. Results: 119 patients were included in the study. The average age was 39 years. 86.5% were female. 54.6% were African Americans and 13.4% were Hispanics. The average BMI was 48.7, 48.2 and 47.2 in the total population, African Americans and Hispanics respectively. Chronic gastritis was the most common finding on pathology (74.7% total study population, 76.9% African Americans and 68.7% Hispanics). 42.8% of total study population had reactive gastropathy which was more common in African Americans than in Hispanics (46.1% Vs 25 %). H. pylori was more common in Hispanics than African Americans (43.7% vs 35.3% respectively). Hiatus hernia was present in 28.5% of total population, 46.1% of African Americans and 18.7% of Hispanics. 10.9% of total population had gastric ulcers. All ulcers were superficial, white based and non-bleeding. 50% of the gastric ulcers had positive H. pylori. Intestinal metaplasia was found in 4.2 % of population. There was no significant difference in endoscopic and pathological finding in patients with BMI < 40 vs. 40-50 vs. > 50. Conclusion: This study appears to indicate an important role for upper endoscopy prior to bariatric surgery particularly in a minority population.

Increased Body Mass Index in Parent-Child Dyads Predicts the Offspring Risk of Meeting Bariatric Surgery Criteria.

Obesity in children is a major public health concern. This study examined the value of using parent-child dyads' adiposity status for predicting the individual's later eligibility for bariatric surgery (EBS). The cohort consisted of 2647 individuals from the longitudinal Cardiovascular Risk in Young Finns Study. Baseline information included own and parental body mass index (BMI) in 1980 (children aged 3-18 years), whereas adult follow-up assessment examined EBS 21-31 years later. EBS in adulthood was defined as: 1) BMI greater than 40 kg/m(2) or 2) BMI greater than 35 kg/m(2) with at least one of the following metabolic complications: type 2 diabetes, hypertension, or dyslipidemia. Addition of parents' BMI improved the prediction of adulthood EBS compared to the model including child's BMI, age, and sex (area under the curve values [95% confidence interval] (0.80 [0.74-0.85] vs 0.74 [0.68-0.81], P = .003). Obese children with an obese parent had a 21.2% chance of being EBS in adulthood. Compared to nonobese families, the risk ratio for EBS was 14.2 (95% confidence interval 8.0-25.2, P < .001) in obese children with an obese parent. The absolute risk of EBS was 30.9% if both child and parent were obese on more than one childhood assessment compared to 15.2% if they were obese only once, or 2.1% if they were never obese (P < .05). These longitudinal data show that a combination of the child's and parents' BMI at baseline assessment is a useful predictive tool for assessing later EBS, and highlights the importance of accounting for parental BMI in the assessment of child obesity.

Sa1346 Eligibility for Bariatric Surgery Among Adults in England: Analysis of National Cross Sectional Survey

Sa1346 Eligibility for Bariatric Surgery Among Adults in England: Analysis of National Cross Sectional Survey