To evaluate long-term weight trajectories and metabolic outcomes after bariatric surgery in patients with extreme obesity (BMI≥60kg/m2). Patients with BMI≥60kg/m2 represent a high-risk subgroup with a substantial cardiometabolic burden, yet long-term outcome data remain limited, particularly beyond 5years and in cohorts including revisional surgery. A retrospective cohort study included patients with BMI≥60kg/m2 who underwent bariatric surgery between April 2008 and August 2019. Outcomes included percentage total weight loss (%TWL), BMI change, and remission or improvement of metabolic comorbidities derived from structured medical records, with follow-up of up to 10years. Early postoperative complications and mortality were also assessed. Sixty patients were included (mean age 41.5years; mean baseline BMI 63.8kg/m2; 67% female), 80% had obesity-related comorbidities and 23% underwent revisional surgery. Mean %TWL declined from 37.99% at ≤2years to 37.36% at 2-5years, 22.37% at 5-10years, and 19.38% at >10years (p=0.054). At the last follow-up (mean 72months), mean BMI decreased to 45.11kg/m2 and mean %TWL was 29.4%. Remission or improvement occurred in NAFLD (73.9%), type 2 diabetes (77.8%), obstructive sleep apnoea (85.7%), and hyperlipidaemia (70.0%), whereas hypertension improved in 29.1%. Two deaths occurred (3.33%): one perioperative death due to an anastomotic leak after revisional surgery and one late death unrelated to surgery. In BMI≥60kg/m2, bariatric surgery delivers durable metabolic benefits despite frequent long-term weight regain, supporting its role as a metabolic intervention beyond weight loss and underscoring the need for strategies that preserve metabolic health over time.

Is Semaglutide a Safer Weight-Management Option Than Bariatric Surgery for Patients Undergoing Total Hip Arthroplasty (THA)?

Long-term study retention of adolescents undergoing metabolic and bariatric surgery: lessons learned from the Teen-Longitudinal Assessment of Bariatric Surgery cohort.

Psychosocial factors associated with a positive phosphatidylethanol test during the preoperative evaluation for metabolic and bariatric surgery.

What we know and where to go: a scoping review of the psychosocial literature in youth undergoing metabolic and bariatric surgery.

Pregnancy after bariatric surgery: persistent obesity and longer time to conception influences peripartum outcomes more than the type of operation.

Roux-en-Y gastric bypass (RYGB) improves glucose homeostasis beyond weight loss, but the underlying mechanisms remain incompletely understood. Counter-regulatory hormones such as glucagon, ACTH, and cortisol are key components of glucose regulation. The aim of this study was to characterize alterations in glucagon, ACTH, and cortisol regulation before and after RYGB using nonlinear mixed-effects (NLME) population modeling, and to explore potential mediators of these changes. Post-hoc analysis of one cross-sectional and two prospective cohort studies. Clinical research unit. In total, 62 individuals without diabetes from three previous clamp studies were included: 39 from a cross-sectional cohort covering a wide range of BMI and insulin sensitivity (cohort 1, utilized for model development only), and 23 participants examined both before and approximately four months after RYGB (cohort 2). Hyperinsulinemic-euglycemic-hypoglycemic (both cohorts) and hyperglycemic (cohort 1 only) clamps. Glucose-dependent secretion dynamics of glucagon, ACTH, and cortisol quantified through NLME modeling and the impact of RYGB and metabolic characteristics on corresponding model parameters. According to models developed using presurgical data from both cohorts, glucagon and ACTH turnover rates and baseline concentrations decreased post-RYGB in cohort 2. Insulin-mediated glucagon suppression and the glucose deficit required for ACTH stimulation increased, while cortisol dynamics remained stable. Higher insulin sensitivity was associated with lower baseline glucagon levels. RYGB induces reductions in glucagon and ACTH responsiveness to hypoglycemia, partially indicative of central nervous system-mediated resetting of glucose regulation. These adaptations may contribute to improved metabolic control following bariatric surgery.

Structured meal replacement low energy diets (MR-LED) are effective in obesity management, but evidence for individuals of minority ethnic groups or those with BMI >35 kg/m2 and significant comorbidities is limited. We evaluated the early effectiveness of a weight management program delivered by a multidisciplinary team within a specialist weight management service. We enrolled three groups: those who had been declined bariatric surgery, young adults with type 2 diabetes (T2D), and people awaiting corneal transplant who had their procedure deferred due to their weight. Individuals were primarily treated with a 12-week MR-LED. Adjunctive obesity medications were available under pre-specified criteria. The present study reports outcomes following the 12-week MR-LED, which was the first phase of a 12 month programme. Of the 1172 people screened, 482 met inclusion criteria and 128 commenced MR-LED. Most participants (111/128, 87%) had previously been declined bariatric surgery; 11/128 (9%) were young adults with T2D and 6/128 (5%) were awaiting corneal transplant surgery. Ninety-three individuals (73%) were from Pacific or indigenous Māori ethnic groups. The cohort had mean (SD) baseline weight of 145.0 (38.6) kg (BMI 49.9 (11.3) kg/m2); 94 (73%) had T2D on treatment, with a mean HbA1c of 67.6 mmol/mol (11 young adults and 83 from the bariatric surgery declined list). Psychological distress was common with 41% and 30% having moderate depressive and anxiety symptoms, respectively. Ninety-two people (72%) completed the 12-week MR-LED, achieving a mean (SD) weight loss of 10.9 (7.8) kg. Young adults with T2D were less likely to complete the programme. Among people with diabetes, 63/94 (67%) completed the 12-week intervention, with 21/63 (33%) achieving an HbA1c <50 mmol/mol on no diabetes medication. Psychological and quality of life scores improved. A 12-week MR-LED intervention delivered in a specialist service achieved clinically meaningful weight loss and improved metabolic and psychological outcomes in a high-risk, multi-ethnic cohort living with higher body weight.

Targeted lipidomics reveals distinct mechanisms driving LDL cholesterol response to gastric bypass and sleeve gastrectomy: An exploratory study.

Obesity and hypertension are interrelated global health challenges sharing common pathophysiological mechanisms, including insulin resistance, chronic inflammation and neurohormonal dysregulation. Emerging evidence highlights the gut microbiome as a crucial mediator in this interplay, influencing intestinal barrier integrity, systemic inflammation and metabolic homeostasis. In this narrative review, we critically examine the interplay between obesity-induced hypertension and the gut microbiome, evaluating current evidence, therapeutic implications and future research priorities. Obesity-associated gut dysbiosis disrupts the intestinal epithelial barrier, increasing translocation of bacterial products like lipopolysaccharides into circulation, promoting systemic inflammation that exacerbates insulin resistance, adipose dysfunction and hypertension. Current treatments targeting obesity, from lifestyle modification to bariatric surgery, show beneficial effects on blood pressure, but microbiome-targeted interventions are an evolving therapeutic frontier. Prebiotics, probiotics, synbiotics and faecal microbiota transplantation have demonstrated potential antihypertensive effects in preclinical and clinical studies, although findings are heterogeneous and require confirmation in larger randomised trials. Methodological challenges remain, including the need for advanced microbial sampling techniques beyond faecal analysis to fully capture disease-relevant microbiota alterations. This review synthesises current knowledge on gut microbiome involvement in obesity-induced hypertension, evaluates microbiome-based therapeutic strategies and identifies critical research gaps to guide future investigations aimed at mitigating the dual pandemics of obesity and hypertension.

Managing Obesity in Heart Failure Patients: Current Evidence and Strategies.

Quality of intubation using remifentanil in obese patients (OBEREM): A randomised, double-blind pilot trial.

Liver and Kidney volume Reduction May Underlie Metabolic Adaptation After Metabolic Bariatric Surgery: A sub-study of the "POWER" Randomized clinical trial.

Update on Idiopathic Intracranial Hypertension.

Background: Obesity has entered a new therapeutic era. The clinical conversation is no longer restricted to lifestyle counseling followed by late referral for bariatric surgery; it now includes highly effective anti-obesity pharmacotherapy, especially glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists. The central practical question for clinicians is no longer whether obesity should be treated aggressively, but which modality should be prioritized, for whom, and at what stage of disease. Methods: This systematic review was structured according to PRISMA 2020 principles. A focused search of PubMed, Scopus, Web of Science, and the Cochrane Library identified contemporary evidence comparing metabolic/bariatric surgery and medical therapy for obesity. Landmark randomized trials, long-term cohort studies, and high-quality systematic reviews/meta-analyses were prioritized. Outcomes of interest included total body weight loss, glycemic control, diabetes remission, cardiovascular effects, durability of response, adverse events, and practical implications for treatment selection. Results: Thirty studies were synthesized. Bariatric surgery remained the most reliable intervention for large and durable weight reduction and for diabetes remission, particularly Roux-en-Y gastric bypass and sleeve gastrectomy. Modern pharmacotherapy, however, substantially narrowed the historical efficacy gap. Liraglutide produced modest but clinically meaningful weight loss, semaglutide moved average outcomes into the mid-teen percentage range, and tirzepatide reached weight reductions exceeding 20% in some trials. Semaglutide also demonstrated cardiovascular event reduction in patients with obesity and established cardiovascular disease without diabetes. Yet drug withdrawal frequently led to clinically significant weight regain, whereas surgery generally produced greater durability, albeit with procedural risk and long-term nutritional surveillance requirements. Conclusions: In the new era, the relationship between surgery and medical therapy should be viewed as complementary rather than adversarial. Surgery remains the reference standard for severe obesity, advanced metabolic disease, and patients needing the highest probability of durable remission. Modern pharmacotherapy has become a powerful first-line or bridging strategy for many patients, especially those with lower surgical readiness, lower BMI, or preference for nonoperative treatment. A patient-centered, phenotype-based, and longitudinal care model is more appropriate than a simplistic surgery-versus-medicine dichotomy.

Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. However, the development or persistence of gastroesophageal reflux disease (GERD) remains a significant concern, particularly in patients with preexisting reflux symptoms. In selected bariatric patients affected by symptomatic GERD, alternative surgical strategies may be required. This prospective observational study aimed to evaluate the long-term outcomes of SG combined with Rossetti fundoplication (SGRF) in a selected population of patients with morbid obesity and documented GERD. Patients with obesity and preoperative GERD symptoms, chronic proton pump inhibitor (PPI) use, and endoscopic evidence of esophagitis were prospectively enrolled, underwent SGRF, and were followed for more than 5 years. Unlike SG combined with Nissen fundoplication, the Rossetti technique requires a smaller portion of the gastric fundus to construct the antireflux wrap. This aspect may be particularly relevant in bariatric surgery, as SG is based on the resection of most of the gastric fundus, which contains ghrelin-producing orexigenic cells. In total, 38 out of 58 patients enrolled (65.5%) completed long-term follow-up (mean 68.5 months). Of all, 92.1% of patients had discontinued PPIs and reported resolution of reflux symptoms. Among the 24 patients who underwent long-term gastroscopy, 96.6% showed no evidence of esophagitis. The adjusted total weight loss (%TWL) was 26.1%. These findings suggest that SGRF may represent a promising surgical option for carefully selected bariatric patients with GERD. Further prospective studies, including objective functional assessments such as esophageal manometry and pH monitoring, are needed to better define the role of this technique.

To assess incidence, indications, symptom relief, complications, and weight outcomes following Roux-en-Y gastric bypass (RYGB) reversal. RYGB is an effective treatment for obesity but may in rare cases be associated with severe long-term complications requiring RYGB reversal. Evidence on incidence and outcomes is limited. This nationwide, multi-center, retrospective cohort study included all patients undergoing RYGB reversal in Sweden between 2007 and 2023. Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) and medical records. During the study period, 199 patients (84% female, mean age 42.5y) underwent RYGB reversal at 13 centers, corresponding to an incidence of 0.3% of 63,797 RYGB-procedures performed. Patients usually had multiple indications, most often abdominal pain (70%), malnutrition (45%), gastrointestinal symptoms (34%), and postbariatric hypoglycemia (29%). Most procedures (84%) were performed laparoscopically, with a median hospital stay of 4 days. Mean body weight increased from 77kg at reversal to 89kg at one year. Overall, 86% of patients reported partial or complete symptom relief, highest rates among those with postbariatric hypoglycemia (94.6%). Early severe complications (Clavien-Dindo grade ≥IIIb) occurred in 24.6% and late severe complications in 21.6%, with seven not surgery-related deaths (3.5%) during follow-up. Reversal of RYGB is rare but can be considered in patients with a substantial burden of complications. Although postoperative morbidity was common, most patients achieved symptom relief. Careful patient selection, perioperative optimization, and realistic expectations are essential. Further studies are needed to determine optimal surgical techniques and long-term outcomes.

The conflicting impact of obesity on pulmonary function has been observed. Our study aimed at exploring the relationship between BMI and pulmonary function parameters in individuals with obesity. This cross-sectional study included a consecutive cohort of bariatric surgery candidates with pulmonary function tests. BMI, analysed as both quartile-stratified groups and a continuous variable, was evaluated for associations with pulmonary function parameters and the risk of pulmonary impairment. A total of 1834 patients with obesity (BMI range: 27.5-76.4 kg/m²) were included in our study. BMI exhibited a significantly positive correlation with FVC, FEV1, TLC, and FRC (P<0.001) and a negative correlation with FVC%pred, FEV1%pred, FEV1/FVC%, and RV/TLC (P<0.05). Non-linear relationships were found between BMI and both FVC%pred and FEV1%pred (P for non-linearity<0.01) after adjusting for covariables. Beyond the threshold BMI of 38.2 kg/m², FVC%pred and FEV1%pred declined significantly (FVC%pred: β=-0.522, 95% CI: -0.756 to -0.289; FEV1%pred: β=-0.435, 95% CI: -0.869 to -0.199), and the risk of pulmonary function impairment increased (OR=1.008, 95% CI:1.002 to 1.014). BMI exhibited a non-linear relationship with pulmonary function parameters. Beyond the critical threshold of 38.2 kg/m2, increasing BMI led to a significant decline in ventilatory capacity, concomitant with an amplified risk of pulmonary function impairment.

Breast cancer is increasingly recognized as a systemic disease influenced by the metabolic environment. Growing evidence suggests that obesity, type 2 diabetes mellitus, metabolic syndrome, and associated cardiovascular diseases significantly elevate the incidence, recurrence, and mortality of breast cancer, while also affecting treatment outcomes and prognosis. These metabolic disruptions alter the tumor microenvironment through mechanisms such as chronic inflammation, insulin/insulin-like growth factor signaling, adipose-immune interactions, gut microbiota imbalance, and epigenetic reprogramming, converging on critical signaling pathways including phosphatidylinositol 3-kinase/protein kinase B/ mammalian target of rapamycin and interleukin-6/Janus kinase/signal transducer and activator of transcription 3. Clinically, this metabolic-tumor axis is reflected in altered molecular subtypes, reduced treatment efficacy, and increased therapy-related toxicity, highlighting the need for integrated management approaches. Traditional cancer treatment models may not fully meet the needs of contemporary patients, necessitating the development of precision interventions and comprehensive management strategies. Repurposing metabolic agents (e.g. , metformin, glucagon-like peptide-1 receptor agonists), implementing structured lifestyle changes, and considering bariatric surgery, alongside emerging technologies such as multi-omics, spatial transcriptomics, and artificial intelligence-driven multimodal risk prediction, are key to advancing precision prevention and personalized survivorship care. Incorporating metabolic health into breast cancer management has become an essential paradigm shift, pivotal for disease prevention, personalized treatment, and prolonged, high-quality survivorship.

EIT-guided individualized PEEP titration versus conventional lung-protective ventilation to prevent pulmonary complications in laparoscopic bariatric surgery: a study protocol for a randomized controlled trial.