Mean Change In BMI Research Articles

Glucagon-like peptide agonists for weight management in antipsychotic-induced weight gain: A systematic review and meta-analysis.

Managing body weight in patients with antipsychotic-induced weight gain (AIWG) is challenging. Besides lifestyle interventions, pharmacological interventions may contribute to weight loss. This systematic review and meta-analysis evaluated the effect on weight loss and adverse effects of glucagon-like peptide-1 (GLP-1) agonists in patients with AIWG. Following PRISMA guidelines, we performed a meta-analysis of blinded and open-label randomised controlled trials (RCTs), non-randomised controlled trials and cohort studies that evaluated treatment with GLP-1 in patients with AIWG, regardless of psychiatric diagnosis. PubMed, Embase, PsycINFO and Cochrane Library databases were searched. Primary outcome measures were changes in body weight and BMI. Secondary outcomes were changes in adverse effects and severity of psychopathology due to GLP-1 agonists. Only data for exenatide and liraglutide could be included, that is, five RCTs and one cohort study. For exenatide the mean weight loss was -2.48 kg (95% Confidence Interval (CI) -5.12 to +0.64; p = 0.07), for liraglutide the mean weight loss was -4.70 kg (95% CI -4.85 to -4.56; p < 0.001). The mean change in BMI was -0.82 (95% CI -1.56 to -0.09; p = 0.03) in the exenatide groups and -1.52 (95% CI -1.83 to -1.22; p < 0.001) in the liraglutide groups. Exenatide and liraglutide did not adversely affect psychopathology. The most common adverse events were nausea, vomiting, and diarrhoea. The GLP-1 agonists exenatide and liraglutide are promising drugs for inducing weight loss in patients with AIWG. The adverse effects are acceptable, and the addition of GLP-1 does not increase the severity of psychopathology. However, more research is needed.

Association of dietary adherence and dietary quality with weight loss success among those following low-carbohydrate and low-fat diets: a secondary analysis of the DIETFITS randomized clinical trial

BackgroundEating a high-quality diet or adhering to a given dietary strategy may influence weight loss. However, these 2 factors have not been examined concurrently for those following macronutrient-limiting diets. ObjectiveTo determine whether improvement in dietary quality, change in dietary macronutrient composition, or the combination of these factors is associated with differential weight loss when following a healthy low-carbohydrate (HLC) or healthy low-fat (HLF) diet. DesignGenerally healthy adults were randomly assigned to HLC or HLF diets for 12 mo (n = 609) as part of a randomized controlled weight loss study. Participants with complete 24-h dietary recall data at baseline and 12-mo were included in this secondary analysis (total N = 448; N = 224 HLC, N = 224 HLF). Participants were divided into 4 subgroups according to 12-mo change in HEI-2010 score [above median = high quality (HQ) and below median = low quality (LQ)] and 12-mo change in macronutrient intake [below median = high adherence (HA) and above median = low adherence (LA) for net carbohydrate (g) or fat (g) for HLC and HLF, respectively]. Baseline to 12-mo changes in mean BMI were compared for those in HQ/HA, HQ/LA, LQ/HA subgroups with the LQ/LA subgroup within HLC and HLF. ResultsFor HLC, changes (95 % confidence level [CI]) in mean BMI were -1.15 kg/m2 (-2.04, -0.26) for HQ/HA, -0.30 (-1.22, 0.61) for HQ/LA, and -0.80 (-1.74, 0.14) for LQ/HA compared with the LQ/LA subgroup. For HLF, changes (95% CI) in mean BMI were -1.11kg/m2 (-2.10, -0.11) for HQ/HA, -0.26 (-1.26, 0.75) for HQ/LA, and -0.66 (-1.74, 0.41) for LQ/HA compared with the LQ/LA subgroup. ConclusionWithin both HLC and HLF diet arms, 12-mo decrease in BMI was significantly greater in HQ/HA subgroups relative to LQ/LA subgroups. Neither HQ nor HA alone were significantly different than LQ/LA subgroups. Results of this analysis support the combination of dietary adherence and high-quality diets for weight loss. Clinical Trial Registryclinicaltrials.gov (Identifier: NCT01826591).

Weight gain and metabolic disturbances in people living with HIV who start antiretroviral therapy with, or switch to, bictegravir/emtricitabine/tenofovir alafenamide after 48 weeks of treatment: A real-world prospective study.

People living with HIV (PLWH) starting or switching to an integrase strand transfer inhibitor-based regimen are more likely to experience weight gain than other classes of antiretroviral regimens. The aim of this study was to evaluate the weight gain and metabolic disturbances in PLWH who start antiretroviral therapy (ART) with bictegravir/emtricitabine/tenofovir alafenamide and in individuals who switch from another ART to BIC/FTC/TAF after 48weeks. A prospective longitudinal study was conducted in an HIV clinic in Mexico. Weight and metabolic parameters were measured at baseline, 24 and 48weeks. A paired t test and Wilcoxon signed-rank test were applied to evaluate weight and metabolic changes. 160 participants completed measurements, median age was 29 (IQR 26-32) and 30 (IQR 27-34)years old for the treatment-naïve and switch group respectively. In the treatment-naïve group, mean weight change was 3.8kg (±5.8) (p < .001) and BMI increased 1.3kg/m2 (±2) (p < .001) at 48weeks. Incidence of BMI >25kg/m2 was 28% (95%CI; 18%-40%) and BMI >30kg/m2 was 7% (95%CI; 2%-16%) at 48weeks in treatment-naïve individuals. In the switch group, mean weight gain and BMI change at 48weeks was 2.8kg (±5.9) and 0.9kg/m2 (±2.0) respectively (p < .001). Incidence of BMI >25kg/m2 was 17% (95%CI; 8%-32%) and BMI >30kg/m2 12.8% (95%CI; 5%-26%) at 48weeks respectively. Weight gain should be considered when men PLWH are treated with BIC/FTC/TAF regimen. They should be informed about this possible adverse event and strategies of intervention.

52-OR: Effect of Oral Nonpeptide GLP-1 Receptor Agonist Orforglipron (LY3502970) in Participants with Obesity or Overweight—A Phase 2 Study

Orforglipron (OFG) is a novel once daily oral non-peptide GLP-1 receptor agonist (RA) which can be taken with or without food, in development for chronic weight management. The objective of this Phase 2 study was to assess the efficacy, safety, and tolerability of OFG in patients with obesity or overweight with ≥1 weight-related comorbidity. Participants (N=272) were randomized to placebo or OFG (12, 24, 36, or 45 mg) treatment. OFG doses were increased to target using different dose escalation schemes in each arm. The primary endpoint was to compare percent body weight (BW) change from baseline in OFG vs placebo at Week 26, while the study continued to 36 weeks. Secondary endpoints included change from baseline in waist circumference (WC) and BMI, and the percentage of participants achieving ≥5 or ≥10% weight loss. At baseline, mean BW was 108.7 kg, BMI was 37.9 kg/m2, and 94% of participants had a BMI ≥30 kg/m2. Mean percentage BW loss, mean change in BMI and WC, and the percentage of participants achieving ≥5% or ≥10% weight loss were significantly greater with all OFG doses vs placebo (Figure). The AE profile was similar to other GLP-1 RAs; most were GI-related and mild to moderate in severity. The novel non-peptide GLP-1 RA OFG led to greater reductions in BW, BMI, and WC compared with placebo. These promising data support continued development of OFG as an oral treatment for obesity. Disclosure S.Wharton: Advisory Panel; Novo Nordisk, Eli Lilly and Company, Boehringer Ingelheim International GmbH, Bausch Health, Canada, Research Support; Novo Nordisk, Eli Lilly and Company, Speaker's Bureau; Novo Nordisk, Eli Lilly and Company, Bausch Health, Canada. C.M.Kazda: Employee; Eli Lilly and Company. M.Konig: None. T.Blevins: Other Relationship; Medtronic, Research Support; Lilly Diabetes, Novo Nordisk, Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Medtronic, Speaker's Bureau; Lilly Diabetes, Novo Nordisk A/S. L.B.Connery: None. J.Rosenstock: Advisory Panel; Applied Therapeutics Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Novo Nordisk, Oramed Pharmaceuticals, Sanofi, Zealand Pharma A/S, Intarcia Therapeutics, Inc., Hanmi Pharm. Co., Ltd., Research Support; Applied Therapeutics Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novartis, Novo Nordisk, Pfizer Inc., Sanofi, Intarcia Therapeutics, Inc. S.Raha: Employee; Eli Lilly and Company. K.J.Mather: Employee; Eli Lilly and Company. A.Haupt: Employee; Lilly, Stock/Shareholder; Lilly. D.A.Robins: None. E.J.Pratt: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

755-P: A Phase 2 Evaluation of a Novel GLP-1 Analog Ecnoglutide (XW003) for Glycemic Control in Adults with Type 2 Diabetes

Ecnoglutide (XW003) is a novel, long-acting GLP-1 analog being developed for the treatment of type 2 diabetes mellitus (T2DM) and obesity. We conducted a Phase 2 randomized, double-blind, placebo-controlled study of ecnoglutide, which enrolled 145 adults at over 20 hospital-based sites in China. Eligible participants had T2DM that was inadequately controlled by lifestyle or a single oral hypoglycemic agent. Participants were randomized to receive 0.4, 0.8, or 1.2 mg ecnoglutide or placebo as once weekly injections for 20 weeks, including dose escalation. Change in mean HbA1c, body weight, and BMI, as well as safety and tolerability were evaluated. At baseline, participants had mean HbA1c of 8.55 ± 0.707 % and BMI of 26.27 ± 3.308 kg/m2. At the end of treatment, participants receiving ecnoglutide achieved significant HbA1c reductions of 1.81% to 2.39% from baseline (P&amp;lt;0.0001 for all cohorts vs placebo). At end of treatment, up to 67% of participants in the ecnoglutide cohorts achieved HbA1c levels ≤6.5% and up to 33% had body weight reductions ≥5% from baseline (Figure). Ecnoglutide was generally safe and well tolerated. There were no treatment-related ≥Grade 3 AEs and no treatment-related SAEs. The proportion of participants reporting any AE ranged from 72.2 to 78.4% for ecnoglutide and 58.3 % for placebo. The most frequently reported AEs were gastrointestinal, including diarrhea and nausea. Disclosure D.Zhu: None. S.Xu: Employee; Sciwind. M.K.Junaidi: None. H.H.Qin: Employee; Sciwind Biosciences, Sichuan Anerobic Biotech. Q.Zheng: Employee; Sciwind Biosciences. J.Ning: None. Z.Zhu: Employee; Sciwind Biosciences. G.Mengying: None. Y.Bu: Employee; Sciwind Biosciences. C.Jones: Employee; Sciwind Biosciences. M.Fenaux: Employee; Sciwind Biosciences, Stock/Shareholder; Terns Pharmaceuticals. Funding Sciwind Biosciences

756-P: A Phase 1c Evaluation of a Novel GLP-1 Analog Ecnoglutide (XW003) for Weight Loss in Adults with Overweight and Obesity

Ecnoglutide (XW003) is a novel, long-acting GLP-1 analog being developed for the treatment of type 2 diabetes and obesity. We conducted a Phase 1c randomized, double-blind, placebo-controlled study of ecnoglutide, which enrolled 60 nondiabetic adults with BMI 24-35 kg/m2. The study was conducted in China. PK, change in mean body weight and BMI, safety, and tolerability were evaluated. Participants received 1.8 or 2.4 mg ecnoglutide or placebo as once weekly injections for 14 weeks, including dose escalation. This core treatment was followed by an open-label extension of the ecnoglutide groups, for a total duration of 26 weeks. At baseline, participants had a mean body weight of 84.61 ± 10.44 kg and BMI of 29.53 ± 1.73 kg/m2. After 14 weeks of core treatment, mean weight reduction from baseline was -8.29 ± 0.52 kg in the 1.8 mg ecnoglutide group and -7.24 ± 0.56 kg in the 2.4 mg group, compared to -0.61 ± 0.82 kg for placebo (P&amp;lt;0.0001 vs placebo for both doses). At Week 14, the proportion of participants achieving ≥5% weight loss from baseline was 87.5% (95% CI, 67.6 to 97.3) and 70.0% (95% CI, 45.7 to 88.1) for 1.8 and 2.4 mg ecnoglutide, respectively, and 22.2% (95% CI, 2.8 to 60.0) for placebo. Continued weight reduction was observed until the end of study at Week 26, with a mean percent change from baseline of -15.0% (95%CI, -16.8 to -13.2) and -13.2% (95% CI, -15.3 to -11.1) for 1.8 and 2.4 mg ecnoglutide, respectively. At Week 26, ≥5% weight loss was observed for 94.7% (95% CI, 74.0 to 99.9) of participants in the 1.8 mg group and 100.0% (95% CI, 75.3 to 100.0) in the 2.4 mg group. At steady state, ecnoglutide showed a mean Cmax of 310 - 468 ng/mL, Tmax of 26 - 29 h, and half-life of 139 - 162 h. Overall, ecnoglutide was safe and well tolerated. The proportion of participants reporting any AE was similar between cohorts (95.2 to 100% for ecnoglutide vs 90% for placebo). The most frequent AEs were gastrointestinal, including diarrhea and vomiting. No drug-related SAE or drug-related AEs ≥Grade 3 were reported. Disclosure G. Wang: None. W. Hu: None. H.H. Qin: Employee; Sciwind Biosciences, Sichuan Anerobic Biotech. Q. Zheng: Employee; Sciwind Biosciences. J. Ning: None. G. Mengying: None. Y. Bu: Employee; Sciwind Biosciences. C. Jones: Employee; Sciwind Biosciences. M. Fenaux: Employee; Sciwind Biosciences. Stock/Shareholder; Terns Pharmaceuticals. S. Xu: Employee; Sciwind. M.K. Junaidi: None. Funding Sciwind Biosciences

RELATIONSHIP BETWEEN BMI IN ADOLESCENCE, BMI TRAJECTORIES IN ADULTHOOD AND CHRONIC KIDNEY DISEASE OUTCOMES: POPULATION-BASED COHORT STUDY

Objective: We aimed to investigate the association of BMI in late adolescence and BMI trajectories in adulthood with chronic kidney disease (CKD), end-stage kidney disease (ESKD) and acute kidney injury (AKI) later in life. Design and method: Two cohort analyses were performed, firstly evaluating the link between adolescent BMI and CKD, ESKD and AKI throughout life, secondly assessing the link between BMI change from adolescence to midlife, and the risk of CKD, ESKD and AKI thereafter. Data from the Swedish Conscription Register, the Northern Sweden Health and Disease Study, the Swedish National Patient Register and the Cause of Death Register were included. Patients were stratified into quintiles of BMI in adolescence and BMI change until midlife. Data were analysed using Cox proportional hazards model. Results: 1 324 831 subjects met the inclusion criteria for BMI evaluation in late adolescence. The mean age at conscription was 18.3±0.8 years and the average BMI was 21.6±2.6 kg/m2. 5593 subjects developed CKD, 2358 developed ESKD and 8029 developed AKI. In the adjusted analyses, an increased risk of developing CKD and ESKD was seen from the fourth BMI quintile (HR 1.25, 95% CI 1.15-1.36 for BMI 21.9-23.6 kg/m2; HR 2.13, 95% CI 1.97-2.31 for BMI &gt;23.6 kg/m2, for CKD), whereas the risk of AKI was increased already from the third BMI quintile (HR 1.15, 95%CI 1.15-1.24 for BMI 20.7-21.9 kg/m2). 32 221 subjects in a regional cohort had an additional BMI evaluation at mean age 42.1±8.6 years. The mean change in BMI between assessments was 4.8±3.2 kg/m2. We found that BMI increase of &gt;7 kg/m2 from late adolescence to mid-life was associated with higher risk of CKD (HR 2.78, 95%CI 1.45-5.30) and AKI (3.49, 2.23-5.47) in non-adjusted analyses; only AKI persisted after adjustment (HR 2.60, 95%CI 1.58-4.28). Conclusions: To conclude, BMI in late adolescence is associated with CKD and ESKD, with increased risk from BMI levels &gt;21.9 kg/m2. BMI increase during adulthood was only associated with an increased risk of AKI after covariate-adjustment, suggesting that adolescence is a critical period for the association between BMI and future kidney disease.

Explaining adult obesity, severe obesity, and BMI: Five decades of change

Obesity rates have increased across all segments of society since the late 1970s, but the reason behind population-level increases in body weight remains unclear. We used the 1971–2020 NHANES data to examine whether the observed trend in obesity prevalence is attributable to changing public health behaviors (i.e., intracohort change) or changing publics (i.e., cohort replacement). We partitioned total change in mean BMI, and rates of obesity and severe obesity, into its IC and CR components using linear and algebraic decomposition methods. We found that the IC mechanism (i.e., broad sectors of individuals changing) plays a dominant role in the overall increase in mean BMI, and obesity and severe obesity prevalence. Birth cohort membership (i.e., the CR mechanism) is also influencing mean BMI, and rates of obesity and severe obesity, but in differing ways. Specifically, the large positive IC and the small positive CR effects are amplifying one another, thus creating a steep increase in the observed rates of severe obesity. Conversely, the large positive IC effect is offset by a small negative CR effect, which created a more gradual rise in mean BMI and rates of obesity. Furthermore, we computed total change for models that entered separately sociodemographic, lifestyle, nutritional, and physical activity measures to estimate differences in mean BMI, and rates of obesity and severe obesity, among cohorts and time periods. Adjustment for all the compositional differences among the cohorts during the study period indicate that a combination of a more pronounced IC and a less pronounced CR drove the observed increase in mean BMI, and rates of obesity and severe obesity. Thus, “universal prevention” (i.e., entire community) strategies for healthy weight promotion may need to be combined with “selective prevention” (i.e., at-risk groups) and/or “targeted prevention” (i.e., at-risk individuals) approaches in order to reverse the obesity epidemic.

Blood Group and Response to Bariatric Surgery in Morbidly Obese Patients: A Retrospective Study in Saudi Arabia.

To explore the relationship between the blood group of patients and their response to bariatric surgery and to identify predictors of better outcomes. This was a retrospective cross-sectional analysis of patients who underwent laparoscopic sleeve gastrectomy for morbid obesity between 2014 and 2020 at King Saud University Medical City in Riyadh, Saudi Arabia. This study included 1434 individuals. The mean change in BMI (pre- versus post-BMI) differed statistically significantly between blood groups (p ≤ 0.01). The greatest drop in body weight was seen in individuals with the AB-negative blood type (56.0 (21.4) kg), which corresponds to the greatest percentage of reduction from baseline (47.7% (14.8)). The mean BMI of the patients decreased by 34.7% (9.2) from a mean pre-operation BMI of 45.5 (8.4) kg/m2 to 29.7 (6.1) kg/m2 (p ≤ 0.001). After laparoscopic sleeve gastrectomy, male patients and those with the B-negative blood type are more likely to see a greater BMI reduction (pre-operation compared to post-operation) (p ≤ 0.05). For morbidly obese patients, laparoscopic sleeve gastrectomy demonstrated promising weight loss outcomes. Blood groups may be able to predict the success rate of bariatric surgery in morbidly obese patients.

Once-Weekly Semaglutide in Adolescents with Obesity

BackgroundA once-weekly, 2.4-mg dose of subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist, is used to treat obesity in adults, but assessment of the drug in adolescents has been lacking.MethodsIn this double-blind, parallel-group, randomized, placebo-controlled trial, we enrolled adolescents (12 to <18 years of age) with obesity (a body-mass index [BMI] in the 95th percentile or higher) or with overweight (a BMI in the 85th percentile or higher) and at least one weight-related coexisting condition. Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68.ResultsA total of 201 participants underwent randomization, and 180 (90%) completed treatment. All but one of the participants had obesity. The mean change in BMI from baseline to week 68 was −16.1% with semaglutide and 0.6% with placebo (estimated difference, −16.7 percentage points; 95% confidence interval [CI], −20.3 to −13.2; P<0.001). At week 68, a total of 95 of 131 participants (73%) in the semaglutide group had weight loss of 5% or more, as compared with 11 of 62 participants (18%) in the placebo group (estimated odds ratio, 14.0; 95% CI, 6.3 to 31.0; P<0.001). Reductions in body weight and improvement with respect to cardiometabolic risk factors (waist circumference and levels of glycated hemoglobin, lipids [except high-density lipoprotein cholesterol], and alanine aminotransferase) were greater with semaglutide than with placebo. The incidence of gastrointestinal adverse events was greater with semaglutide than with placebo (62% vs. 42%). Five participants (4%) in the semaglutide group and no participants in the placebo group had cholelithiasis. Serious adverse events were reported in 15 of 133 participants (11%) in the semaglutide group and in 6 of 67 participants (9%) in the placebo group.ConclusionsAmong adolescents with obesity, once-weekly treatment with a 2.4-mg dose of semaglutide plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone. (Funded by Novo Nordisk; STEP TEENS ClinicalTrials.gov number, NCT04102189.)

Recipes for Health: A Community-Based Nutrition and Culinary Intervention.

Obesity is a major public health concern in the United States, especially since it has been associated with an increased incidence of multiple co-morbidities. Positive eating behavior modifications learned through nutrition education sessions are the main interventions proposed to target overweight and obesity. The aim of this study was to determine if nutrition education and hands-on cooking classes will result in improvement in eating habits and cooking skills tomanage chronic disease. Methods: A convenience sample of 21 participants were recruited from primary health clinics in Miami-Dade, Broward, and Palm Beach counties. A total of eight weekly virtual lessons were conducted, which included both a culinary and a nutrition education portion. At baseline and post-intervention, participants filled out a validated questionnaire with questions related to nutrition knowledge and behavior, fruit and vegetable consumption, and cooking skills. Weight was self-reported. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) and included descriptive statistics and a paired t-test to compare pre- and post-intervention data. Throughout the eight weeks, subject attendance ranged from 61-95%. Nineteen participants completed the post-intervention questionnaire. Results showed a statistically significant mean weight loss of 3.74 ±5.26 lbs (p=0.006) and a statistically significant mean BMI change of -0.66 ±0.86 (p=0.004) at post-intervention compared to baseline. In addition, subjects reported increased confidence in dietary habits and culinary skills post-intervention. Our results show exciting data in support of this project's objectives that a healthy cooking intervention can increase nutrition knowledge, increase confidence in healthy food choices, increase confidence in food preparation skills, and improve weight and BMI in participants.

870 The Efficacy and Safety of Bariatric Surgery in Kidney Transplantation Candidates: A Systematic Review and Meta-Analysis

Abstract Introduction Kidney transplantation (KT) remains a high-risk procedure which requires extensive pre-operative assessment and optimisation. Obesity is known to increase the risk of adverse post-operative consequences. Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in KT candidates. Method We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients KT candidates. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT rate. Results Nine observational studies met the inclusion criteria with a total of 179 patients (48% male). Mean change in BMI following BS was -11.2 (-12.9 to -9.5, p &amp;lt; 0.001) within a median follow up time of 43 months (IQR 36 to 47 months). Sleeve gastrectomy (44.7%, n=80) and gastric bypass (46.9%, n=84) were the most common procedures. Median time from BS to KT was 17 months (IQR 6 to 18 months) with a mean KT rate of 80.1% (SD = 14.9). Conclusion This review highlights that BS is both safe and efficacious for KT candidates and can be an effective means of optimising BMI prior to transplantation.

871 The Efficacy and Safety of Bariatric Surgery in Patients with End-Stage Renal Disease Awaiting Listing for Kidney Transplantation: A Systematic Review and Meta-Analysis

Abstract Aim Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and hinders changes for waiting list allocation of kidney transplantation (KT). Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in ESRD awaiting KT. Method We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients with ESRD awaiting KT. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT listing rate. Results Nine observational studies met the inclusion criteria with a total of 1903 patients (43.9% male). Mean change in BMI following BS was -11.3 (-15.3 to -7.3, p &amp;lt;0.001) within a median follow up time of 27.6 months (IQR 12 to 36.6 months). Sleeve gastrectomy (44.6%, n=849) and gastric bypass (43.6%, n=829) were the most common procedures. Mean age at BS was 47.3 years with a mean rate to KT listing of 59.9% (SD = 1.13). Conclusion This review highlights that BS is both safe and efficacious on patients with ESRD and can aid with optimisation for waiting list allocation.

864 The Efficacy and Safety of Bariatric Surgery in Patients with Previous Kidney Transplantation: A Systematic Review and Meta-Analysis

Abstract Introduction Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and those with prior kidney transplantation (KT). Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in those with KT. Method We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients with ESRD awaiting KT. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT listing rate. Results Ten observational studies met the inclusion criteria with a total of 198 patients (45.1% male). Mean change in BMI following BS was -11.0 (-14.9 to -7.1, p &amp;lt; 0.001) within a median follow up time of 30 months (IQR 25 to 139 months). Gastric bypass (49.5%, n=98) was the most common procedure. Mean age at BS was 46.5 years (SD = 5.5) with a mean time from KT to BS of 4.9 (SD = 1.9). The 5-year graft failure rate (Post BS) was 18.6% (n = 7). Conclusions This review highlights that BS is both safe and efficacious on patients with a previous history of KT.

268 The Efficacy and Safety of Bariatric Surgery in Patients with End-Stage Renal Disease and Kidney Transplantation: A Systematic Review and Meta-Analysis

Abstract Aim Obesity is associated with adverse outcomes in end-stage renal disease (ESRD) and kidney transplant (KT) recipients. Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in ESRD or KT. Method A literature search was conducted using MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Articles were categorised into patients awaiting waiting list acceptance, awaiting transplantation, undergoing simultaneous BS and kidney transplantation, and undergoing BS following transplantation in the past. Primary outcome was change in BMI with secondary outcomes as adverse events, graft outcomes and KT. Results Twenty-eight articles were selected: fourteen on patients awaiting listing (n = 1984), nine on patients listed for KT (n = 196), one on simultaneous BS and KT and ten on patients undergoing BS following KT (n = 198). Mean change in BMI for patients awaiting listing was -10.5 (-4.1 to -17.0, p = 0.001), change in BMI for patients listed for KT was -11.2 (-9.5 to -12.9, p&amp;lt;0.001) and change for patients with prior KT was -11.0 (-7.09 to -14.9, p&amp;lt;0.001). 60.4% of patients undergoing BS were successfully listed for KT. 74.1% of patients listed for KT undergoing BS underwent KT within 17 months (SD = 78.5). Time from KT to BS was 59.2 months (SD = 43.0). Conclusion BS is both safe and efficacious on patients with ESRD, those awaiting KT, and those with prior KT and should be considered when obesity is a hurdle to favourable outcomes.

TU1.2 Revisional Bariatric Surgery: 7-Year Experience from a Tertiary Institution

Abstract Background Revisional surgery is an expanding area in bariatric surgery which reflects a rising need to treat adverse sequelae of primary procedures. Despite the increase, their safety and efficacy remain unclear. We aimed to review revisional bariatric surgery indications and outcomes at our tertiary centre. Methods Data on revisional bariatric surgery was collected prospectively from 2013 and analysed retrospectively, including indications and postoperative outcomes. Results From January 2013 to December 2021, 80 patients (mean age: 51.4 years) undergoing revisional surgery were identified: 38 laparoscopic gastric band (LGB) to Roux-en-Y gastric bypasses (RYGB), 34 sleeve gastrectomies (SG) to RYGB, 6 mini-gastric bypasses (MGB) to RYGB and 2 RYGB revisions. The most common indication for revision was weight regain (56.4%) followed by intolerable reflux (21.3%). Other indications included band complications (15%), obesity-related problems (2.5%), excessive weight loss (2.5%), corkscrewing of sleeve (1.3%), and dumping syndrome (1.3%). There were 11 post-operative complications, with mean length of stay of 2.8 days. In addition to treating primary complications, the mean change in BMI at 12 months for LGB to RYGB revisions and SG to RYGB revisions was -9.5 and -5.3 respectively. Average change in BMI at 24 months for LGB to RYGB revisions and SG to RYGB revisions was -9.4 and -8.6 respectively. Conclusion Revisional bariatric surgery effectively treated the undesirable results from primary surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic procedures with minimal complications. In experienced hands, with careful patient selection &amp; education, satisfactory additional weight loss can be achieved.

Weight Bias: Examining Achalasia Therapy in the Obese Patient.

We hypothesize that obesity is a common diagnosis in those with achalasia at our institution but time to diagnosis and treatment is longer compared to normal weight counterparts due to implicit bias. We retrospectively reviewed all adult patients between 1/1/2013 and 6/31/2020 with a diagnosis of achalasia. Demographics, comorbidities, Eckardt scores, interventions, complications, time to consult, duration of symptoms, and follow-up were evaluated. More than half of the patients were seen in the most recent 2 years following POEM introduction and 138 had available BMI data. 46 were obese (33%) and 92 were non-obese (67%). Obese patients reported a shorter duration of symptoms prior to seeking treatment 12 versus 24 months. There was no difference in time to intervention or procedure offered. There was a non-significant trend toward higher leak (11 vs 5%) and overall complication rate (19 vs 17%) in obese patients. In follow-up 98 patients had BMI data. There was a a significant difference in mean BMI change -1.2 +/- 4.2 kg/m2 in obese patients and +0.1 +/- 2.1 kg/m2 in normal weight patients. One year follow-up was available in 16 (47%) obese and 25 (33%) non-obese patients and showed a non-significant trend toward greater weight gain in the normal/overweight group (+3.2 +/- 1.1 kg/m2) compared to obese (+2.0 +/- 3.5 kg/m2). Obese patients with achalasia have unique considerations. Duration of symptoms may be shorter in the obese patient with esophageal dysphagia. We noted trends toward greater weight gain following interventions in non-obese patients with equivalent complication rates.

Exenatide for weight-loss maintenance in adolescents with severe obesity: A randomized, placebo-controlled trial.

This study sought to evaluate the effect of 52 weeks of exenatide extended release (XR) on the maintenance of meal replacement therapy (MRT)-induced BMI reduction in adolescents with severe obesity. In this randomized, double-blind, placebo-controlled trial, 100 participants aged 12 to 18 years with BMI≥1.2 × 95th percentile were enrolled in a short-term MRT run-in phase. Those who achieved ≥5% BMI reduction during the run-in were then randomized to 52 weeks of exenatide XR 2.0 mg or placebo weekly. Both groups also received lifestyle therapy. The prespecified primary end point was mean percent change in BMI from randomization (post run-in) to 52 weeks in the intention-to-treat population. A total of 100 participants were enrolled, and 66 (mean age 16 = [SD 1.5] years; 47% female) achieved ≥5% BMI reduction with MRT and were randomized (33 to exenatide XR and 33 to placebo). From randomization (post run-in) to 52 weeks, mean BMI increased 4.6% and 10.1% in the exenatide XR and placebo groups, respectively. The placebo-subtracted exenatide XR treatment effect was -4.1% (95% CI: -8.6% to 0.5%, p = 0.078). Although not achieving statistical significance, exenatide XR, compared with placebo, may partly mitigate the propensity toward BMI rebound in adolescents who achieved initial weight loss with dietary intervention.

Dietary Counseling Aimed at Reducing Sugar Intake Yields the Greatest Improvement in Management of Weight and Metabolic Dysfunction in Children with Obesity.

Pediatric obesity is a significant public health problem, the negative outcomes of which will challenge individual well-being and societal resources for decades to come. The objective of this study was to determine the effects of dietary counseling on weight management and metabolic abnormalities in children with obesity. One hundred and sixty-five patients aged 2–18 years old were studied over a two and a half year period. Data collected included demographic information, anthropometric assessment, laboratory measurements, and self-reported eating behaviors. Dietary counseling was provided at each visit. The data was analyzed from the first and last visits and the subjects were retrospectively divided into responders and non-responders based on a decrease in their BMI. After receiving dietary guidance, BMI decreased in 44% of the children, and these participants were classified as responders (BMI-R; n = 72). However, BMI did not improve in 56% of the participants, and these were classified as non-responders (BMI-NR; n = 93). At the initial visit, anthropometric measurements and dietary habits were similar between the groups. At the time of the last visit, mean change in BMI was −1.47 (SD 1.31) for BMI-R and +2.40 (SD 9.79) for BMI-NR. Analysis of food intake revealed that BMI-R significantly improved their dietary habits (p = 0.002) by reducing the intake of sugar-sweetened beverages (p = 0.019), processed foods (p = 0.002), sweets (p < 0.001), and unhealthy snacks (p = 0.009), as compared with BMI-NR. There was no change in the intake of second helpings, portion sizes, skipping meals, frequency of meals eaten at school, condiment use, intake of fruits and vegetables and consumption of whole grains between the groups. BMI-R also achieved an improvement in fasted glucose (p = 0.021), triglycerides (p < 0.001), and total cholesterol (p = 0.023), as compared to BMI-NR. In conclusion, children with obesity who were able to decrease their BMI implemented a significant reduction in consumption of foods with high sugar content. Focusing on reducing sugar intake may yield the biggest impact in terms of weight management and the improvement of metabolic abnormalities.

P566 Impact of induction therapy and clinical remission on resting energy expenditure in children with Crohn’s Disease

Abstract Background Crohn’s Disease (CD) is known to affect nutritional status and linear growth in affected children. Patients with CD often have decreased oral intake, malabsorption, and increased intestinal losses. Basal metabolic rate may be affected by chronic inflammation and states of anorexia or malnutrition in these patients. In this study, our aim was to compare the effect of different induction regimens in children with CD on resting energy expenditure (REE) and nutritional status. Methods We recruited patients under 18 years old with new-onset CD or relapse, diagnosed at our centre over a three-year period from July 2016. Patients included had one of the following induction regimens: corticosteroids, exclusive enteral nutrition (EEN), or anti-TNF therapy (Infliximab). REE was assessed at baseline and 6 to 8 weeks after induction. REE (kcal/d) was measured using an open-circuit indirect calorimeter with computerized metabolic cart (Vmax Encore, Vyaire Medical). Secondary outcomes included anthropometrics and clinical and biochemical response, defined by improved wPCDAI and negative inflammatory markers and fecal calprotectin, respectively. Results 17 patients were enrolled and 8 patients excluded (loss to follow-up (n=3), therapeutic change (n=3), revised diagnosis (n=2)). 9 patients completed REE assessments (44.4% anti-TNF (n=4), 44.4% EEN (n=4), 11.1% corticosteroid (n=1)). 3 out of 4 patients on anti-TNF had clinical and biochemical response, while only 1 of 4 patients responded to EEN. For patients in the EEN group, mean BMI change was +0.9 (SD 0.4), compared to +0.4 (SD 1.1) in the anti-TNF group. There was no difference in REE change between treatment groups. Data was then pooled based on response to treatment. 100% of non-responders had increased per cent of predicted REE (REEPP), while 75% of responders decreased their REEPP. Mean REEPP change in non-responders was +12.5% (1, 22) vs. -4.3% (-10, 6) in responders. Figure I. Relationship between REE and weight at baseline and on follow-up in non-responders. Figure II. Relationship between REE and weight at baseline and on follow-up in responders. Conclusion Our results suggest that induction regimen did not impact REE change on follow-up. In our patients, clinical response to therapy was related to a tendency to decrease REE. Patients who did not achieve remission after induction therapy increased their REE. We suspect that this increase in basal metabolic rate is related to persistent inflammation despite improved nutritional status. Further studies with larger patient populations are needed to infer significance and compare subgroups based on body composition.