Differences In Weight Loss Outcomes Research Articles

Safety and Effectiveness of Two Different Fluid-Filled Intragastric Balloons: A Single Center Experience.

The aim of the study is to compare weight loss and safety outcomes of two different commonly available fluid-filled intragastric balloons (IGBs) used for weight loss. A retrospective cohort study of a prospectively maintained database of adult patients who underwent IGB insertion between July 2020 and November 2021 in a single private clinic in Kuwait. The patient either received the Elipse™ or Orbera365™ balloon and was followed until the end of treatment. A total of 358 patients were included, of which 265 and 93 each received the Elipse and Orbera365 balloons, respectively. The mean age of patients was 32.8 (SD 9), the mean body mass index (BMI) was 35kg/m2 (SD 4.8), and 72.1% of patients were female. In the Elipse group, 254 patients completed treatment, and 84 patients completed the treatment with Orbera365. Weight loss outcomes were measured at the end of treatment: 4months after Elipse insertion, and 12months after Orbera365 insertion. Interim 4months weight loss outcomes were also measured for the Orbera365 balloon. Patients in the Orbera365 group had significantly better total body weight loss (%TBWL, 14.7kg [SD 8.9]) compared to the Elipse group (%TBWL 10kg, [SD 5.6], p ≤ 0.0001) at the end of treatment, while there was no difference in weight loss outcomes between the two balloons at 4months. There were more complications requiring premature balloon removal in the Orbera365 group (9.7%) compared to the Elipse group (3.4%). IGBs provide significant weight loss with an acceptable safety profile. The Orbera365 ballon shows better weight loss outcomes compared to the Elipse, likely due to longer duration of treatment. However, there was a higher rate of complications requiring premature balloon removal in the Orbera365 group. Studies with larger patient cohort is needed to verify the findings of this study.

Gender differences in adherence and retention in Mediterranean diet interventions with a weight-loss outcome: A systematic review and meta-analysis.

The Mediterranean diet has been shown to be effective in improving health outcomes and for weight loss. Adherence and retention in dietary interventions are critical to ensure the benefits of the exposure. No studies to date have assessed the role of gender in understanding participants who remain engaged and adhere to Mediterranean diet interventions. This study aimed to explore gender differences in recruitment, adherence, and retention for Mediterranean diet interventions and whether these were associated with differences in weight-loss outcomes. A systematic search was completed in EMBASE, Medline, Cochrane, and clinicaltrials.gov from inception to March 2023. A meta-analysis of studies reporting retention by gender was completed using odds ratios comparing female to male dropout numbers. A second meta-analysis was completed for adherence comparing standardized mean difference of Mediterranean diet scores stratified by gender. Newcastle Ottawa score was used to assess risk of bias. A total of 70 articles were included in the systematic review with six articles included in the adherence meta-analysis and nine in the dropout meta-analysis. No statistically significant difference was shown for adherence or retention by gender. Weight-loss outcomes were inconsistent. The results of the study suggest a higher adherence and lower dropout for women although these results were not statistically significant. Future studies of Mediterranean diet interventions should include adherence, retention, and weight-loss data stratified by gender to allow further investigation of this relationship.

Improving Equity of Access to a Publicly Funded Bariatric Surgery Programme by Removal of Mandatory Weight Loss Targets.

Obesity disproportionately affects 50.8% of Māori and 71.3% of Pacific adults in New Zealand, and these groups also have reduced access to bariatric surgery. Mandatory preoperative weight loss targets are a requirement of many bariatric surgery programmes globally; however, the evidence supporting their efficacy is inconclusive. In 2017, mandatory preoperative weight loss targets were eliminated from the bariatric surgery programme at Auckland City Hospital in New Zealand, with the aim to improve equity of access to bariatric surgery. This study will review postoperative patient outcomes following the elimination of preoperative weight loss targets from the programme. A retrospective analysis of 231 patients who underwent bariatric surgery at Auckland City Hospital from 2018 to 2021 was performed. Nineteen patients were lost to follow up and 12 were excluded (revision surgery or pregnancy). The comparison group of 100 consecutive patients, retrospective from 2017, had been required to lose 10% of excess body weight preoperatively to qualify for surgery. Outcomes assessed were weight loss and diabetes resolution at 12months, and postoperative complications within 90days. Elimination of preoperative weight loss targets was associated with greater numbers of Māori and Pacific patients undergoing bariatric surgery. There was no significant difference in weight loss outcomes or postoperative complications. Elimination of preoperative weight loss targets improves access to bariatric surgery for Māori and Pacific patients, inequitably affected by obesity. Removal of preoperative weight loss targets does not adversely affect weight loss outcomes, or postoperative complications, thus supporting their elimination.

Does Antrum Size Matter in Sleeve Gastrectomy? Volume II-A Retrospective Multicentric Study with Long-Term Follow-Up.

Background: Laparoscopic sleeve gastrectomy (LSG) is the most widespread bariatric procedure due to its safety and efficacy. Despite continuous refinement, achieving a globally standardized procedure remains challenging. Moreover, due to its wide adoption, numerous studies have focused on complications associated with the technique, such as gastroesophageal reflux disease (GERD). This study evaluates the impact of antrum size (wide antrectomy versus small antrectomy) in LSG on long-term anthropometric outcomes and complications in patients with morbid obesity. Methods: Body mass index (BMI), percentage of excess weight loss (%EWL) at a 5-year follow-up, GERD Health-Related Quality-of-Life (GERD-HRQL) scores, and obesity-related diseases of patients undergoing LSG with gastric resections starting 2 cm and 6 cm from the pylorus were retrospectively evaluated. Results: Between January 2015 and November 2019, 597 patients who met the criteria for LSG were included in the study. Group A (241 patients) underwent wide antrectomy, while Group B (356 patients) underwent small antrectomy. Weight, BMI, %EWL, and %TWL significantly improved at 6 and 12 months in the wide-antrectomy group. However, these differences diminished by 24 months, with no significant long-term differences in weight loss outcomes between the two groups at 5 years. Conversely, GERD-HRQL scores were significantly better in the small-antrectomy group until 24 months; thereafter, results were comparable between groups over the long term. Conclusions: Therefore, while wide antrectomy may offer superior short-term anthropometric outcomes, both techniques yield similar long-term results regarding weight management and GERD incidence. Larger prospective studies are needed to further address this issue.

Differences in weight-loss outcomes among race-gender subgroups by behavioural intervention delivery mode: An analysis of the POWER trial.

Prior in-person behavioural intervention studies have documented differential weight loss between men and women and by race, with Black women receiving the least benefit. Remotely delivered interventions are now commonplace, but few studies have compared outcomes by race-gender groups and delivery modality. We conducted a secondary analysis of POWER, a randomized trial (NCT00783315) designed to determine the effectiveness of 2 active, lifestyle-based, weight loss interventions (remote vs. in-person) compared to a control group. Participants with obesity and at least one cardiovascular disease risk factor (N = 415) were recruited in the Baltimore, MD area. Data from 233 white and 170 Black individuals were used for this analysis. Following an intention-to-treat approach, we compared the mean percent weight loss at 24 months by race-gender subgroups using repeated-measures, mixed-effects models. Everyone lost weight in the active interventions however, weight loss differed by race and gender. white and Black men had similar results for both interventions (white: in-person (-7.6%) remote (-7.4%); Black: in-person (-4.7%) remote (-4.4%)). In contrast, white women lost more weight with the in-person intervention (in-person (-7.2%) compared to the remote (-4.4%)), whereas Black women lost less weight in the in-person group compared to the remote intervention at 24 months (-2.0% vs. -3.0%, respectively; p for interaction <.001). We found differences between the effectiveness of the 2 weight loss interventions-in-person or remote-in white and Black women at 24 months. Future studies should consider intervention modality when designing weight loss interventions for women.

Metabolic adaptation is associated with a greater increase in appetite following weight loss: a longitudinal study

BackgroundWeight loss is associated with a disproportionate reduction in energy expenditure, along with increases in hunger feelings and ghrelin concentrations. These changes are presumed to be homeostatic mechanisms to counteract the energy deficit. The possibility that these 2 components of the energy balance equation are mechanistically linked has never been examined. ObjectiveThis study aimed to determine if the disproportionate reduction in resting metabolic rate (RMR) seen with weight loss is associated with changes in the plasma concentration of gastrointestinal hormones involved in appetite regulation and subjective appetite ratings. MethodsThis was a longitudinal study with repeated measurements. Fifty-six individuals with obesity (body mass index [BMI]: 34.5±0.5 kg/m2; age: 47±1 y; 26 males) underwent an 8 wk low-energy diet, followed by 4 wk of refeeding and weight stabilization. The RMR, respiratory quotient (RQ), body composition, plasma concentrations of ghrelin, glucagon-like peptide 1, peptide YY, cholecystokinin, insulin, and appetite ratings in the fasting and postprandial states were measured at baseline, Wk9 and 13. Metabolic adaptation was defined as significantly lower when measured versus the predicted RMR (pRMR) (from own regression model using baseline data). ResultsA 14.2±0.6 kg weight loss was seen at Wk9 and maintained at Wk13. RQ was significantly reduced at Wk9 (0.82±0.06 vs. 0.76±0.05, P< 0.001) but returned to baseline at Wk13. Metabolic adaptation was seen at Wk9, but not Wk13 (-341±58, P <0.001 and -75±72 kJ/d, P = 0.305, respectively). The larger the difference between measured and predicted RMR at both timepoints, the greater the increase in hunger, desire to eat, and composite appetite score (fasting and postprandial at Wk9, postprandial only at Wk13), even after adjusting for weight loss and RQ. ConclusionA larger metabolic adaptation during weight loss is accompanied by a greater drive to eat. This might help explain the interindividual differences in weight loss outcomes to dietary interventions.

Body Image and Weight Loss Outcome After Bariatric Metabolic Surgery: a Mixed Model Analysis.

As in nonsurgical weight loss populations, body image may partly explain differences in weight loss outcomes after surgery. The aim of this study was to determine the prospective association between body image and weight loss in a longitudinal cohort of patients up to 3 years after bariatric metabolic surgery. The BODY-Q self-report questionnaire was used to assess body image. Linear mixed models evaluated associations of baseline body image with weight loss in the first year as well as associations of body image at 12 months and first-year change in body image with weight loss 12 to 36 months after surgery. Available body image data included 400 (100%), 371 (93%), 306 (77%), 289 (72%), and 218 (55%) patients at baseline and 4, 12, 24, and 36 months, respectively. Body image scores improved significantly until 12 months, followed by a gradual decline. Scores remained improved in comparison to baseline (β = 31.49, 95% CI [27.8, 35.2], p < .001). Higher baseline body image was associated with less weight loss during the first year, and the effect size was trivial (ß = -0.05, 95% CI [-0.09, -0.01], p = .009). Body image and change in body image were not associated with weight loss 12 to 36 months after surgery. Body image improved after bariatric metabolic surgery. Although no clinically relevant associations of body image with weight loss were demonstrated, the gradual decline in body image scores underlines the importance of long-term follow-up with regular assessment of this aspect of quality of life.

Differences in weight loss outcomes for males and females on a low-carbohydrate diet: A systematic review

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

Rural/urban weight-loss outcomes following bariatric surgery.

Obesity disproportionately affects rural populations; however, there is limited research examining disparities in bariatric surgery outcomes between patients from rural versus urban areas. This study aimed to compare the demographic characteristics of patients undergoing bariatric surgery from rural versus urban bariatric areas and to explore differences in weight-loss outcomes between these groups. A retrospective chart review identified a sample of 170 patients (52 rural, 118 urban) who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy procedures over a 1-year period. Data collected included age, race, gender, insurance status, surgery type, height, and pre- and postoperative weights at 3 and 6 months. Significant differences in race, ethnicity, and surgery type were observed between rural/urban patients (ps<0.05). Patients from rural areas demonstrated significantly greater percent total weight losses at 3 months (p = 0.018; however, there were no significant differences between groups at 6 months (p>0.05). The results suggest that patients from rural counties experience postoperative weight-loss outcomes comparable to those of their urban counterparts.

Gastrojejunostomy in Roux-En-Y Gastric Bypass for Morbid Obesity: Linear Stapler Length Does Not Affect Mid-term Outcomes.

The purpose of this study was to compare whether different linear stapler lengths used to form the gastrojejunostomy during laparoscopic Roux-En-Y gastric bypass affects mid-term weight loss outcomes. A retrospective single center analysis was performed. Surgical technique was identical other than either a 35 or 45 mm linear stapler being used to form the gastrojejunostomy. Multivariate regression was used to assess the relationship between the different stapler lengths and weight loss outcomes 2 years following surgery. Of the 97 patients identified, 67 (69.1%) were included in the study. There were 30 patients in the 35 mm group and 37 in the 45 mm group. The groups were comparable in terms of basic demographic data and preoperative weight characteristics. There was no significant difference in weight loss outcomes 2 years following surgery when comparing between the different linear stapler lengths. Thirty-five versus 45 mm linear stapler lengths does not affect mid-term weight loss outcomes.

Abstract PD11-04: The impact of sleep on weight loss in overweight or obese breast cancer survivors

Abstract BACKGROUND: Sleep disturbance, common in cancer survivors, is associated with obesity, eating behaviors and metabolism, and may impact weight loss treatment outcomes. Weight loss promotion in breast cancer survivors is important because it can potentially decrease cancer recurrence. We have previously demonstrated the efficacy of a behavioral weight loss (BWL) intervention for overweight/obese breast cancer survivors in the POWER-remote breast cancer trial. In the current study we aimed to evaluate the impact of baseline sleep on weight outcomes at 6 and 12 months. We hypothesized that participants with poor sleep at baseline will lose significantly less weight. METHODS: Women with a history of stage 0-III breast cancer, who completed local therapy and chemotherapy, with a body mass index ≥25 kg/m2 were randomized to a self-directed approach or the 12-month POWER-remote intervention, a BWL intervention consisting of telephone-based coaching, online educational materials and tracking of diet, physical activity and weight. Participants completed demographic questionnaires at baseline, and patient-reported outcomes (PROs) at baseline, 6 and 12 months, including the 6-item NIH PROMIS Adult Sleep Disturbance Version 1.0 Short Form, assessing sleep quality, depth, and restoration over the last week. Weight was measured at baseline, 6 and 12 months and % total weight loss (%TWL) was calculated from baseline weight. Those with poor sleep were defined as having a sleep T-score &amp;gt;55, and associations between sleep scores and change in weight at 6 and 12 months were made using a linear regression model, while adjusting for baseline weight. Fisher’s exact test was also used to compare the number of patients who had 5% weight-loss between sleep groups. RESULTS: A total of 48 women with early stage breast cancer received BWL. Those with poor sleep in the BWL group (n= 16) lost significantly less weight than those with normal sleep in the BWL group (n=32) at both 6 (-4.06% vs -6.77% TWL, p&amp;gt;0.05) and 12 months (-3.87% vs -7.54% TWL, p&amp;gt;0.05), respectively. Similar findings were seen in poor sleepers in the BWL group and attaining 5% weight loss at 6 (p&amp;gt;0.05) and 12 months (p&amp;gt;0.05). There were no significant differences in weight loss outcomes among those in usual care. CONCLUSION: Breast cancer survivors receiving the weight loss intervention who reported normal sleep at baseline had double the weight loss than those with sleep disturbance at 12 months (-7.54% vs -3.87%). While this is not statistically significant, it is clinically significant and leaves room for further study. These results suggest that sleep may affect weight loss. Updated data, including comparison with control group and analyses by weight loss irrespective of arm, will be reported at the conference. Further studies are need to evaluate the association between baseline sleep and weight loss, and determine if interventions that detect and treat underlying sleep disturbance may augment behavioral interventions for weight loss. FUNDING: Breast Cancer Research Foundation, Cigarette Restitution Fund Table 1: Weight Loss Summary in BWL group based on Sleep DisturbanceVariablesPoor sleep (T-score &amp;gt;55)Normal sleep (T-Score &amp;lt;55)TotalSample SizeN = 16N = 32N = 48Baseline Weight - Mean (SD)202.1 (32.26)182.64 (27.73)Weight Loss 6mo. (lbs) - Mean (SD)-8.5 (10.02)-11.58 (11.03)Weight Loss 12mo. (lbs) - Mean (SD)-7.92 (14.61)-12.63 (13.72)Percent change in weight from BL to 6mo. - Mean (SD)-4.06 (4.83)-6.77 (6.45)p&amp;gt;0.05Percent change in weight from BL to 12mo. - Mean (SD)-3.87 (7.29)-7.54 (7.91)p&amp;gt;0.05 Citation Format: Jennifer Y Sheng, Amanda K Montanari, Amanda L Blackford, David D Lim, Cesar A Santa-Maria, Vered Stearns, Michael T Smith, Janelle W Coughlin. The impact of sleep on weight loss in overweight or obese breast cancer survivors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-04.

Insurance-Mandated Medical Weight Management Programs in Sleeve Gastrectomy Patients Do Not Improve Postoperative Weight Loss Outcomes at 1Year.

Qualification for bariatric surgery is based upon strict medical guidelines, but individual insurance companies may introduce additional requirements for approval and coverage as they deem necessary. A mandatory preoperative medical weight loss management (MWM) program is commonly such a requirement. The primary objective of this study is to assess the effect of MWM programs on weight loss outcomes. A retrospective review of all sleeve gastrectomies performed between 2012 and 2016 at our institution was conducted. Patients were divided into two groups: those who required a preoperative MWM program, and those who did not. A 1:1 greedy nearest-neighbor method matching algorithm was used to match patients based on age, BMI, smoking, gender, race, sleep apnea, and diabetes. Total weight loss and percent excess weight loss at 1year for each group were compared. A total of 3059 sleeve gastrectomy patients were reviewed. Of these, 941 patients had adequate data points to be evaluated. The matching algorithm resulted in 530 patients for the final analysis, 265 patients in each group. There were no significant differences between the groups in terms of age, BMI, smoking, gender, race, sleep apnea, or diabetes. A paired t test found no significant differences between the MWM group and the control group at 1year in both total weight loss (36.7kg vs 36.2kg) and in percent excess weight loss (56.5% vs 55.8%, p = 0.24). There was no significant difference in weight loss outcomes after 1year in patients required by insurance to participate in MWM programs compared to those who were not. The necessity of these programs should be questioned.

Bariatric endoscopy procedure type or follow-up: What predicted success at 1 year in 962 obese patients?

Background and study aims It is uncertain if the difference in weight loss outcomes between different endoscopic bariatric therapies (EBTs) is technique-related or multidisciplinary team (MDT) follow-up-related. We hypothesized that at 1 year, the weight loss is determined more by adherence to MDT follow-up than by procedure type. We aimed to compare 1 year weight loss outcomes of four different EBTs at a single center with a standardized MDT follow-up. Patients and methods We prospectively collected and retrospectively analyzed outcomes in 962 patients (female-691, 71.2 %; mean age, 44.8 ± 10.6 years, mean BMI, 37.8 ± 5.9 Kg/m 2 ) treated with Intragastric balloons (IGBs) or endoscopic gastroplasty (EG) at HM Sanchinarro University Hospital between March 2012 to January 2017. The procedures were performed by the same endoscopist and followed up by the same MDT. We compared the percentage total body weight loss (%TWBL) at 1 year. We performed linear and logistic regression to identify predictive factors for weight loss and follow-up adherence at 1 year. Results Four hundred and eighty-one IGBs (Orbera-80.9 %; ReShape Duo-19.1 %), and 481 EG (Apollo ESG-51.3 %; Primary obesity surgery endoluminal-POSE-48.6 %) were performed. Only 480 patients (IGB- 45 %; EG- 55 %) completed 1 year follow-up. Among them, Apollo ESG achieved significantly higher TBWL (19.5 ± 13 %, P = 0.035), %TBWL (17.4 ± 10.2 %, P = 0.025), and ≥ 20 % TBWL (36.7 %, P = 0.032). However, in linear regression after adjusting for variables, only higher initial BMI (B = 0.31, P < 0.001) and higher percentage follow-up attendance (B = 0.24, P < 0.001) significantly predicted %TBWL at 1 year in the completion group but not the procedure type (B = 0.02, P = 0.72). In logistic regression, we observed female sex ( P = 0.01), high initial BMI ( P < 0.001), endoscopic gastroplasty ( P = 0.04), and high 1-month %TBWL ( P < 0.001) significantly predicted follow-up completion at 1 year. Conclusions Weight loss at 1 year is dependent on MDT follow-up rather than procedure type. Endoscopic gastroplasty promoted follow-up adherence more than IGBs.

An Investigation of Racial Disparities in Weight Loss Outcomes: Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy.

The current study aimed to test if racial disparities in weight loss outcomes between African American and Caucasian patients who underwent bariatric surgery were due to pre-surgical BMI differences. Primary data was collected from pre-surgical evaluations conducted at a midwestern hospital. A retrospective chart review was conducted of 136 patients. Patient age and race, type of procedure, and pre- and 1-year post-surgical BMI were collected. African American patients were less likely to undergo bariatric surgery compared with Caucasian patients. Caucasian patients undergoing Roux-en-Y Gastric Bypass (RYGB) had a greater change in BMI compared with African American patients who underwent RYGB. Significant differences in weight loss outcomes were not found among patients who underwent the sleeve gastrectomy. Race was not related to pre-surgical BMI or procedure type. Despite pre-surgical BMI typically being higher among African American patients, this was not found in the current study. Pre-surgical BMI may not explain the racial disparities in weight loss post-bariatric surgery that are found between African American and Caucasian patients. Future studies should consider psychosocial, environmental, and cultural influences on racial disparities.

Mobile health applications enhance weight loss efficacy following bariatric surgery

IntroductionWith the epidemic of obesity numerous mobile health (mHealth) applications have been designed with the goal of facilitating weight loss. This technology has the potential to focus behavioral modification in a manner that’s effective for weight loss. We examined the use of this mHealth technology in our bariatric surgery population to evaluate effects on weight loss following surgery. MethodsSingle institution prospective randomized control trial performed at an academic center. 56 patients who recently underwent a laparoscopic sleeve gastrectomy (LSG) were enrolled into a control group with standard post-operative monitoring and a mHealth application group provided with iPad© minis with the MyFitnessPal© mHealth application. Participants were followed for 24 months. The primary outcomes were effect on weight loss as determined by excess body weight loss (%EWL) and excess BMI loss (%EBL). ResultsStatistically significant differences in weight loss outcomes between the groups were present throughout the duration of the study. At 12 months, %EWL was 74.41% (control) vs 81.41% (mHealth) p value 0.047 and at 24 months, it was 59.10% (control) vs 71.47% (mHealth) p value 0.0078. %EBL findings at 12 months was 28.02% (control) vs 32.15% (mHealth) p value 0.0007 and at 24 months, it was 25.39% (control) vs 27.87% (mHealth) p value 0.048. ConclusionOur results demonstrate mHealth applications are a useful adjunct to improve and maintain weight loss following bariatric surgery. We suggest mHealth applications should be utilized following bariatric surgery for improved outcomes.

Influence of Asian Ethnicities on Short- and Mid-term Outcomes Following Laparoscopic Sleeve Gastrectomy.

Prevalence of obesity in Asia has been on the increasing trend, with corresponding increase in utilisation of bariatric surgery. The objective of this study was to examine differences in weight loss outcomes following bariatric surgery between Asian ethnicities. A retrospective database review was conducted of patients undergoing primary laparoscopic sleeve gastrectomy between 2009 and 2013 in 14 centres from Singapore, Malaysia, Taiwan, Hong Kong, Japan, Korea, India, Australia, Switzerland, and the USA. All patients with available follow-up data at 12months and 36months post-surgery were included in this study. Outcome measures used were percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Differences in outcomes between ethnicities were analysed after adjusting for age, gender, baseline body mass index (BMI), and presence of diabetes. The study population (n = 2150) consisted of 1122 Chinese, 187 Malays, 309 Indians, 67 Japanese, 259 Koreans, and 206 Caucasians. 67.1% were female and 32.9% were male. Mean age was 37.1 ± 11.2years. Mean pre-operative BMI was 40.7 ± 8.1kg/m2. With the Caucasian population as reference, Japanese had the best %TWL (3.90, 95% CI 1.16-6.63, p < 0.05) and %EWL (18.55, 95% CI 10.33-26.77, p < 0.05) while the Malays had the worst outcomes. Both Chinese and Koreans had better %EWL but worse %TWL as compared to Caucasians and there were no significant differences with the Indian study group. There are differences in weight loss outcomes following bariatric surgery between Asian ethnicities.

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study.

There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. To compare weight loss and safety among bariatric procedures. Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674). 41 health systems in the National Patient-Centered Clinical Research Network. 65093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. 32208 Roux-en-Y gastric bypass (RYGB), 29693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44978 (84%), 20783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. Patient-Centered Outcomes Research Institute.

Journal Digest

Journal Digest

FABP2, LEPR223, LEP656, and FTO Polymorphisms: Effect on Weight Loss 2 Years After Bariatric Surgery

Differences in weight loss outcomes after bariatric surgery may be related to individual preoperative characteristics. The aim of this study was to evaluate the potential effect of fatty acid binding protein-2 (rs1799883), leptin receptor (LEP223, rs1137101 and LEP656, rs1805094), and fat mass and obesity-related (rs9939609) genotypes on weight loss 2years after bariatric surgery in Brazilian patients. Prospective observational study involving 105 patients (lost to follow-up, 25.7%). In the preoperative period, patients were clinically evaluated and a fasting blood sample for genetic analysis (by real-time DNA amplification technique) was collected. From the patient's medical records, follow-up weight loss (3, 6, 12, 24months) was obtained. Percentage of excess weight loss (%EWL) was examined by pairwise comparison across the polymorphisms. At baseline, the mean weight was 127.5 (23.3) kg and age 43.1 (10.9) years old. The %EWL was significant over time (p < 0.01). Only the LEP223 genotype showed association (p < 0.01). Up to 6months after surgery, no differences were observed. At 12months, a significant difference (p = 0.03) between AA (n = 19) and GG (n = 34) groups was observed, with 76.5% EWL versus 52.0%, respectively. This difference remained at 24months. Other genotypes did not present any significant association. There is a different evolution of weight loss in carriers of the LEP223 after bariatric surgery. The AA genotype seems to be associated with a higher weight loss. However, this pattern was evident only at 12months after surgery.

Secondary data analysis from a randomized trial examining the effects of small financial incentives on intrinsic and extrinsic motivation for weight loss

ABSTRACTThe purpose of this study was to examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation “crowd out” intrinsic motivation for weight control. Participants (N = 153, 80.4% female; body mass index [BMI] = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL + $). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9-month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire (TSRQ), with questions added to specifically target extrinsic motivation related to incentives. Compared to WBWL alone, WBWL + $ had better weight loss and higher levels of both extrinsic and intrinsic motivation for weight management (p-values ≤ .02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL + $ (p = .58). Extrinsic motivation was not a significant mediator of treatment outcomes. These results suggest that modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions. Clinicaltrials.gov number: NCT01560130.