Durable Weight Loss Research Articles

Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study

More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures. To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years. Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use. Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants. Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB. clinicaltrials.gov Identifier: NCT00465829.

Total Gastrectomy for Hereditary Diffuse Gastric Cancer at a Single Center: Postsurgical Outcomes in 41 Patients.

The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.

Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3–7 year results – A retrospective cohort study

IntroductionFew studies have addressed the mid to long term impact of Laparoscopic Sleeve Gastrectomy (LSG) on weight loss and obesity associated co-morbidities, particularly in Indian population. The aim of this study is to assess the efficacy of LSG in morbid obesity over 3–7 years follow up. Materials and methodsData of all patients who underwent LSG between January 2008 and March 2015 and completed their at least 1 year follow up till March 2016 was retrospectively reviewed using a prospectively collected database. Results424 patients undergoing primary LSG were included. The mean age (±2SD) was 39.8 ± 22.5 years and the mean Body Mass Index (BMI) (±2SD) was 46.67 ± 15.8 kg/m2. 124 patients (29.2%) were super-obese (BMI >50 kg/m2). The percentage follow-up at 1 year, 3 years, 5 years and 7 years was 78.3%, 66.7%, 42.3% and 38.4% respectively. The mean percentage Excess weight Loss (%EWL) (±2SD) at 1year, 3years, 5years, and 7years was 71.8 (±50.5%), 64.95% (±41.8%), 61.7% (±46.2%) and 57.15% (±50.2%) respectively. The preoperative BMI significantly correlated with %EWL at 5 year (r2 = 0.107, p = 0.018). The overall complication rate was 5.8%. Early complications included staple line leak (1.2%), bleeding (1.2%), deep venous thrombosis (0.4%) and 30-day mortality (0.21%). Late complications included stricture formation (0.21%) and new onset Gastro-esophageal Reflux Disease (GERD) (2.8%).At 5 years, 83.3% of diabetic patients showed remission while rest showed improvement in glycemic control with decrease in dosage. 69.3% patients showed improvement in hypertension, 100% patients showed improvement in Obstructive Sleep Apnea Syndrome, 75% patients showed improvement in hypothyroidism after surgery. GERD resolved in 62.8% patients while worsened in 11.4% patients. ConclusionsLSG has durable weight loss at 5 year with %EWL of 61% and significant resolution of obesity associated co-morbidities.

Long-Term (over 10Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding.

Laparoscopic adjustable gastric banding (LAGB) placements have progressively decreased in recent years. This is related to poor long-term weight loss outcomes and necessity for revision or removal of these bands. Long-term outcome results following LAGB are limited. The aim of our study was to determine the long-term outcome after LAGB at our institution. The aim of our study was to determine the long-term outcome after LAGB at our institution. The setting of this is Academic Center, Israel. Patients who underwent LAGB between 1999 and 2004 were reviewed. Patient comorbidities and weight loss parameters were collected preoperatively and at defined postoperative periods. Improvement in weight loss was defined as percent excess weight lost, and improvement in comorbidities was defined based on standardized reporting definitions. In total, 74 (80%) patients who underwent LAGB met inclusion criteria. The mean age at LAGB placement was 50.5±9.6years, and the mean body mass index (BMI) was 45.5±4.8kg/m2. Preoperative comorbidities were diabetes mellitus (13.5%), hypertension (32%), hyperlipidemia (12.1%), obstructive sleep apnea (5.4%), joints disease (10.8%), mood disorders (5.4%), and gastro-esophageal reflux disease (GERD) symptoms (8.1%). The mean follow-up was 162.96±13.9months; 44 patients (59.4%) had their band removed, and 22 (30%) had another bariatric surgery. The follow-up BMI was 35.7±6.9 (p<0.001), and the % total weight loss was 21.0±0.13. There was no improvement in any of the comorbidities. GERD symptoms worsened at long-term follow-up (p<0.001). Undergoing another bariatric procedure was associated with a higher weight loss (OR 12.8; CI 95% 1.62-23.9; p=0.02). LAGB required removal in the majority of our patients and showed poor resolution of comorbidities with worsening of GERD-related symptoms. Patients who go on to have another bariatric procedure have more durable weight loss outcomes.

A5276 - Impact of Preoperative Weight Loss on Long-Term Weight Loss Results

It is common for patients pursuing metabolic and bariatric surgery to undergo preoperative weight loss programs. The long-term effects on the durability of weight loss after bariatric surgery in patient’s that achieved preoperative weight loss is largely unknown. Is preoperative weight loss predictive of long-term weight loss success after bariatric surgery?

Neuroendocrine mechanisms underlying bariatric surgery: Insights from human studies and animal models.

Obesity has reached epidemic proportions and, to date, bariatric surgery remains the only effective treatment for morbid obesity in terms of its capacity to achieve durable weight loss. Bariatric surgery procedures, including Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and sleeve gastrectomy (SG), have been the primary procedures conducted over the past decade, with SG increasing in popularity over the past 5years at the expense of both RYGB and AGB. Although these procedures were initially proposed to function via restrictive or malabsorptive mechanisms, it is now clear that profound physiological changes underlie the metabolic improvements in patients who undergo bariatric surgery. Data generated in human patients and animal models highlight the rapid and sustained changes in gut hormones that coincide with these procedures. Furthermore, recent studies highlight the involvement of the nervous system, specifically the vagus nerve, in mediating the reduction in appetite and food intake following bariatric surgery. What is unclear is where these pathways converge and interact within the gut-brain axis and whether vagally-mediated circuits are sufficient to drive the metabolic sequalae following bariatric surgery.

Effect of vertical sleeve gastrectomy on alcohol consumption and preferences in dietary obese rats and mice: A plausible role for altered ghrelin signaling

Vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) are the most common surgical options for the treatment of obesity and metabolic disorder. Whereas RYGB may result in greater and more durable weight loss, recent clinical and pre-clinical studies in rats have raised concerns that RYGB surgery may increase risk for alcohol use disorder (AUD). In contrast, recent clinical reports suggest a lesser risk for AUD following VSG, although no preclinical studies have been done to confirm that. Therefore, the present study sought to determine the effects of VSG on ethanol intake and preferences in rodent models using protocols similar to those previously used in animal studies for RYGB. Male Sprague Dawley rats and male C57B6 mice were made obese on a high fat diet (60%kcal from fat) and received VSG or no surgery (controls). All animals then were given access to increasing concentrations of ethanol (2%, 4%, 6%, and 8%), presented for few days each. Compared to controls, VSG rats consumed significantly less of 2, 6 and 8% ethanol and showed significantly reduced preferences to 6 and 8% ethanol over water. VSG mice also displayed reduced intake and preference for 6 and 8% ethanol solutions. After a two-week period of forced abstinence, 8% ethanol was reintroduced and the VSG rats and mice continued to exhibit reduced consumption and less preference for ethanol. Regarding the underlying mechanism, we hypothesized that the removal of the ghrelin producing part of the stomach in the VSG surgery is a possible contributor to the observed reduced ethanol preference. To test for functional changes at the ghrelin receptors, the VSG and control rats were given IP injections of acyl-ghrelin (2.5nmol and 5nmol) prior to ethanol access. Neither concentration of ghrelin resulted in a significant increase in 8% ethanol consumption of VSG or control subjects. Next, the rats were given IP injections of the ghrelin receptor antagonist, JMV (2.5mg/kg body weight). This dose induced a significant reduction in 8% ethanol consumption in the VSG group, but no effect on ethanol intake in the controls. While ghrelin injection was uninformative, increased sensitivity to subthreshold doses of the ghrelin receptor antagonist may indicate reduced ghrelin signaling following VSG. Overall, these findings suggest that bariatric patients with increased susceptibility to AUD may benefit from receiving VSG instead of RYGB surgery, and that changes in ghrelin signaling, at least in part, may play a role in the differential AUD risks between the two most commonly performed bariatric surgical procedures.

Roux-en-Y gastric bypass for the treatment of Asian type II diabetes

Since the development of gastric bypass 50 years ago by Mason and Ito, Roux-en-Y gastric bypass (RYGB) gradually become the most durable and commonly performed bariatric surgery. RYGB has been shown to be effective in achieving significant and durable long-term weight loss as well as improving medical co-morbidities in morbidly obese patients, and currently regarded as a gold standard bariatric/metabolic procedure. Recently, RYGB became the most commonly performed metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM). Many reports about metabolic surgery are coming from this region because of the characters of Asian T2DM patients. In this review, the current literature evidence about the long-term result of RYGB on weight control and diabetic remission in Asian T2DM patients will be analyzed.

Medical devices for the treatment of obesity.

Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic mini gastric bypass in the treatment of obesity: study protocol for a randomized controlled trial

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard in bariatric surgery, achieving durable long-term weight loss with improvement of obesity-related comorbidities. Lately, the laparoscopic mini gastric bypass (LMGB) has gained worldwide popularity with similar results to LRYGB in terms of weight loss and comorbidity resolution. However, there is a lack of randomized controlled trials (RCT) comparing LMGB and LRYGB. This article describes the design and protocol of a randomized controlled trial comparing the outcomes of these two bariatric procedures.Methods/DesignThe trial is designed as a single center, randomized, patient and observer blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that LMGB is not inferior to LRYGB in terms of excess weight loss (EWL) the study is conducted as a non-inferiority trial with the sample-size calculations performed accordingly. EWL 12 months after surgery is the primary endpoint, whereas 3-year EWL, morbidity, mortality, remission of obesity related comorbidities, quality of life (QOL) and hormonal and lipid profile changes are secondary endpoints. Eighty patients, 18 years or older and with a body mass index (BMI) between 35 and 50 kg/m2 who meet the Swiss guidelines for the surgical treatment of morbid obesity will be randomized. The endpoints and baseline measurements will be assessed pre-surgery, peri-surgery and post-surgery (fixed follow up measurements are at discharge and at the time points 6 weeks and 12 and 36 months postoperatively).DiscussionWith its 3-year follow up time, this RCT will provide important data on the impact of LMGB and LRYGB on EWL, remission of comorbidities, QOL and hormonal and lipid profile changes.Trial registrationClinicalTrials.gov, NCT02601092. Registered on 28 September 2015.

Reproductive and Other Health Considerations for Women Undergoing Bariatric Surgery

Bariatric surgery continues to gain popularity as a means of attaining durable weight loss and ameliorating obesity-related comorbidities, such as

Sleeve Gastrectomy and Left Ventricular Assist Device for Heart Transplant.

Background and Objectives:Heart failure (HF) is a severe obesity-related comorbidity. Many patients with end-stage HF eventually require cardiac transplantation for long-term survival. These patients may be precluded from enrollment in heart transplant programs secondary to morbid obesity. We propose a pathway involving sleeve gastrectomy (SG) for patients with morbid obesity and HF to afford cardiac transplantation eligibility.Methods:Three patients with HF and morbid obesity underwent implantation of a left ventricular assist device (LVAD) and SG at an academic tertiary care institution in Washington, DC. This retrospective review from April 2012 through January 2017 examines the perioperative course of these 3 patients with regard to bariatric and cardiac indices, including ejection fraction (EF), HF classification, comorbid diseases, and percentages of total weight loss (%TWL) and excess weight loss (%EWL).Results:All three patients underwent LVAD placement as a bridge to transplant but were excluded from cardiac transplantation secondary to body mass index (BMI) and were referred for bariatric surgery. All have demonstrated considerable weight loss, with average decrease in BMI of 19 points, 39% TWL, and 81% EWL at a mean of 44 months after SG. Two patients have gone on to receive heart transplants, with near normalization of their EF.Conclusion:LVAD and SG constitute a feasible pathway to cardiac transplantation in morbidly obese patients with end-stage HF. LVAD permits temporary cardiac support, whereas SG assists in efficacious weight loss. We explore SG as a durable weight loss option in patients with HF, with LVAD to improve eligibility for orthotopic cardiac transplantation.

Benefit of feeding tube placement for refractory malnutrition after bariatric surgery

BackgroundBariatric surgery provides durable weight loss and decreases the incidence of co-morbid conditions for people with obesity. Most patients benefit from resultant weight loss, but some are at risk for postoperative refractory malnutrition, a serious but poorly understood complication. ObjectiveTo evaluate differences in bariatric surgery patients who received a feeding tube postoperatively for malnutrition compared with other indications. SettingRetrospective cohort study at an academic bariatric surgery center (1985–2015). MethodsAll bariatric surgery patients that received a feeding tube postoperatively over a 30-year period were identified. Data abstraction from the medical record was performed to assess demographic characteristics, operative details, tube indication, and resultant body mass index (BMI) changes. ResultsFrom a total of 3487 patients who underwent bariatric surgery during the study period, 139 (3.9%) required placement of a feeding tube postoperatively. Refractory malnutrition was the indication in 24 patients, all after Roux-en-Y gastric bypass. There were no significant differences between these patients and other bariatric surgery patients in terms of mean age (40.6±9.9 versus 43.1±13.4 years, P = .4) and preoperative BMI (47.5±10.5 versus 51.0±9.6 kg/m2, P = .1). The median time from surgery to tube placement for malnutrition patients was 4 years. Compared with other feeding tube indications, malnutrition patients had higher percent excess BMI lost after surgery (126.2±31.9 versus 52.5±44.3%, P<.0001). After tube placement, malnutrition patients had a significant increase in mean BMI compared with other indications (14.5±20.9 versus−13.0±14.0%, P< .001). ConclusionPatients with refractory malnutrition benefit from feeding tube placement, which results in a significant increase in BMI.

The Physiology and Molecular Underpinnings of the Effects of Bariatric Surgery on Obesity and Diabetes.

Bariatric surgeries, such as Roux-en-Y gastric bypass and vertical sleeve gastrectomy, produce significant and durable weight loss in both humans and rodents. Recently, these surgical interventions have also been termed metabolic surgery because they result in profound metabolic improvements that often surpass the expected improvement due to body weight loss alone. In this review we focus on the weight-loss independent effects of bariatric surgery, which encompass energy expenditure and macronutrient preference, the luminal composition of the gut (i.e., the microbiota and bile acids), the transformation of the gastrointestinal lining, increases in postprandial gut hormone secretions, glycemic control, pancreas morphology, and micronutrient and mineral absorption. Taken together, these data point to several important physiological changes that contribute to the profound benefits of these surgical procedures. Identifying the underlying molecular mechanisms for these physiological effects will allow better utilization of these existing procedures to help patients and develop new treatments that harness these surgical effects with less invasive interventions.

Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

BackgroundAdaptive thermogenesis (AT) is described as a change in resting metabolic rate (RMR) that is greater than would be predicted from changes in lean body mass (LBM) and fat mass (FM) alone during periods of energy imbalance. Whereas an AT-related downregulation of RMR has been implicated in suboptimal weight loss and weight regain after nonsurgical weight loss, defense against AT may underpin the durable weight loss after laparoscopic Roux-en-Y gastric bypass (LRYGB) and other bariatric surgeries. However, methodological differences across the few studies that have evaluated postoperative AT limit interpretation as to the effects of these procedures on RMR. ObjectiveTo quantify AT 6 months after LRYGB and laparoscopic adjustable gastric banding (LAGB). SettingThe study was conducted in a large university hospital in the United States. MethodsChanges in body composition and RMR were assessed in 13 severely obese adults 6 months after LRYGB (n = 8) and LAGB (n = 5). AT was calculated as the difference between measured RMR and RMR predicted from LBM, FM, age, and sex before and after surgery. ResultsRMR significantly decreased after LRYGB (−270±96 kcal/d, P<.01) but not after LAGB. Despite significantly greater reductions in weight, FM, and LBM with LRYGB than LAGB, AT responses after LRYGB (15±110 kcal/d, P = .7) and LAGB (42±97 kcal/d, P = .4) were similar (P = .7). ConclusionDespite significant weight and body composition changes, AT was minimal after LRYGB. A blunting of AT may be an additional mechanism that favors sustainable weight loss with LRYGB.

The rural women connecting for better health trial—A landmark study that establishes several “firsts”

The study by Befort et al. is a pioneering effort that charts several “firsts” with regard to weight management interventions (1). This study establishes several noteworthy benchmarks in the following areas: (1) it is among a handful of trials to target rural cancer survivors and the first to test a weight management intervention; (2) it utilizes unique approaches that heretofore have not been employed in cancer survivor populations, i.e., prepackaged meals and shakes and group conference calls; (3) it utilizes a two-phase approach to specifically address weight maintenance; and (4) it is the first weight management intervention among cancer survivors to assess cost. All of these are remarkable accomplishments which make substantial contributions to the extant literature, not only with respect to weight management specifically in cancer survivors, but to the general body of weight management evidence. To begin, the team is to be commended for reaching out to a rural population. Rural cancer survivors are acknowledged as underserved and are at significantly higher risk of poorer health outcomes (2). Moreover, the problem of obesity is far more prevalent in rural or frontier areas (3), yet there are few documented interventions that effectively tackle the challenging logistics of delivering weight loss programs to rural dwellers. Befort et al. overcome barriers of distance using group conference calls which not only offer provider contact but also afford the support inherent with group classes. Fidelity to caloric restriction is enhanced by a dietary regimen that includes prepackaged meals and shakes. This approach is innovative; moreover, it is laudable since the magnitude of weight loss, i.e., 14% at 6 months, is roughly double that reported by other weight loss trials that have been conducted among breast cancer survivors to date, including those that were clinic based (4). Not only was weight loss impressive, but this two-phase trial was specifically designed to test a weight maintenance strategy that continued to rely on regular conference calls, though the frequency was scaled back from weekly to biweekly, and was compared with a control condition of mailed newsletters. Given that recidivism (i.e., weight regain) is a major issue with weight loss trials (5), the strides made in this study are notable and may be particularly noteworthy in cancer survivor populations in whom durable weight loss may be potentially important for cancer control. Here, Befort et al. show that a fairly minimal intervention of biweekly conference calls appears effective in sustaining much of the initial weight loss and provide data that indicate a mean weight loss of 10% from baseline to 18 months—again, roughly double the long-term weight loss achieved in other trials, both among cancer survivors and in the general population at large (4, 5). Moreover, since cost data were collected and analyzed, it should be noted that this weight maintenance was achieved at costs that were fairly nominal, i.e., $882. Thus, the breakthroughs made by the Rural Women Connecting for Better Health Trial are commendable and represent a quantum leap in the science of cancer survivorship and weight management.

Weight loss and improvement of lipid profiles in morbidly obese patients after laparoscopic one-anastomosis gastric bypass: 2-year follow-up.

Obesity is the most frequent chronic metabolic disease globally. There is a direct correlation between increasing body mass index (BMI) and elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL), and triglycerides (Tg), and an inverse correlation with high-density lipoprotein cholesterol (HDL); all these lipid derangements are associated with an increased risk of cardiovascular disease. Our aim was to evaluate lipid profiles in morbidly obese patients before and after one-anastomosis gastric bypass (OAGB) performed at a single-center during a 2-year follow-up. A prospective, observational and descriptive study was carried out, including morbidly obese patients with at least one lipid abnormality, who underwent laparoscopic OAGB. Lipid profiles were evaluated preoperatively and at different intervals during a 2-year follow-up. A total of 150 patients were included (73% females and 27% males). Mean age was 45.83±10.65years, mean BMI was 42.82kg/m2±6.43, and mean weight was 116.23kg±22.70; 2years after surgery, the latter two decreased to 24.73±4.43 (p<0.001) and 67.34±13.35 (p<0.001), respectively, thus leading to a mean weight loss (WL) of 48.85kg±15.64 and mean %excess WL of 71.87±13.41. Tg, TC and LDL levels significantly decreased: 123.60±56.34 versus 84.79±33.67, 194.33±43.90 versus 173.65±34.84, and 124.47±36.07 versus 97.36±25.05, respectively (p<0.001); HDL levels significantly increased: 43.61±9.85 versus 61.56±12.63 (p<0.001). OAGB leads to substantial and durable WL in morbidly obese patients after a 2-year follow-up. Postoperative lipid profiles significantly improved; these changes translate into theoretical relevant cardiovascular risk benefits.

Recent advances in the modification of taste and food preferences following bariatric surgery.

There is a large body of evidence indicating that bariatric surgery provides durable weight loss and health benefits to patients who are obese and have comorbidities such as type 2 diabetes (T2D). However, there are still many questions related to mechanisms of metabolic improvement, predictors of success/failure, and long term consequences, which need to be answered. More recently, there has been a particular interest in the modulation of taste and food preferences that occurs after bariatric surgery and how this affects weight loss in different individuals. Animal models as well as human studies have shed some light on the role of taste in changing food preferences and how these changes may affect weight loss after surgery. The goal of this review is to discuss the physiological and behavioral consequences of bariatric surgery as a treatment for obesity and T2D, with particular emphasis on recent studies describing bariatric surgery-induced modifications in taste perception and food preferences.

Changes in Resting Energy Expenditure in Relation to Body Weight and Composition Following Gastric Restriction: A Systematic Review.

In comparison to gastric bypass surgery, gastric restriction without malabsorption more closely simulates dietary adherence while still producing durable weight loss. The latter is achieved despite considerable reductions in resting energy expenditure (REE), and whether REE is adjusted for body weight/composition using ratio- or regression-based methods could influence understanding of how these procedures affect energy balance. This systematic review identified studies that reported REE before and after gastric restriction in order to compare changes using each method. Ratio assessments revealed increases and decreases when REE was expressed per kilogram of body weight and per kilogram of fat-free mass, respectively. In comparison, measured REE tended to be less than predicted from linear regression after surgery. Explanations for these seemingly disparate findings and future directions are discussed.

The use of adjustable gastric bands for management of severe and complex obesity

Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups. Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies. Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures. Reliable Level 1 evidence of the relative effectiveness of the operations is lacking. As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both. Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question 'which is the best of the three operations most frequently performed?' This review considers the current evidence for gastric banding for the treatment of severe and complex obesity.