Expected Weight Loss Research Articles

Patients experience with preoperative use of anti-obesity medications and associations with bariatric surgery expectations

BackgroundFew studies have investigated the use of anti-obesity medications (AOMs) before bariatric surgery and how prior use impacts patients’ goals and expectations for surgery. ObjectivesThis study investigated associations between patients’ experiences with AOMs and weight loss expectations before bariatric surgery. SettingsSingle tertiary university hospital. MethodsPatients were electronically surveyed with a 31-item questionnaire via email or the patient portal with a primary predictor variable of AOMs presurgery. Outcomes included degree of weight loss and weight regain and motivation for seeking surgery. ResultsA total of 346 persons were invited to complete the survey; 112 surveys (32.4%) were completed, with 7 excluded because of not answering the AOM question. 73% reported AOM use. Among those who took AOMs before seeking bariatric surgery, average weight loss was 13 kg (SD 10) corresponding to a 4.4-kg/m2 decrease in BMI. Of past AOM recipients, 87% reported weight regain on stopping AOMs. Average weight regain was 18 kg (SD 13; 126% increase). Patients reported improved longevity and quality of life as motivation for seeking surgery, with AOM use history having no effect. Subjects reported an average weight loss goal of 65.8 kg (39% of baseline weight) from bariatric surgery. ConclusionsAOMs were commonly used in those seeking bariatric surgery, but motivation for surgery did not differ by AOM use history. Motivations were most often related to goals for better overall health.

Contemporary Management of Obesity: A Comparison of Bariatric Metabolic Surgery and Novel Incretin Mimetic Drugs.

The global prevalence of obesity has risen sharply during the past half-century, reaching pandemic proportions and creating a public health crisis. Obesity is a recognized risk factor for the development of diabetes, atherosclerosis, hypertension, hepatic steatosis, and many other cardiometabolic disorders with significant resultant morbidity and mortality. Though treatment of obesity can prevent or slow the progression of the aforementioned illnesses, efforts to help patients achieve reliable and sustainable weight loss have had limited success. Improving nutrition and increasing physical activity results in a host of health benefits; however, the weight loss achieved with lifestyle interventions alone is modest and difficult to sustain. Early attempts at medical and surgical treatment of obesity were plagued with adverse effects and complications. Moreover, these approaches failed to demonstrate long-term health benefits, even when weight loss was achieved. Recently, novel incretin-based therapies targeting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors have gained popularity because of their effectiveness in achieving substantial weight loss in patients both with and without diabetes. Following many successful clinical trials, there are now multiple GLP-1 receptor agonists and one dual GLP-1-GIP receptor agonist approved by the Food and Drug Administration for chronic weight management. Advancements in laparoscopic surgical technique and refinements in procedure selection have similarly improved the safety and efficacy of bariatric metabolic surgery for patients with obesity. In this review, we discuss the advantages and disadvantages of contemporary pharmacologic and surgical weight management strategies. We review the data regarding expected weight loss, glycemic control, cardiometabolic benefits, and potential adverse effects of various treatment approaches. As obesity rates continue to rise worldwide, it is imperative that clinicians keep these considerations in mind in order to better care for patients.

Metabolic surgery results in greater metabolic benefits in patients who achieve healthy weight

BackgroundA percentage of total weight loss (%TWL) >20% as the expected weight loss target after metabolic surgery might be insufficient to produce adequate metabolic benefits. ObjectivesThis study identified the optimal weight loss target to achieve substantial benefits from metabolic surgery. SettingUniversity-affiliated tertiary care center. MethodsIn this retrospective study, participants were categorized into healthy weight (18.5 kg/m2 ≤ body mass index [BMI] < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2), and obesity groups (BMI ≥28 kg/m2) according to their BMI 1 year after metabolic surgery. The weight loss and remission of obesity-related comorbidities were evaluated. Ordinal logistic regression analysis was used to identify predictors for achieving healthy weight 1 year postoperatively. ResultsOverall, 125 patients (112 sleeve gastrectomies, 13 Roux-en-Y gastric bypasses) were recruited in this study. Forty-two participants achieved healthy weight, 38 were overweight, and 45 had obesity. Type 2 diabetes mellitus and obstructive sleep apnea were relieved in all groups. Individuals who achieved healthy weight showed more improvements in nonalcoholic fatty liver disease, hypertension, and hyperuricemia than those who did not. Preoperative BMI was an independent predictor for the BMI achieved postoperatively, and the optimal cut-off point for achieving healthy weight was 34.9 kg/m2. ConclusionsHealthy weight was a more stringent target for patients who underwent metabolic surgery than the %TWL. Populations with a preoperative BMI of <34.9 kg/m2 were prone to realize the goal. Additional weight loss interventions could be considered for those with higher preoperative BMIs and enforced within 1 year postoperatively.

Performance of a predictive weight loss model in terms of rapid detection of inadequate weight loss after Roux-en-Y gastric bypass

BackgroundPredictive weight loss models can help patients meet their expectations after bariatric surgery and assist physicians in responding to deviations from the predicted weight. A model published by Seyssel et al. appears to accurately predict postoperative body mass index. ObjectivesWe aimed to demonstrate this model’s performance in terms of rapid detection of insufficient weight loss (surgical nonresponse). SettingCantonal Hospital, Switzerland. MethodsWe retrospectively analyzed weight and body mass index deviations at 2 years postoperatively, based on values predicted by the model of Seyssel et al. The primary outcome was the timing of detection of surgical nonresponse. The secondary outcome was how patients’ weight loss expectations influenced their real weight loss. ResultsBetween 2016 and 2019, 190 patients underwent Roux-en-Y gastric bypass. Of these patients, 36 were lost to follow-up and 154 were included in this study. At 24 months, 16 patients had surgical nonresponse, defined as a real weight of +1 standard deviation higher than that predicted. Among these patients, 44% had a weight of ≥+1 standard deviation higher than predicted at 3 months, and 63% at 12 months. The positive and negative predictive values at 12 months were 59% and 95%, respectively. Patients with a lower hypothetically wanted weight (38.5%) exhibited greater weight loss (P < .05). ConclusionsThe predictive weight loss model of Seyssel et al. enables rapid detection of surgical nonresponse, allowing physicians to react as early as 3 months postsurgery. Patients’ overestimation of postoperative weight loss was positively correlated with the actual weight loss achieved.

Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year.

This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).

Preoperative and early adjuvant weight loss medications in bariatric surgery patients with body mass index over 60 or suboptimal initial response to surgery.

Few studies have examined the adjuvant use of antiobesity medications with surgery, especially in the pre- and early postoperative periods. Evaluate the impact of adjuvant pharmacotherapy on bariatric surgery outcomes. University hospital, United States. A retrospective chart review of patients receiving adjuvant pharmacotherapy for obesity treatment and bariatric surgery. Patients received pharmacotherapy either preoperatively if their body mass index was >60, or in the first or second postoperative years for suboptimal weight loss. Outcome measures included percentage of total body weight loss as well as comparison with the expected weight loss curve as determined by the Metabolic and Bariatric Surgery Risk/Benefit Calculator. A total of 98 patients were included in the study, with 93 (94.9%) undergoing sleeve gastrectomy and 5 (5.1%) undergoing Roux-en-Y gastric bypass surgery. During the study period, patients were prescribed phentermine and/or topiramate. At postoperative year 1, patients who received pharmacotherapy preoperatively lost 31.3% of their total body weight (TBW) compared with 25.3% TBW for patients with suboptimal weight loss who received medication in the first postoperative year, and 20.8% TBW for patients who did not receive any antiobesity medication in the first postoperative year. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) curve for comparison, patients receiving medication preoperatively weighed 2.4% less than expected, whereas patients receiving medication during the first postoperative year weighed 4.8% higher than expected. For patients having bariatric surgery who fall below the expected MBSAQIP weight loss curve, early initiation of antiobesity medications can improve the weight loss, with preoperative pharmacotherapy having the greatest effect.

847-P: SGLT2 Inhibitors and GLP-1s Are Falling Short of Expectations among Patients with Type 2 Diabetes Newly Initiating Therapy

SGLT-2s and GLP-1s have demonstrated significant glucose lowering, cardiorenal, and weight loss benefits. However, the exisiting research on patients’ perception of these benefits is limited. Thus, the present study aims to identify and compare new users' expectations of SGLT-2s and GLP-1s and the degree to which their expectations have been met. In September 2022, 3,785 adults living with T2D took an online survey in which they indicated their SGLT-2 and GLP-1 usage and start date. Those who initiated SGLT-2 (n=108) or GLP-1 (n=128) use in the past year reported their expected changes upon starting the therapy. Participants were then asked the degree to which their expectations were met for each expectation held. Met expectations were calculated based on the percent of people selecting a 9 or 10 on a 10-point Likert scale. New SGLT-2 users expected lower A1c, increased protection against kidney disease, and weight loss (76%, 43%, and 40%, respectively), although less than a third of SGLT-2 new users expecting a lower A1c and weight loss felt that their expectations were met (29% and 28%, respectively). GLP-1 new users expected lower A1c, weight loss, and fewer instances of hyperglycemia (80%, 74%, and 48%, respectively). Only a third of new users felt their expectations of lower A1c and weight loss were met (34% and 33%, respectively). Expectations of A1c lowering were similar between GLP-1s and SGLT-2s (80% vs. 76%); however, weight loss expectations were significantly higher among GLP-1 users compared to those on SGLT-2s (74% vs. 43%, p&amp;lt;.01). Among patients initiating SGLT-2 or GLP-1 therapy, A1c lowering and weight loss expectations were not met for the majority of participants. These findings emphasize the need for improved expectation management and realistic goal setting. Future research is needed to understand how failed expectations translate into clinical outcomes and medication adherence, and to identify steps to better align patient expectations and outcomes. Disclosure C.Holleman: Employee; Close Concerns, Other Relationship; Abbott Diabetes, Eli Lilly and Company, LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Medtronic, Ascensia Diabetes Care, MannKind Corporation, dQ&amp;A. E.Xu: Employee; dQ&amp;A. E.Cox: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

A195 Expected Weight Loss After Completion of a Duodenal Switch Remote from Vertical Sleeve Gastrectomy

A195 Expected Weight Loss After Completion of a Duodenal Switch Remote from Vertical Sleeve Gastrectomy

Animal Protein Intake Is Associated with Obesity Remission After Roux-en-Y Gastric Bypass: an Isocaloric Replacement Analysis.

Some patients do not have the expected weight loss, and the post-surgical diet may partially explain these differences. To estimate the impact of macronutrient substitution on obesity remission after RYGB, considering the protein source. This study included 58 patients undergoing RYGB. Data collection was performed preoperatively, 3 and 12months after surgery.Eight participants dropped out of the study at 3 months,and the others remained for 12 months. The foods consumed were registered using a 24-h, 3-day food recall. For the isocaloric substitution analysis, foods were classified according to the protein source. The groups were compared using hypothesis tests, and Cox proportional hazard ratio regression was used to analyze isocaloric substitution. At three months after surgery, every 5% energy from plant protein replaced by animal protein increased by 3.50 [CI 1.204 - 10.205; p = 0.021] the probability of obesity remission. Stratified analysis by protein groups indicated that replacing vegetable protein with white meat was positively associated with remission of obesity. Every 5% vegetable protein replaced with white meat increased by 3.20 [CI 1.026 - 9.981; p = 0.045] the probability of obesity remission. Both results were independent of age, body mass index (BMI), and the presence of comorbidities. The results suggest that the consumption of animal proteins after RYGB, mainly white meat, favors weight loss.

Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach.

People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

The Role of Change in Self-efficacy in Maintaining Exercise-Associated Improvements in Mood Beyond the Initial 6 Months of Expected Weight Loss in Women with Obesity.

Although mechanisms are unclear, there is a robust association between exercise and mood improvements. However, beyond ~ 6months of expected weight loss, weight-management behaviors such as exercise wane as weight gradually regains in most adults. The amount of exercise required to maintain mood improvement is unknown, as is the possible role of theory-based psychosocial changes associated with treatment such as in self-efficacy. Women who volunteered for a community-based cognitive-behavioral obesity treatment emphasizing exercise and building self-efficacy via self-regulating through lifestyle challenges/barriers, and were of the 86% who reduced their negative mood during its initial 6months, were allocated into groups who either maintained their negative mood reduction (Sustain group, n = 43) or reverted toward initial levels of negative mood (Revert group, n = 73) during months 6-24. A binary stepwise logistic regression analysis assessed whether exercise amount and/or change in self-efficacy significantly classified Sustain vs. Revert group membership. Change in exercise amount was not significantly associated with group membership. However, after additional entry of change in exercise self-efficacy, a significant association was found - successfully classifying 70% and 42% of the Revert and Sustain group participants, respectively. When self-efficacy change was entered as the sole independent variable, group membership was classified with 62% accuracy, overall (96% in the Revert group). Consistent with behavioral explanations of the exercise-mood change relationship, it was interpreted that self-efficacy, rather than exercise amount, was an important correlate of mood change beyond month 6. Suggestions for bolstering self-efficacy later in behavioral obesity treatments were provided.

Weight Loss After Bariatric Surgery in Different Age Groups.

Weight loss after bariatric operations may be reduced in older patients due to changes in metabolism. Some studies showed inferior weight loss in older patients compared to younger ones while others showed no such difference. In order to counsel patients about the expected weight loss after bariatric surgery, recommendations stratified by age are important. This study encompasses a retrospective analysis of 500 consecutive patients with RYGB or sleeve gastrectomies from a single institution with a mean follow-up time of 3.6years. Patients were stratified into five groups according to age at the time point of the operation: < 30years, 30-39years, 40-49years, 50-59years, and ≥ 60years. Weight loss expressed in percent excessive body mass index loss (%EBMIL) at nadir were 86.6, 89.5, 84.0, 77.9, and 76.4% and 75.6, 78.4, 73.3, 68.0, and 69.0% at the time of last follow-up for the five groups, respectively. Weight loss was significantly higher in younger patients than in older patients for both time points. The total number of comorbidities that showed complete remission (normal values without treatment), was also significantly higher in the younger age groups. Primary bariatric operations yield better weight loss results and remission rates of obesity related comorbidities in younger patients, but are still effective in older individuals.

A history of adjustment disorder predicts greater weight loss after sleeve gastrectomy.

Bariatric surgery is one of the most effective long-term options for treating class III obesity or class II obesity with medical co-morbidities; however, a significant number of patients do not achieve the expected weight loss. New studies are needed to find the predictive value of different variables on surgery outcomes. Our aim was to study a number of physical, medical, and psychopathological variables as potential risk factors for poor outcomes in patients with class II-IV obesity scheduled for sleeve gastrectomy. Sagrat Cor University Hospital in Barcelona, Spain. This prospective longitudinal study enrolled a sample consisting of 441 patients from whom a descriptive analysis was obtained. For 235 of them, we performed a comparative analysis between the patients with differing responses to sleeve gastrectomy after 1 year of follow-up. The remaining patients had differing follow-up data or were lost to follow-up. To collect the data, a semi-structured interview was conducted, and various tests were administered to assess the patients' psychopathology (Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale) and functionality (Global Assessment of Functioning Scale). The results show the prognostic relationship between certain presurgery variables and the good or poor outcomes of the bariatric surgery, based on the patients' weight loss. Advanced age, high body mass index, diabetes, and respiratory problems were significant predictors of a poor response to surgery. Contrarywise, a history of adjustment disorder predicted a better response. The results allow us to conclude that, beyond well-established physical and medical conditions, a psychopathological study of patients prior to bariatric surgery including adjustment disorders could be predictive of therapeutic response and could help to personalize the follow-up.

Effect of Weight Goals on Sitting and Moving During a Worksite Sedentary Time Reduction Intervention.

Although many US adults report trying to lose weight, little research has examined weight loss goals as a motivator for reducing workplace sitting and increasing physical activity. This exploratory analysis examined weight goals and the association with changes in workplace sitting, physical activity, and weight. Employees (N = 605) were drawn from worksites participating in Stand and Move at Work. Worksites (N = 24) were randomized to a multilevel behavioral intervention with (STAND+) or without (MOVE+) sit-stand workstations for 12 months; MOVE+ worksites received sit-stand workstations from 12 to 24 months. At each assessment (baseline and 3, 12, and 24 months), participants were weighed and wore activPAL monitors. Participants self-reported baseline weight goals and were categorized into the "Lose Weight Goal" (LWG) group if they reported trying to lose weight or into the "Other Weight Goal" (OWG) group if they did not. Generalized linear mixed models revealed that within STAND+, LWG and OWG had similar sitting time through 12 months. However, LWG sat significantly more than OWG at 24 months. Within MOVE+, sitting time decreased after introduction of sit-stand workstations for LWG and OWG, although LWG sat more than OWG. Change in physical activity was minimal and weight remained stable in all groups. Patterns of change in workplace sitting were more favorable in OWG relative to LWG, even in the absence of notable weight change. Expectations of weight loss might be detrimental for reductions in workplace sitting. Interventionists may want to emphasize non-weight health benefits of reducing workplace sitting.

Adjustment of Unrealistic Weight Loss Expectations on a Mobile CBT-Based Behavior-Change Program: Prospective One-Armed Study

Background: Moderate weight loss of 5–10% is considered a realistically achievable weight loss goal and is associated with decreased risk of obesity-related health complications. However, individuals tend to expect that they will lose as much as 20–30% of their body weight when they start a behavioral weight loss program. Current research is limited on how these expectations change over time during weight loss and the consequences of adjusting one’s expectations in a more realistic direction, particularly on a CBT-based program. Method: Therefore, this prospective cohort study evaluated whether individuals adjusted their weight loss expectations over time during real-world use of a mobile CBT-based behavior-change program (Noom Weight) and how this adjustment related to weight loss outcomes, as well as how the amount of adjustment depended on program engagement. Participants had recently signed up for Noom Weight and reported their weight, expectations for weight loss, and psychological well-being at baseline and six months. Engagement was automatically recorded by the program. Results: We found that after using Noom Weight for six months, participants’ expectations became more realistic (i.e., significantly decreased) compared to baseline (−5.77, s.e. = 0.57, p &lt; 0.001), and this downward adjustment was associated with greater weight loss (b = 1.80, 95% CI 1.21–2.38, p &lt; 0.001). Higher program engagement, particularly reading articles focused on CBT-based principles, was associated with greater decreases in expectations over time (b = −0.007, t = −2.22, p = 0.03). Conclusions: The results suggest that CBT-based principles may aid in adjusting weight loss expectations to more realistic levels and that such adjustment is associated with positive weight outcomes. Future research should build on these results by evaluating adjustment in weight loss expectations over time, rather than solely expectations at baseline.

Combination therapy with exenatide decreases the dapagliflozin-induced changes in brain responses to anticipation and consumption of palatable food in patients with type 2 diabetes: A randomized controlled trial.

AimsSodium‐glucose cotransporter‐2 inhibitors induce less weight loss than expected. This may be explained by sodium‐glucose cotransporter‐2 inhibitor‐induced alterations in central reward‐ and satiety circuits, leading to increased appetite and food intake. Glucagon‐like peptide‐1 receptor agonists reduce appetite and body weight because of direct and indirect effects on the brain. We investigated the separate and combined effects of dapagliflozin and exenatide on the brain in response to the anticipation and consumption of food in people with obesity and type 2 diabetes.Materials and MethodsAs part of a larger study, this was a 16 week, double‐blind, randomized, placebo‐controlled trial. Subjects with obesity and type 2 diabetes were randomized (1:1:1:1) to dapagliflozin 10 mg with exenatide‐matched placebo, exenatide twice‐daily 10 μg with dapagliflozin‐matched placebo, dapagliflozin plus exenatide, or double placebo. Using functional magnetic resonance imaging, the effects of treatments on brain responses to the anticipation of food and food receipt were assessed after 10 days and 16 weeks.ResultsAfter 10 days, dapagliflozin increased activation in right amygdala and right caudate nucleus in response to the anticipation of food, and tended to decrease activation in right amygdala in response to actual food receipt. After 16 weeks, no changes in brain activation were observed with dapagliflozin. Dapagliflozin plus exenatide reduced activation in right caudate nucleus and amygdala to the anticipation of food, and decreased activation in the right amygdala in response to food receipt after 16 weeks.ConclusionsThe dapagliflozin‐induced changes in brain activation may contribute to the discrepancy between observed and expected weight loss with dapagliflozin. Exenatide blunted the dapagliflozin‐induced changes in brain activation, which may contribute to the additional weight loss with combined treatment.

Patients lose weight after a total knee arthroplasty: myth or reality?

Obesity is one of most discussed factors when assessing prosthetic knee surgery outcomes. Prior to the procedure, most patients perceive that their excessive weight is secondary to the low level of activity due to limiting knee pain. The main objective of this study was to assess whether patients undergoing total knee arthroplasty (TKA) lose weight after the procedure. The secondary objective was to correlate weight loss with post-operative knee function. A prospective observational study was designed including 247 patients who undergone TKA from January 2018 to January 2019. A significant change in weight was considered anything above or below 5% of the pre-operative weight. Three groups were established based on a change in weight: loss of more than 5%, those who did not pass above or below 5% of their initial weight and increase of more than 5%. Follow-up was carried out at 12months after the intervention assessing patient's BMI (kg/m2), functional level (KSS), weight loss expectations, and range of motion. Among the total population, 17 (6.9%) lost weight, 168 (68%) did not have a change, and 62 (25.1%) increased weight at oneyear follow-up. The mean pre-operative BMI was 31.5kg/m2, and mean postoperative BMI was 31.98kg/m2. Furthermore, obese patients were more likely to present weight reduction than non-obese (p = 0.01). When comparing functional results between groups, no differences were observed in terms of KSS-K and KSS-F. Patients who undergo TKA do not lose weight one year after surgery. When correlating weight loss with post-operative outcomes, no differences were observed between groups.

Five-year attrition, active enrollment, and predictors of level of participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study.

Reporting high-quality bariatric surgery outcomes depends on participant attrition and level of study participation among enrolled participants. Our aims are to report participant attrition, active enrollment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation through 5 years. The Longitudinal Assessment of Bariatric Surgery-2 study which enrolled 2458 adults undergoing a first bariatric surgical procedure at 1 of 6 US cites from 2006 through 2009. In-person research assessments were conducted pre-surgery and annually for five years. Extensive retention strategies including offering remote assessments (telephone, email, mail, or a combination) were fully implemented in 2009. Among living participants, including those inactivated, annual follow-up assessments were categorized as in-person, remote or missed through 5 years. By year 5, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n = 121). Controlling for site and calendar year, missed assessments increased from 14.7%-21.8% between years 1 and 2 and then stayed relatively stable (20.8%-19.6%) for years 3-5. Younger age, male sex, White race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations preoperatively were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up. The LABS-2 participant attrition was low. The percentage of missed assessments did not increase after year 2, perhaps due to implementation of a comprehensive retention plan. Predictors of missed assessments highlight subgroups to target for focused retention efforts.

Danish translation and linguistic validation of new body-Q scales measuring expectations, eating behavior, distress, symptoms and work life

The aim of this study was to translate and achieve a linguistical and cultural adaption of the newly developed BODY-Q Obesity Module for use in Danish patients. The BODY-Q Eating Module consists of five new modules aiming to measure expectations of weight-loss, eating behavior, eating-related distress, eating-related symptoms and work life. Translation and linguistic validation were performed using a combination of the recommendations developed by the World Health Organization and the International Society for Pharmacoeconomics and Outcomes Research. The translation was performed in five steps consisting of a forward translation, backward translation, expert panel meeting, cognitive debriefing and final proofreading. Each step aimed for a conceptual and cultural equal translation that was easily understood by patients. The discrepancies encountered in the forward translation included the use of layperson versus medical terminology, different tense and sentence structure. The harmonized version was then backwards translated which led to no conceptual differences. The expert panel reviewed the instrument in full and found two items needing correction in the instrument. Cognitive debriefing did not lead to any revisions and the instrument was well received by the participant group. Proofreading of the instrument led to few corrections in grammar and punctuation but no conceptual corrections. The translation of the BODY-Q Eating Module led to a conceptual and cultural equal version of the instrument for use in Danish patients. The instrument can be used in clinical care and research to inform advancements in the field of bariatric and body contouring surgery.

Effects of Dapagliflozin and Combination Therapy With Exenatide on Food-Cue Induced Brain Activation in Patients With Type 2 Diabetes.

ContextSodium-glucose cotransporter-2 inhibitors (SGLT2i) cause less weight loss than expected based on urinary calorie excretion. This may be explained by SGLT2i-induced alterations in central reward and satiety circuits, leading to increased appetite and food intake. Glucagon-like peptide-1 receptor agonists are associated with reduced appetite and body weight, mediated by direct and indirect central nervous system (CNS) effects.ObjectiveWe investigated the separate and combined effects of dapagliflozin and exenatide on the CNS in participants with obesity and type 2 diabetes.MethodsThis was a 16-week, double-blind, randomized, placebo-controlled trial. Obese participants with type 2 diabetes (n = 64, age 63.5 ± 0.9 years, BMI 31.7 ± 0.6 kg/m2) were randomized (1:1:1:1) to dapagliflozin 10 mg with exenatide-matched placebo, exenatide twice daily 10 µg with dapagliflozin-matched placebo, dapagliflozin and exenatide, or double placebo. Using functional MRI, the effects of treatments on CNS responses to viewing food pictures were assessed after 10 days and 16 weeks of treatment.ResultsAfter 10 days, dapagliflozin increased, whereas exenatide decreased CNS activation in the left putamen. Combination therapy had no effect on responses to food pictures. After 16 weeks, no changes in CNS activation were observed with dapagliflozin, but CNS activation was reduced with dapagliflozin-exenatide in right amygdala.ConclusionThe early increase in CNS activation with dapagliflozin may contribute to the discrepancy between observed and expected weight loss. In combination therapy, exenatide blunted the increased CNS activation observed with dapagliflozin. These findings provide further insights into the weight-lowering mechanisms of SGLT2i and GLP-1 receptor agonists.