Higher Initial Body Mass Index Research Articles

Exploring Post-treatment Weight Changes in Overweight and Obese Patients With Graves' Disease: A Retrospective Analysis.

Graves' disease (GD) is associated with primary hyperthyroidism, leading to weight loss before treatment. During the treatment, weight gain is frequently observed, often surpassing the initial weight loss. This study aimed to analyze weight fluctuations in GD patients, focusing on the subset of overweight and obese (OAO) individuals, considering the significant metabolic implications and heightened cardiovascular risk of these weight changes. A retrospective cohort study included 122 GD patients with biochemical primary hyperthyroidism and at least 12 months of clinical follow-up after treatment for analysis. The OAO cohort comprised individuals with a body mass index (BMI) ≥25 kg/m². Data on laboratory, demographic, and weight variables were collected longitudinally. During the hyperthyroidism state, 34.4% (n=42) of patients presented with weight loss, a phenomenon linked to lower serum thyroid-stimulating hormone levels at diagnosis (p=0.010) and an extended need for anti-thyroid drug treatment (p<0.001). Following treatment, around 60% (n=73) of individuals encountered weight gain, exhibiting a higher prevalence among women (p<0.001) and those undergoing definitive treatment modalities (p=0.024). Notably, 26.2% (n=32) experienced excessive weight gain, which was correlated with higher premorbid BMI and diminished weight loss induced by hyperthyroidism (p<0.001). Within the OAO cohort, 66.7% (n=26) observed an increase in weight post-treatment, and in 28.2% (n=11), excessive weight gain was reported. Weight gain and excessive weight gain were noted in patients with higher initial BMIs. This study highlights that post-treatment weight gain is common, emphasizing the need for careful weight management in GD. In OAO GD patients, the association between initial BMI and increased weight underscores potential cardiovascular risks, warranting vigilant monitoring and early intervention.

Exploring the Utility of the Rorschach Test in Predicting Weight Loss After Bariatric Surgery

Abstract: Bariatric surgery (BS) is an effective approach to treat severe obesity, which should include multidisciplinary care. Prior to surgery, candidates for BS usually undergo a psychological assessment based mostly on self-report of clinical symptoms. However, the results of this assessment are not always sufficient to predict outcomes. Therefore, this study examined the potential of a multimethod approach to assessing patients seeking BS using both self-report and performance-based measures of cognitive and affective functioning. A sample of 50 women who had applied for surgery at a public facility in Brazil were assessed with the Difficulties in Emotion Regulation Scale (DERS), the Rorschach Performance Assessment System (R-PAS), and the Trail Making Test (TMT). Patients who dropped out before treatment ( n = 27) had higher initial body mass index and poorer performance on cognitive flexibility at baseline. In the remaining 23 patients who underwent surgery, indicators of emotional and cognitive functioning from all measures were associated with weight loss (WL) at 6 and 12 months after surgery. However, only R-PAS variables regarding psychological resources were associated with WL 18 months after surgery. We discuss the usefulness of the Rorschach as a source of information for patients seeking BS and the implications for current assessment practices in the field.

Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity

Information on the probability of weight loss among US adults with overweight or obesity is limited. To assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race. This cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years. Initial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity). The 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9). The 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category. Results of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight.

Long-term outcome after biliopancreatic diversion with duodenal switch: a single-center experience with up to 20 years follow-up.

Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective standard bariatric procedure in terms of weight loss and remission of co-morbidities but carries the risk of severe long-term side effects. The aim of this study was to analyze the long-term effects of BPD/DS in terms of morbidity, weight loss, remission of associated medical problems, deficiencies, and reoperations. Academic teaching hospital, Switzerland. This is a retrospective, single-center study of prospectively collected data of all patients who underwent BPD/DS from 1999 to 2011 with a minimal follow-up (FU) of 10 years. A total of 116 patients (83.6% female) underwent BPD/DS with a mean initial body mass index (BMI) of 47 ± 6.5 kg/m2. Of these, 68% of the procedures were performed in open technique and 32% laparoscopically. The majority (76.7%) of patients had laparoscopic adjustable gastric banding before BPD/DS. The mean FU time was 14 ± 4.4 years and the FU rate at 5, 10, and 14 years was 95.6% (n = 108), 90% (n = 98), and 75.3% (n = 70), respectively. The mean excess BMI loss at 5, 10, and 14 years was 78% ± 24.1%, 76.5% ± 26.7%, and 77.8% ± 33.8%, respectively. Complete (n = 22) or partial remission (n = 4) of type 2 diabetes was observed in 92.8% of patients. Forty reoperations were necessary in 34 patients (29.3%) because of malnutrition or refractory diarrhea (n = 13), insufficient weight loss or weight rebound (n = 7), reflux or stenosis (n = 10), and various/combined indications (n = 10). The mean time to reoperation was 7.7 ± 5 years. There were no procedure-related deaths in the short or long term. BPD/DS offers sustainable long-term weight loss but is associated with important side effects that may be acceptable in selected patients with a high initial BMI (>50 kg/m2) and/or for nonresponders after primary restrictive procedures. Regular FU is necessary to detect and treat malnutrition and vitamin deficiencies.

Transition patterns of weight status: A cohort study of Chinese school-age children.

Childhood overweight and obesity are increasing public concerns. However, little is known about the transition patterns of childhood weight status, especially in developing countries. In this study, we aimed to evaluate patterns of change in weight status and the risk factors among Chinese school-age children. This retrospective cohort study included 2,334 children aged 6 years with complete 5-year (2012-2017) physical examination data in Minhang District, Shanghai. A time-homogeneous three-state Markov model was fit to the longitudinal data with dynamic outcomes (normal weight, overweight, and obesity). According to the Markov model, 42.3% of school-age children who were initially overweight transitioned to another weight status within 1 year, with 24.8% (95% confidence interval [CI]: 23.1, 27.0) transitioning to normal weight and 17.5% (95% CI: 15.9, 19.3) becoming obese. In contrast, children who were initially normal weight (92.9% [95% CI: 92.3, 93.5]) or obese (83.1% [95% CI: 81.1, 84.8]) tended to maintain their initial weight status. Male sex, semi-urban area, absence of late adiposity rebound, lower annual height increments, higher annual weight increments, and higher initial body mass index were significantly associated with a higher risk of developing or maintaining overweight and obesity (p < 0.05). The weight status of Chinese school-age children is more likely to change among those who are initially overweight than in those who are initially obese. Interventions to promote healthy weight status may be more effective if key groups are targeted, such as overweight and pre-school-age children.

Genetic polymorphisms are not associated with energy intake 1 year after Roux-en-Y gastric bypass in women.

The present study aimed to investigate the influence of food intake on body weight loss (WL) and the association of gene polymorphisms, 1 year after Roux-en-Y gastric bypass (RYGB) surgery. In total, 95 obese women (age ranged 20-50 years) in a Brazilian cohort underwent RYGB surgery and completed the study. Anthropometric measurements and food intake were assessed before and 1 year after surgery. Twelve gene polymorphisms (GHRL rs26802; GHSR rs572169; LEP rs7799039; LEPR rs1137101; 5-HT2C rs3813929; UCP2 rs659366; UCP2 rs660339; UCP3 rs1800849; SH2B1 rs7498665; TAS1R2 rs35874116; TAS1R2 rs9701796; and FTO rs9939609) were determined using a real-time polymerase chain reaction and a TaqMan assay. The subjects were divided into quartiles regarding percentage of excess weight loss (%EWL). The effect of genetic variants on energy and macronutrient intake was evaluated by simple logistic regression, followed by multiple logistic regression. Subjects in the first and second quartiles showed a higher initial body mass index. Energy and macronutrient intake before and 1 year after RYGB surgery did not differ between the %EWL quartiles. None of gene polymorphisms investigated showed an association with the estimated energy intake 1 year after surgery. In conclusion, the estimate energy and food intake did not predict a greater body WL 1 year after RYGB surgery. In addition, the 12 gene polymorphism investigated did not affect the energy intake among female patients.

Response to growth hormone according to provocation test results in idiopathic short stature and idiopathic growth hormone deficiency.

Purpose To investigate growth response in children with either idiopathic short stature (ISS) or growth hormone (GH) deficiency (GHD).Methods The data of prepubertal GHD or ISS children treated using recombinant human GH were obtained from the LG Growth Study database. GHD children were further divided into partial and complete GHD groups. Growth response and factors predicting growth response after 1 and 2 years of GH treatment were investigated.Results This study included 692 children (98 with ISS, 443 partial GHD, and 151 complete GHD). After 1 year, changes in height standard deviation score (ΔHt-SDS) were 0.78, 0.83, and 0.96 in ISS, partial GHD, and complete GHD, respectively. Height velocity (HV) was 8.72, 9.04, and 9.52 cm/yr in ISS, partial GHD, and complete GHD, respectively. ΔHt-SDS and HV did not differ among the 3 groups. Higher initial body mass index standard deviation score (BMI-SDS) and midparental height standard deviation score (MPH-SDS) were predictors for better growth response after 1 year in ISS and the partial GHD group, respectively. In the complete GHD group, higher Ht-SDS and BMI-SDS predicted better growth response after 1 year. After 2 years of GH treatment, higher BMI-SDS and MPH-SDS predicted a better growth outcome in the partial GHD group, and higher MPH-SDS was a predictor of good growth response in complete GHD.Conclusions Clinical characteristics and growth response did not differ among groups. Predictors of growth response differed among the 3 groups, and even in the same group, a higher GH dose would be required when poor response is predicted.

Remote gestational weight gain monitoring in a large low-risk US population.

BackgroundOver the past decade there have been rapid advancements in telemedicine and mobile health technology (mHealth) and rapid increases in adoption of these technologies among OB‐GYN providers. Mobile technology is routinely used in the general adult population to simplify monitoring of food intake and weight. Studies have demonstrated that weight loss achieved via remote monitoring, through use of wi‐fi scales and web applications, is similar to weight loss achieved with in‐person support. These technologies also increase flexibility for subjects and providers. However, there has been limited large‐scale research to evaluate the use of these technologies to improve adherence to weight‐gain recommendations during pregnancy.ObjectivesTo evaluate gestational weight gain tracking in a large low‐risk obstetrical population using remote patient monitoring and a mobile phone app.MethodsSelf‐reported age, height, estimated due date, and weight data were extracted from low‐risk, singleton pregnancies entered from 50,769 participants who were enrolled in the BabyScripts TM phone app between 1 January 2016 and 1 March 2020. After data cleaning, 15,468 participants were included the final analysis. Linear regression and Spearman's correlation were used to examine the relationships between total weight gain, rate of weight gain, body mass index (BMI), postpartum weight loss, and app engagement.ResultsThe average weight gain in the first, second, and third trimester were 0.09 ± 1.8 kg, 4.2 ± 3.3 kg, and 3.9 ± 3.9 kg, respectively. The average rate of weight gain per week for the second and third trimesters were 0.5 ± 0.4 kg/wk and 0.6 ± 0.8 kg/wk, respectively. Participants with higher initial BMI had slower rate of weight gain than those with lower initial BMI (r = −0.24, r = −0.05, for second and third trimester, respectively). Overall, 21.4% of participants met the Institutes of Medicine (IOM) recommendation for total weight gain during pregnancy. Patients who were highly engaged with the mobile app had increased adherence to the IOM guidelines (29.8% vs. 9.4%, p < 0.001). A larger proportion of highly engaged patients adhered to the IOM guidelines for rate of weight gain in the second and third trimester, compared to the lowest engaged patients (12.7% vs. 6.8%, p < 0.001). On average, participants lost 8.8 ± 3.3 kg over an average of 8.1 ± 4.6 weeks in the immediate postpartum period. This weight loss was positively associated with engagement (r = 0.3, p < 0.001).CommentsEngagement with the mobile app was associated with increased adherence to the IOM gestational weight gain guidelines and with increased postpartum weight loss. Use of remote patient monitoring in conjunction with mHealth technology may be a strategy to improve adherence to IOM guidelines.

Efficacy of Somnodent® Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients Somnodent® OAs for Moderate to Severe OSAHS

Objective: Oral appliances are one of the treatments of obstructive sleep apnea hypopnea syndrome. The main objective of the study was to determine the efficacy of the Somnodent® oral appliance on Apnea-Hypopnea Index. The secondary objective was to measure the efficacy on other oxymetric parameters and to determine its tolerance and dropout rate. Methods: Efficacy results of the oral appliances based on the apnea hypopnea index, the oxygen desaturation index and the lower oxygen saturation reduction, appliance complications and dropout rates were retrospectively collected from 25 patients with a moderate to severe obstructive sleep apnea hypopnea syndrome treated by a Somnodent® oral appliance. The procedure was entirely performed by otolaryngologists. Results: The AHI with OA was more significantly reduced in patients with a higher initial apnea hypopnea index and a higher initial body mass index but reduction was not related to age and not proportional to degree of mandibular advancement. The 50%-AHI reduction rate after OA was 55.6%, the AHI ≤5/h rate after OA was 22.2%. The OA significantly reduced the mean apnea-hypopnea index (-14.3/h, p&lt;10-5). No patient had his AHI increased with oral appliance. One patient stopped using OA mainly because of nausea. Conclusions: Somnodent® is an effective and well-tolerated treatment for moderate to severe obstructive sleep apnea hypopnea syndrome.

Body Mass Index Trajectories during 6–18 Years Old and the Risk of Hypertension in Young Adult: A Longitudinal Study in Chinese Population

Background Overweight/obesity in childhood is suggested to increase the risk of hypertension later in life. We aimed to assess whether and how body mass index (BMI) trajectories during 6–18 years of age are associated with hypertension in young adulthood (18–37 years) in the Chinese population. Methods Based on the China Health and Nutrition Survey (CHNS), a total of 1,872 participants who received ≥2 measurements of BMI during 6–18 years and had assessment of blood pressure (BP) in young adulthood were included. BMI trajectories were explored using latent class growth mixture models, and associations between identified trajectories with hypertension in young adulthood were examined by logistic regression analyses. Results Five heterogeneous BMI trajectories were identified: the low slow-increasing (20.03%), low moderate-increasing (56.14%), low rapid-increasing (17.04%), moderate-increasing (3.63%), and elevated-decreasing (3.15%) groups. Compared with the low slow-increasing group, another three increasing groups had gradually elevated risk of hypertension, yielding maximally adjusted odds ratio (95% confidence interval) (OR (95% CI)) of 2.48 (1.39–4.42), 3.24 (1.66–6.31), and 3.28 (1.19–9.08), respectively, whereas the elevated-decreasing group reversed overweight/obesity to normal weight in childhood, rendering its association with hypertension as not statistically significant (OR (95% CI) = 2.74 (0.98–7.65)). Conclusion Our study indicates that there are varied BMI trajectories from childhood to adulthood and that an elevated BMI trajectory during childhood is related with an increased risk of hypertension in young adulthood. In contrast, weight loss of children with high initial BMI may mitigate or reverse the risk. Our findings emphasize the importance of BMI continuous monitoring during early life.

Direct and two-step single anastomosis duodenal switch (SADI-S): Unicentric comparative analysis of 232 cases

IntroductionThe “Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy” (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure. MethodsUnicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019. ResultsTwo hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo ≥ IIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6 kg/m2 in comparison of 56.2 kg/m2 in the two-step SADI-S (P < .001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, P < .05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques. ConclusionIn medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S.

Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients.

Oral appliances (OAs) are a treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). The main objective of the study was to determine the predictive factors of OA efficacy. The secondary objective was to measure the efficacy rates and determine OAs' tolerance and dropout. Retrospective study. Efficacy results of the OAs based on the apnea hypopnea index (AHI) reduction, complications, and dropout rates were retrospectively collected from 347 patients with a moderate to severe OSAHS treated by a retention OA. The procedure was entirely performed by otolaryngologists. The AHI with OA was more significantly reduced in patients with a higher initial AHI and a higher initial body mass index but reduction was not related to age and not proportional to the degree of mandibular advancement. The 50% AHI reduction rate after OA was 65.2%, the AHI ≤5/hr rate after OA was 26.1%, and the <50% AHI reduction and residual AHI > 10/hr rate was 50.1%. The OA significantly reduced the mean AHI (-14.9/hr, P < .0001). In 7.8% of patients, the AHI increased with OA. Seven patients (1.5%) experienced adverse effects. Thirty-seven (7.8%) patients stopped using OA mainly because of its ineffectiveness. Advancement can be considered beyond the initial maximal advancement. It can be effective sometimes; however, increasing advancement did not significantly reduce AHI. OA is an effective and well-tolerated treatment for moderate to severe OSAHS. This treatment was effective for reduction of the AHI ≥50% in two-thirds of cases studied and it should be considered in more cases. 4 Laryngoscope, 131:E2089-E2096, 2021.

Long-term outcomes of gastric banding: Experience of a single tertiary care center specialized in bariatric surgery

BackgroundLaparoscopic adjustable gastric banding (LAGB) was one of the first performed bariatric procedure performed in Europe in the 2000s with low postoperative morbidity and mortality. Our goal was to determine long term outcomes of LAGB. Methods138 consecutive patients underwent a LAGB between 2007 and 2019. Demographic data were recorded. Weight loss evolution over time, gastric band removal and revisional procedures were analyzed. Weigth loss success was defined at the end of the follow-up according to Reinhold’s criteria: BMI ≤ 35 and / or EBL% ≥50 %. Results125 patients were analyzed. Initial body weight was 121,9 kg (SD +/- 22,2) and initial body mass index (BMI) was 44 kg/m2 (SD+/- 6,5). Age at the first surgery (gastric banding) was 32,7 years (SD +/- 11,9). 45.6 % of all the patients had a successful outcome according to Reinhold's criteria with a median follow-up of 75,6 months (SD+/- 50,3). Mean excess weight loss was 40,4 (SD+/- 36,6) at last follow-up.54 patients (43,2 %) underwent band removal in a mean time of 54,2 months (SD+/- 35,8): 37 patients (29,6 %) had a second bariatric procedure. Success rate was 50 % after conversion. In univariate analysis, factors implicated with weight loss success at the last visit were success at 6 months, 1 and 2 years, the number of band tightening, lower initial BMI and better follow up. ConclusionThe factors significantly associated with LAGB success were early weight loss, better follow-up, a band not too tightened whereas high initial BMI was associated to failure.

Cruce duodenal de una anastomosis (SADI-S) en uno o dos tiempos: análisis comparativo de 232 casos de un solo centro

IntroductionThe «Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy» (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure. MethodsUnicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019. ResultsTwo hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo ≥ IIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6 kg/m2 in comparison of 56.2 kg/m2 in the two-step SADI-S (p < 0.001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, p < 0.05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques. ConclusionIn medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S.

Effectiveness of Laparoscopic Sleeve Gastrectomy in Super-obese and Non-Super-obese Patients.

The primary aim of this study was to assess the effectiveness of sleeve gastrectomy (SG) in super-obese patients. The secondary aim was to identify patient characteristics associated with worse SG outcomes in this group. A retrospective analysis was carried out of our electronic prospective bariatric surgery patient database, including all patients who underwent SG between January 2007 and January 2017. The sample was divided according to the initial body mass index (BMI) (> or <50 kg/m). The initial characteristics and results in terms of weight loss and comorbidity resolution between the groups were compared. A subanalysis of the variable distributions was carried out according to whether or not the final BMI in the super-obese group had reached <35 kg/m. Data analysis was carried out using STATA 13.1, with a P-value <0.05 considered to be significant. The mean initial BMI was 42.8 kg/m in group 1 (<50 kg/m) and 55 kg/m in group 2 (>50 kg/m). The median follow-up (FU) was 56.2 months. Maximum weight loss was attained at the 18-month FU in both groups (BMI: 28.8 and 34.7 kg/m, respectively). At the 5-year FU, percentage of total weight loss was higher in group 2 and percentage of excess weight loss was statistically higher in group 1 (29.6% vs. 33.1% and 67% vs. 59%, respectively). Outcomes for type 2 diabetes mellitus, hypertension, and dyslipidemia were similar in both groups. The variables associated with attaining a final BMI <35 kg/m in the super-obese group were lower initial BMI, absence of baseline weight-related conditions (type 2 diabetes mellitus, obstructive sleep apnea syndrome, home continuous positive airway pressure, arthropathy, heart disease), and absence of gastroesophageal reflux disease. We observed a statistically significant increase in poor outcomes in patients with a higher initial BMI and with weight-related comorbidities. These parameters could be considered to be potentially good predictors of less satisfactory outcomes in the super-obese patients.

Grandparents' wealth and the body mass index trajectories of grandchildren.

The aims of this study are to (i) examine associations between grandparents' wealth and grandchild's initial body mass index (BMI) in early childhood and its subsequent growth patterns, and to (ii) assess whether the associations are similar for white and black children. Data are from the U.S. Panel Study of Income Dynamics (PSID) and its supplemental studies of Child Development Supplement (CDS) and Transition to Adulthood (TA) (N = 2,128). Three-level growth curve models are used to analyze the association between exposure to grandparental wealth in early childhood and grandchildren's BMI growth trajectories, accounting for parental sociodemographic characteristics and maternal BMI levels. Children with less grandparental wealth in early childhood have higher initial BMI than children with more grandparental wealth. Further, increases in grandparental wealth in childhood are associated with a slower BMI growth rate. The wealth-body mass index associations are more evident among white children than black children. The study reveals a multigenerational social gradient to body mass index. Elevating the wealth levels of the grandparent generation could potentially reduce their grandchildren's obesity risk. The protective role of grandparental wealth seems to be more evident among white families than black families.

Achievement of weight loss in patients with overweight during dietetic treatment in primary health care.

IntroductionDietitians are the preferred primary health care professionals for nutritional care in overweight patients. Guidelines for dietitians recommend a weight reduction of ≥ 5% of initial body weight after one year of treatment. The purpose of this study was to evaluate weight change in patients with overweight who were treated by dietitians in Dutch primary health care, and to identify patient characteristics that were associated with it.Materials and methodsThis observational study data was based on real life practice data of patients with overweight during the period 2013–2017, derived from dietetic practices that participated in the Nivel Primary Care Database. Multilevel linear regression analyses were performed to investigate weight change after dietetic treatment and to explore associations with patient characteristics.ResultsIn total, data were evaluated from 56 dietetic practices and 4722 patients with a body mass index (BMI) ≥ 25 kg/m2. The mean treatment time was 3 hours within an average timeframe of 5 months. Overall, patients had a mean weight change of -3.5% (95% CI: -3.8; -3.1) of their initial body weight, and a quarter of the patients reached a weight loss of 5% or more, despite the fact that most patients did not meet the recommended treatment duration of at least one year. The mean BMI change was -1.1 kg/m2 (95% CI: -1.2; -1.0). Higher weight reductions were shown for patients with a higher initial BMI and for patients with a longer treatment time. Sex and age were not associated with weight change, and patients with other dietetic diagnoses, such as diabetes, hypertension, and hypercholesterolemia, had lower weight reductions.ConclusionsThis study showed that dietetic treatment in primary health care coincided with modest weight reduction in patients with overweight. The weight loss goals were not reached for most patients, which was possibly due to a low treatment adherence.

Prediction of thirty-day morbidity and mortality after laparoscopic sleeve gastrectomy: data from an artificial neural network.

Multiple patient factors may convey increased risk of 30-day morbidity and mortality after laparoscopic vertical sleeve gastrectomy (LVSG). Assessing the likelihood of short-term morbidity is useful for both the bariatric surgeon and patient. Artificial neural networks (ANN) are computational algorithms that use pattern recognition to predict outcomes, providing a potentially more accurate and dynamic model relative to traditional multiple regression. Using a comprehensive national database, this study aims to use an ANN to optimize the prediction of the composite endpoint of 30-day readmission, reoperation, reintervention, or mortality, after LVSG. A cohort of 101,721 LVSG patients was considered for analysis from the 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national dataset. Select patient factors were chosen a priori as simple, pertinent and easily obtainable, and their association with the 30-day endpoint was assessed. Those factors with a significant association on both bivariate and multivariate nominal logistic regression analysis were incorporated into a back-propagation ANN with three nodes each assigned a training value of 0.333, with k-fold internal validation. Logistic regression and ANN models were compared using area under receiver-operating characteristic curves (AUROC). Upon bivariate analysis, factors associated with 30-day complications were older age (P = 0.03), non-white race, higher initial body mass index, severe hypertension, diabetes mellitus, non-independent functional status, and previous foregut/bariatric surgery (all P < 0.001). These factors remained significant upon nominal logistic regression analysis (n = 100,791, P < 0.001, r2= 0.008, AUROC = 0.572). Upon ANN analysis, the training set (80% of patients) was more accurate than logistic regression (n = 80,633, r2= 0.011, AUROC = 0.581), and it was confirmed by the validation set (n = 20,158, r2= 0.012, AUROC = 0.585). This study identifies a panel of simple and easily obtainable preoperative patient factors that may portend increased morbidity after LSG. Using an ANN model, prediction of these events can be optimized relative to standard logistic regression modeling.

Single- or double-anastomosis duodenal switch versus Roux-en-Y gastric bypass as a revisional procedure for sleeve gastrectomy: A systematic review and meta-analysis

BackgroundLaparoscopic sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedure worldwide. There is currently no consensus on which revisional procedure is best after an initial SG. ObjectivesTo compare the efficacy and safety between single-anastomosis duodeno-ileal bypass (SADI) or biliopancreatic diversion with duodenal switch (BPD-DS) versus Roux-en-Y gastric bypass (RYGB) as a revisional procedure for SG. SettingUniversity Hospital, Canada. MethodsMEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PubMed were searched up to August 2018. Studies were eligible for inclusion if they compared SADI or BPD-DS with RYGB as a revisional bariatric procedure for SG. Primary outcome was absolute percentage of total weight loss. Secondary outcomes were length of stay, adverse events, and improvement or resolution of co-morbidities (diabetes, hypertension, or hypercholesterolemia). Pooled mean differences were calculated using random effects meta-analysis. ResultsSix retrospective cohort studies involving 377 patients met the inclusion criteria. The SADI/BPD-DS group achieved a significantly higher percentage of total weight loss compared with RYGB by 10.22% (95% confidence interval, −17.46 to −2.97; P = .006). However, there was significant baseline equivalence bias with 4 studies reporting higher initial body mass index (BMI) in the SADI/BPD-DS group. There were no significant differences in length of stay, adverse events, or improvement of co-morbidities between the 2 groups. ConclusionSADI, BPD-DS, and RYGB are safe and efficacious revisional surgeries for SG. Both SADI and RYGB are efficacious in lowering initial BMI but there is more evidence for excellent weight loss outcomes with the conversion to BPD-DS when the starting BMI is high. Further randomized trials are required for definitive conclusions.

Do patients with higher baseline BMI have improved weight loss with Roux-en-Y gastric bypass versus sleeve gastrectomy?

BackgroundAs sleeve gastrectomy (SG) becomes the most common bariatric procedure, it remains unclear for which patients laparoscopic Roux-en-Y gastric bypass (LRYGB) may be advantageous. Some contend that patients with higher initial body mass index (BMI) achieve better weight loss with LRYGB. ObjectivesThis study evaluates weight loss in SG versus LRYGB patients based on preoperative BMI. SettingCommunity teaching hospital, Baltimore, Maryland. MethodsA convenience cohort of 4935 individuals, undergoing bariatric surgery from 2001 to 2015, was studied to examine 5-year postsurgical trends in weight loss stratified by baseline BMI and procedure. Student t tests compared mean weight loss of baseline BMI groups (<45 versus ≥45; <50 versus ≥50; and <55 versus ≥55) and line graphs and plotted 95% confidence intervals of mean weight loss by year were examined to discern differences in percent excess weight loss (%EWL) by procedure type. ResultsAll patients were more likely to be female (79%) and Caucasian (62.5%). Nearly twice as many patients underwent LRYGB (N = 3236) compared with SG (N = 1699). In patients in the BMI <45, 50, and 55 kg/m2 categories, there was no significant difference in %EWL based on procedure. However, in those patients in the BMI ≥45 and 55 kg/m2 categories, there is significantly higher %EWL in the LRYGB group over SG. ConclusionIn conclusion, patients with lower baseline BMI had improved %EWL regardless of procedure, but those patients with higher baseline BMI who underwent LRYGB did have higher %EWL than those undergoing SG at 2 years follow-up. BMI is one of many key factors when selecting a procedure for an individual patient.