Initial Body Mass Index Research Articles

Effectiveness of robotic metabolic and bariatric surgery in patients with BMI ≥ 50-59.9 and BMI ≥ 60 for the treatment of severe obesity in a national medical center in Mexico.

Obesity is a global health issue that significantly increases morbidity and mortality when the Body Mass Index (BMI) reaches values ≥ 50. While metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, it carries risks. Robotic surgery is promising but not extensively studied in Mexico, which presents an opportunity for research at a National Hospital with an academic program. This retrospective study reviewed 44 patients who underwent robotic MBS using the da Vinci surgical system from January 2018 to August 2023 at Centro Médico Nacional 20 de Noviembre, ISSSTE. Data collected included surgery type, duration, complications, and weight loss metrics over 54months post-operatively. The study involved 44 patients with severe obesity including BMI ≥ 50-59.9kg/m2 for group 1 and BMI ≥ 60kg/m2 for group 2. The average initial BMI was 54.7kg/m2 for group 1 and 68kg/m2 for group 2. The average operative times for group 1 were 10.09min for docking, 86.23min for robotic console time, and 95.73min for total intraoperative time. Group 2 had average times of 9.80min for docking, 82.4min for robotic console time, and 92.2min for total intraoperative time. Follow-up showed significant weight loss initially, with weight recurrence after 24months due to different factors. No serious complications or mortality were observed. Robotic MBS at a national academic medical center in Mexico shows promising outcomes for patients with BMI ≥ 50-59.9 and BMI ≥ 60, with significant weight and BMI improvements at 54month follow-up. Further studies with larger cohorts and longer follow-up are needed to strengthen these findings.

Body Mass Index and Surgical Diagnosis of Endometriosis: Do Obese Patients Experience an Operative Delay?

Objectives: The objective of this study was to quantify the time to diagnosis of endometriosis by laparoscopy for patients of varying body mass index (BMI), as well as the safety of laparoscopy for endometriosis by BMI. Materials and Methods: We performed a retrospective cohort study of reproductive-age women receiving a primary laparoscopic diagnosis of endometriosis at an academic tertiary hospital from January 2017 to December 2020. Patients excluded were those undergoing repeat laparoscopy, with previously histologically diagnosed endometriosis, asymptomatic endometriosis, an unknown first gynecologic encounter, or an unknown initial BMI. Our primary outcome was time to surgical diagnosis of endometriosis by BMI class. Our secondary outcome was the evaluation of peri/postoperative risk of laparoscopy for endometriosis. Results: A total of 152 patients received a primary surgical diagnosis of endometriosis, including 44% normal or underweight patients, 29% overweight patients, and 27% obese patients. Obese patients experienced a delay from gynecologic presentation to diagnostic laparoscopy (18.4 months, interquartile range [IQR] 3.1–42.8) compared to overweight patients (9.0 months, IQR 2.5–23.2) and normal and underweight patients (3.8 months, IQR 1.1–17.0) (P = 0.02). Although a higher percentage of overweight and obese patients was Hispanic and non-Hispanic Black, multiple linear regression maintained a significant relationship between time to surgery and BMI (P = 0.03). Perioperative and postoperative complications did not differ by BMI class. There were no differences in repeat laparoscopy for endometriosis within 3 years by BMI (P = 0.99). Conclusion: BMI is independently associated with time to surgical diagnosis of endometriosis in our retrospective study. Diagnostic laparoscopy appears safe in obese patients, without significant perioperative morbidity.

Fat Mass Index Predicts the Effect of Weight Loss and Quality of Life Early After Laparoscopic Sleeve Gastrectomy.

Fat mass index (FMI) is a body composition indicator that reflects body fat content. Laparoscopic sleeve gastrectomy (LSG) is widely performed in patients with obesity. This study aimed to evaluate the value of the FMI in predicting weight loss effect and quality of life early after LSG. From January 2014 to July 2022, the clinical data and computed tomography (CT) images of patients who underwent LSG at a tertiary referral teaching hospital were analyzed. Body composition indicators were calculated using the SliceOmatic software. Achieving initial body mass index within 6months postoperatively was defined as early eligible weight loss (EEWL). The relationship between body composition and EEWL was analyzed. A total of 243 patients were included. Receiver operating characteristic (ROC) curve analysis showed that the predictive value of the FMI for EEWL in patients after LSG was higher than that of other indicators (all P < 0.05; area under the curve = 0.813). The best FMI cut-off point was 13.662. Accordingly, the patients were divided into the high-FMI group and low-FMI group. The %EWL and BMI of patients in the low-FMI group at 1, 3, 6, 9, 12, and 24months after surgery were better than those in the high-FMI group (all P < 0.001). Patients in the low-FMI group had higher BAROS (Bariatric Analysis and Reporting Outcome System) scores than those in the high-FMI group (P < 0.001). Compared with other body composition indicators, FMI can effectively predict the early effect of weight loss and quality of life after LSG.

Eating Habits Related to Pregnancy, Body Perception, Attractiveness and Self-Confidence.

Pregnancy is a period of many changes in a woman's life, including those related to eating habits, taking care of health and fitness, as well as esthetic and psychological considerations. The study was conducted between January 2021 and December 2022. A questionnaire was used to conduct the study, the questions of which concerned eating habits, as well as perceptions of one's body and changes in appearance during pregnancy. Respondents filled out the questionnaire twice. The first survey was in the first two weeks after the doctor's confirmation of pregnancy and after the end of pregnancy, up to a maximum of 2 months after delivery. The purpose of the study was to evaluate changes in women's eating habits during pregnancy compared to before pregnancy to analyze the impact of pregnancy on women's body perception and attractiveness and self-confidence; furthermore, the study aimed to analyze the body mass index (BMI) of women before pregnancy and to compare weight gain during pregnancy depending on the initial BMI, taking into account different age groups. The values of measurable parameters were presented using the arithmetic mean, median, dominant and standard deviation. Non-measurable parameters were presented using percentages. The Chi2 test of homogeneity was used to examine differences between groups. During pregnancy, respondents mostly ate five meals a day, increased the amount of vegetables and fruits in their diets, and ate their meals without rushing (defined as slowly, calmly and without measuring the time left until the end of the meal break). Respondents reduced their coffee intake during pregnancy, while they increased their water intake to about 2 L a day. In the survey, about 2% of respondents followed a weight-loss diet during pregnancy. Respondents who were more likely to take body circumference measurements equally often monitored their daily energy intake. Women changed their eating habits during pregnancy to healthier ones compared to before pregnancy. The women's eating habits and well-being were also not affected by their age. Also, there was no significant relationship between eating habits and well-being in pregnant women, regardless of their age. The study may assist medical staff in promoting healthier eating habits and tailoring psychological support, which is crucial for the well-being of pregnant women.

Impact of the swallowable Allurion intragastric balloon on body weight and composition: An Ecuadorian experience

SummaryPeople with excess weight and obesity compose 64.5% of the Ecuadorian population. The Allurion Intragastric Balloon (IGB) is a noninvasive weight loss alternative for patients ineligible for other bariatric procedures. The impact of the procedure on weight loss and body composition, along with insertion complications and secondary effects were investigated. This is a single‐centre retrospective study of patients who underwent Allurion IGB insertion from July 2020 to March 2021. This study followed 167 patients for 12 months after EIGB insertion. Our sample had a mean initial weight of 83.6 ± 13.8 kg and initial body mass index of 31.3 ± 3.6 kg/m2. Percentage total weight loss was 4.65% ± 0.56%, 8.5% ± 4%, 12.29% ± 4.65%, 15.68% ± 5.22%, 17.14% ± 6.05%, and 14.68% ± 18.02% for months 1, 2, 3, 4, 6 and 12, respectively. In the fourth month, 92 patients (56.4%) had lost ≥50% excess body weight; at month 6, 104 patients (67.5%) achieved this goal. Regarding body composition, body fat percentage started at 38.99% ± 7.92%, and at month 6 was 35.67% ± 6.84%, this was the only significance in the statistical analysis.This study aligns with the literature's safety and efficacy results for the Allurion IGB while illustrating the need for further research regarding weight behaviour after its expulsion.

Sustained improvements in brain health and metabolic markers 24 months following bariatric surgery.

Obesity and its metabolic complications are associated with lower grey matter and white matter densities, whereas weight loss after bariatric surgery leads to an increase in both measures. These increases in grey and white matter density are significantly associated with post-operative weight loss and improvement of the metabolic/inflammatory profiles. While our recent studies demonstrated widespread increases in white matter density 4 and 12 months after bariatric surgery, it is not clear if these changes persist over time. The underlying mechanisms also remain unknown. In this regard, numerous studies demonstrate that the enlargement or hypertrophy of mature adipocytes, particularly in the visceral fat compartment, is an important marker of adipose tissue dysfunction and obesity-related cardiometabolic abnormalities. We aimed (i) to assess whether the increases in grey and white matter densities previously observed at 12 months are maintained 24 months after bariatric surgery; (ii) to examine the association between these structural brain changes and adiposity and metabolic markers 24 months after bariatric surgery; and (iii) to examine the association between abdominal adipocyte diameter at the time of surgery and post-surgery grey and white matter densities changes. Thirty-three participants undergoing bariatric surgery were recruited. Grey and white matter densities were assessed from T1-weighted magnetic resonance imaging scans acquired prior to and 4, 12 and 24 months post-surgery using voxel-based morphometry. Omental and subcutaneous adipose tissue samples were collected during the surgical procedure. Omental and subcutaneous adipocyte diameters were measured by microscopy of fixed adipose tissue samples. Linear mixed-effects models were performed controlling for age, sex, surgery type, initial body mass index, and initial diabetic status. The average weight loss at 24 months was 33.6 ± 7.6%. A widespread increase in white matter density was observed 24 months post-surgery mainly in the cerebellum, brainstem and corpus callosum (P < 0.05, false discovery rate) as well as some regions in grey matter density. Greater omental adipocyte diameter at the time of surgery was associated with greater changes in total white matter density at 24 months (P = 0.008). A positive trend was observed between subcutaneous adipocyte diameter at the time of surgery and changes in total white matter density at 24 months (P = 0.05). Our results show prolonged increases in grey and white matter densities up to 24 months post-bariatric surgery. Greater preoperative omental adipocyte diameter is associated with greater increases in white matter density at 24 months, suggesting that individuals with excess visceral adiposity might benefit the most from surgery.

Screening for undernutrition in gastric bypass: a case study of four patients in the Marrakech Tensift Al Haouz region, Morocco

Undernutrition presents a major risk to patients’ health and well-being following gastric bypass surgery. After undergoing this surgery, the nutritional status of three women and one man was examined in this study. Follow-up visits were used to measure weight, body composition, and biological and biochemical data. After 3 months of follow-up after gastric bypass surgery, our findings revealed a reduction in muscle mass. The average loss of muscle mass was 4.375±1.470 kg. Their initial body mass index, which was 45.01 kg/m2, on average, dropped to 28.38 kg/m2. Significant drops were observed in the mean levels of albumin and pre-albumin (albumin: 38.6 g/L to 24.8 g/L, pre-albumin: 195 mg/L to 113 mg/L). In our study, patients with micronutritional deficiencies and gastric bypass demonstrated a significant and adaptive reduction in daily caloric intake. Early identification of undernutrition makes it possible to assess its severity and, as part of the patient’s overall follow-up, to implement appropriate nutritional management.

Myosteatosis predicts bariatric surgery response: A longitudinal study in patients with morbid obesity.

Data on the preoperative factors for bariatric surgery response in patients with morbid obesity are limited, and there are no studies on the relationship between myosteatosis and surgery response. We investigated the preoperative factors determining bariatric surgery response and the impact of preoperative muscle fat infiltration on bariatric surgery response. This retrospective longitudinal cohort study included 125 individuals (37 men, 88 women) with morbid obesity who underwent bariatric surgery. Muscle fat infiltration (skeletal muscle fat index [SMFI]) was evaluated using computed tomography-based psoas muscle mass and density at the 4th lumbar level. A bariatric surgery response was defined as ≥50% excessive weight loss at one year postoperatively. Before bariatric surgery, the patient mean body weight and body mass index (BMI) were 107.0 kg and 39.0 kg/m2, respectively. After one year, the mean body weight was 79.6 kg. The mean excessive weight loss at one year was 75.6% and 102 (81.6%) patients were categorized as responders. There were no statistically significant differences in initial BMI, age, sex, or proportion of diabetes between responders and non-responders. Responders were more likely to have lower SMFI and triglyceride and glycated hemoglobin A1c levels than non-responders at baseline (P<0.05). Multiple logistic regression analysis showed that a lower baseline SMFI was associated with bariatric surgery response (odds ratio=0.31, 95% confidence interval=0.14-0.69, P=0.004). Preoperative myosteatosis may determine the response to bariatric surgery.

Association between social jetlag and weight and fat reduction in dieting

Objectives: Social jetlag (SJL), the discrepancy between an individual’s inherent circadian rhythm and external social schedule, is associated with obesity. This study aimed to investigate whether SJL also influences body weight and body fat loss during dieting. Methods: This was an observational study from 2015 to 2018 with participants who had joined an exercise and nutrition program at a private personal training gym. Data from 11,829 individuals provided by the gym along with their sleep logs were analyzed. Differences in change in body mass index (BMI) and body fat percentage (%body fat) were compared by the degree of SJL. Regression was conducted for the change in BMI and %body fat on SJL, adjusted for gender, age, engagement duration in the program, initial BMI, initial %body fat, chronotype, and dietary intakes. Results: The subjects comprised 3,696 men and 8,133 women with a mean age of 40.4 years. Greater SJL was associated with a lower efficacy of BMI and %body fat reduction. The change in BMI (+ 0.56 / hour: SJL) and %body fat (+ 1.40 / hour: SJL) was associated with SJL after adjusting for each variable including dietary intake. Conclusion: SJL was associated with the effect of exercise and nutrition instruction on BMI and body fat reduction, even after adjustment for covariates related to dietary intake. Maintaining consistent sleep–wake rhythms may be crucial for enhancing the efficacy of weight loss programs.

Correlation Between Age, Initial Body Mass Index (BMI) with Excessive Weight Loss in Very Early Postoperative Period

Introduction. As a major outcome of bariatric surgery, weight loss can be affected by many factors, such as sociodemographic, behavioral problems, genetics, patient status, and the surgical technique. However, limited data were available. This research aimed to seek a correlation between age and BMI with excessive weight loss after bariatric surgery. Method. Cross–sectional study design from 2 bariatric centers in Jakarta, using data from 2018–2022. Percentage Excessive Weight Loss (%EWL) 3 months was an outcome measurement tool. Results. Of 87 subjects enrolled with male to female ratio was 1:4. Age ranged from 14–62 years (median 39 years). Type 1 obesity, type 2 obesity, and type 3 were 37.9%, 20.6%, and 28.7%, respectively. Bariatric surgeries include gastric balloon (10.3%), endoscopic sleeve gastrectomy (ELSG) (8%), laparoscopic sleeve gastrectomy (LLSG) (41.3%), sleeve gastrectomy with duodenojejunal bypass (1.1%), Roux en Y gastric bypass (RYGB) (31%), single anastomosis duodeno–ileal bypass (SADI) (8%). In the 3rd month postoperative, it was found 29.8% of participants with %EWL ≥50%: mean %EWL LLSG 46.7% (41.6–51.9%), mean %EWL RYGB 45.5% (40.5–50.7%). Correlation analysis showed a reverse correlation between BMI with %EWL (r = –0.294, p 0.006) and age showed a weak correlation to %EWL (r = 0.063, p 0.565) Conclusion. In the 3rd month, the higher the BMI, the lower %EWL found. Age barely correlates with weight loss.

Relationships between Food Insecurity, Self-Efficacy, and Changes in Body Mass Index among the Youth in Taiwan: Analysis from a Longitudinal Cohort Survey.

Food insecurity is a heightened concern among economically disadvantaged youth, and it may contribute to the atypical body mass index (BMI) patterns frequently observed in this group. Self-efficacy seems to intervene in the negative impacts of contextual restraints. This study investigated the relationship between food insecurity, self-efficacy, and BMI trajectory among economically disadvantaged Taiwanese youth. We utilized three-wave longitudinal data from the Taiwan Database of Children and Youth in Poverty. The Food Insecurity Score (FIS) assessed food insecurity with a 4-item scale measuring reduced meal frequency, hunger, skipping meals, and economic constraints. Moreover, the General Self-Efficacy Scale (GSES) assessed self-efficacy, showcasing the ability to handle stress effectively and envision success scenarios, contributing to positive outcomes. By employing latent growth modeling, we were able to delineate the impacts of baseline food insecurity and self-efficacy on initial BMI and its subsequent growth trajectory. Elevated baseline FIS significantly predicted higher initial BMI (coefficient = 0.420, p = 0.042). Baseline GSES was negatively associated with initial BMI (coefficient = -0.093, p < 0.001) but positively predicted the BMI growth rate (coefficient = 0.023, p = 0.011). Enhancing self-efficacy may be an effective multidisciplinary intervention to address psychosocial and socioeconomic factors when tackling weight problems in vulnerable youth groups.

One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis.

One Anastomosis Duodenal Switch (OADS/SADI-S) is used both as a one stage and a second-step procedure, either planned or revisional after a failed sleeve gastrectomy. However, there is lack of adjusted comparative evidence validating its use. Propensity-score matched comparison between patients submitted to one-stage vs. two-step OADS, adjusted by age, gender, and initial body mass index (BMI). One hundred ninety-five patients (130 one-stage and 65 two-step OADS) were included, with mean initial BMI 52.4kg/m2. Overall complication rate was 6.6% in the short-term (3.3% Clavien-Dindo ≥ III), and 7.3% in the long-term, with no differences between groups. Follow-up at 1 and 3years was 83.6% and 61.5%. After one-stage OADS, total weight loss was 36.6 ± 8.2% at 1year and 30.4 ± 10.3% at 3years, vs. 30.2 ± 9.4% and 25.6 ± 10.2% after two-steps OADS (p = 0.021). Resolution rates of diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea were 86.4%, 80.4%, 78.0%, and 73.3%, with no differences between groups. One-stage OADS is a safe and effective bariatric technique for patients with grade III and IV obesity. The two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.

The effectiveness of mobile app usage in facilitating weight loss: An observational study.

With increasing rates of global obesity and associated health issues, there is an ever-increasing need for weight management solutions to be more accessible. Mobile applications offer accessible support systems and have the potential to offer a viable and effective weight management solution as an alternative to traditional healthcare models. To evaluate the effectiveness of the SIMPLE mobile application for time-restricted eating in achieving weight loss (WL). User data were analyzed between January 2021 and January 2023. In-app activity was calculated as the proportion of active days over 12, 26 and 52weeks. A day is considered active if it contains at least one in-app action (e.g., logging weight, food, fasting, or physical activity). Users were categorized into four in-app activity levels: inactive (in-app activity <33%), medium activity (33%-66%), high activity (66%-99%), and maximal activity (100%). Weight change among in-app activity groups was assessed at 12, 26, and 52weeks. Out of 53,482 users, a positive association was found between the use of the SIMPLE app and WL. Active app users lost more weight than their less active counterparts. Active users had a median WL of 4.20%, 5.04%, and 3.86% at 12, 26, and 52weeks, respectively. A larger percentage of active users-up to 50.26%-achieved clinically significant WL (≥5%) when compared to inactive users. A dose-response relationship between WL and app usage was found after adjusting for gender, age, and initial Body Mass Index; a 10% increase in app activity correlated with increased WL by 0.43, 0.66 and 0.69kg at 12, 26, and 52weeks, respectively. The study demonstrates that the SIMPLE app enables effective WL directly associated with the level of app engagement. Mobile health applications offer an accessible and effective weight management solution and should be considered when supporting adults to lose weight.

Laparoscopic Sleeve Gastrectomy as a First Step Procedure for Oncologic Purposes: An Indication Beyond the Updated Guidelines.

Obesity is a well-established risk factor for cancer. Laparoscopic sleeve gastrectomy (LSG) is established as a safe procedure providing accelerated weight loss and comorbidity improvement or remission. Additionally, it is approved as a bridging procedure for various non-oncologic surgeries, with very limited data for oncologic procedures. The aim of this study is to present a series of patients with severe obesity and concomitant cancer who underwent LSG prior to definitive oncological procedure. A retrospective review (2008-2023) was conducted in three institutions, identifying 5 patients with cancer and severe obesity who underwent LSG as bridging procedure. Variables analyzed were initial weight, initial body mass index (BMI), type of malignancy, comorbidities, interval between LSG and oncological surgery, weight and BMI before the second intervention, percentage of excess weight loss (%EWL), and postoperative morbidity and mortality. Malignancies identified were 2 prostate cancers, 1 periampullary neuroendocrine tumor, 1 rectal cancer, and 1 renal clear cell carcinoma. Mean age of patients was 50.2 years, mean initial BMI 47.4 kg/ , and mean BMI before oncological surgery 37 kg/ . Mean time interval between LSG and oncological surgery was 8.3 months. Mean %EWL achieved was 45.2%. Two thromboembolic events were encountered after LSG, while none of the patients developed complications after definitive oncological treatment. The mean follow-up after oncological surgery was 61.6 months. LSG can be proposed as bridging procedure before oncological surgery in meticulously selected patients. Achieved weight loss can render subsequent oncological procedures easier and safer.

Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion's Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker.

Obesity represents a growing public health concern, affecting more than 15% of the global adult population and involving a multi-billion market that comprises nutritional, surgical, psychological, and multidisciplinary interventions. The objective of this retrospective study was to evaluate the short-term efficacy and body weight measurements associated with differing levels of physical activity following the use of Allurion's ingestible gastric balloon that was designed to increase feelings of fullness and decrease food consumption, being naturally eliminated after approximately 16 weeks. This study involved 571 individuals who qualified for the intervention for being older than 20 years with a body mass index (BMI) of 27 kg/m2 or more. Utilizing the Scale App Health Tracker and Allurion's smartwatch, this study was able to track vital signs and physical activity in real time. The participants had an average initial BMI of 34.1 kg/m2 and a median age of 41 years. Notable outcomes were observed in both study groups, "Less Active" and "More Active", which were classified by achieving less or more than a median number of 8000 daily steps. Specifically, body fat percentage saw a reduction from 33.1 ± 9.4 to 28.3 ± 10.2 in the less active group and from 32.2 to 27.5 in the more active group, with both groups achieving statistical significance (p < 0.001). Additionally, there was a significant reduction in average weight, dropping from 98.2 ± 22.8 kg to 84.6 ± 19.3 kg in the less active group and from 97.7 ± 21.0 kg to 82.1 ± 22.9 kg in the more active group (both p < 0.001). Interestingly, those in the more active group also experienced a significant increase in lean mass compared to their less active counterparts (p = 0.045), although no substantial differences in weight loss, BMI reduction, and total body fat decrease were observed between the two groups. This investigation confirms the hypothesis that Allurion's ingestible gastric balloon significantly reduces weight in the short term and enhances several physical health metrics, demonstrating effectiveness as an autonomous method for challenging weight management, regardless of the level of daily physical activity.

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.

Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study.

Although dolutegravir (DTG) is deemed stable, safe, cost-effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG-based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE-to-TLD switchers) in three large primary care facilities in South Africa METHODS: We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE-to-TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed-effect models among TEE-to-TLD switchers to consider repeated measures. Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow-up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m2 (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m2, and CD4 counts <200 cells/μL. Of 298 TEE-to-TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE-to-TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch. We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE-to-TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current findings are reassuring for those switching to a DTG-based regimen.

The Impact of Preoperative Weight Loss Timing on Surgical Outcomes in Total Hip Arthroplasty

BackgroundElevated body mass index (BMI) increases surgical complications post-total hip arthroplasty (THA). However, the effects of rapid weight loss pre-THA remain unclear. This study evaluated patients who had initial BMIs between 40 and 50, and then achieved a BMI under 35 at various intervals before their THA. Comparisons were made with consistent obese and nonobese groups to understand potential complications. MethodsUsing a national database, we categorized THA patients based on initial BMI and weight loss timing before the surgery. These were contrasted with those maintaining a steady BMI of 20 to 30 or 40 to 50. We monitored outcomes like periprosthetic joint infections (PJI), surgical site infections (SSI), and noninfectious revisions for 2 years postsurgery, incorporating demographic considerations. Statistical analyses utilized Chi-square tests for categorical outcomes and Student's t-tests for continuous variables. ResultsAmong patients who had a BMI of 45 to 50, weight loss 3 to 9 months presurgery increased PJI risks at 90 days (Odds Ratios [OR]: 2.15 to 5.22, P < .001). However, weight loss a year before the surgery lowered the PJI risk (OR: 0.14 to 0.27, P < .005). Constantly obese patients faced heightened PJI risks 1 to 2 years postsurgery (OR: 1.64 to 1.95, P < .015). Regarding SSI, risks increased with weight loss 3 to 9 months before surgery, but decreased when weight loss occurred a year earlier. In the BMI 40 to 45 group, weight loss 3 to 6 months presurgery showed higher PJI and SSI at 90 days (P < .001), with obese participants consistently at greater risk. ConclusionsWhile high BMI poses THA risks, weight loss timing plays a crucial role in postoperative complications. Weight loss closer to the surgery (0 to 9 months) can heighten risks, but shedding weight a year in advance seems beneficial. Conversely, initiating weight loss approximately a year before surgery offers potential protective effects against postoperative issues. This highlights the importance of strategic weight management guidance for patients considering THA, ensuring optimal surgical results and reducing potential adverse outcomes.

Sleeve Gastrectomy Reduces the Need for Liver Transplantation in Patients with Obesity and Non-Alcoholic Steatohepatitis: a Predictive Model.

Non-alcoholic steatohepatitis (NASH) is one of the leading indications for liver transplantation (LT) in the United States. As with the current obesity epidemic, the incidence of NASH continues to rise. However, the impact of broad utilization of bariatric surgery (BS) for patients with NASH is unknown, particularly in regard to mitigating the need for LT. Markov decision analysis was performed to simulate the lives of 20,000 patients with obesity and concomitant NASH who were deemed ineligible to be waitlisted for LT unless they achieved a body mass index (BMI) < 35kg/m2. Life expectancy following medical weight management (MWM) and sleeve gastrectomy (SG) were estimated. Base case patients were defined as having NASH without fibrosis and a pre-intervention BMI of 45kg/m2. Sensitivity analysis of initial BMI was performed. Simulated base case analysis patients who underwent SG gained 14.3years of life compared to patients who underwent MWM. One year after weight loss intervention, 9% of simulated MWM patients required LT compared to only 5% of SG patients. Survival benefit for SG was observed above a BMI of 32.2kg/m2. In this predictive model of 20,000 patients with obesity and concomitant NASH, surgical weight loss is associated with a reduction in the progression of NASH, thereby reducing the need for LT. A reduced BMI threshold of 32kg/m2 for BS may offer survival benefit for patients with obesity and NASH.

Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial

New obesity medications result in large weight losses. However, long-term adherence in a real-world setting is challenging, and termination of obesity medication results in weight regain towards pre-treatment body weight. Therefore, we investigated whether weight loss and improved body composition are sustained better at 1year after termination of active treatment with glucagon-like peptide-1 (GLP-1) receptor agonist, supervised exercise program, or both combined for 1 year. We conducted a post-treatment study in extension of a randomised, controlled trial in Copenhagen. Adults with obesity (aged 18-65 years and initial body mass index 32-43kg/m2) completed an eight-week low-calorie diet-induced weight loss of 13.1kg (week-8 to 0) and were randomly allocated (1:1:1:1) to one-year weight loss maintenance (week 0-52) with either supervised exercise, the GLP-1 receptor agonist once-daily subcutaneous liraglutide 3.0mg, the combination of exercise and liraglutide, or placebo. 166 Participants completed the weight loss maintenance phase. All randomised participants were invited to participate in the post-treatment study with outcome assessments one year after treatment termination, at week 104. The primary outcome of the post-treatment assessment was change in body weight from after the initial weight loss (at randomisation, week 0) to one year after treatment termination (week 104) in the intention-to-treat population. The secondary outcome was change in body-fat percentage (week 0-104). The study is registered with EudraCT, 2015-005585-32, and with ClinicalTrials.gov, NCT04122716. Between Dec 17, 2018, and Dec 17, 2020, 109 participants attended the post-treatment study. From randomisation to one year after termination of combined exercise and liraglutide treatment (week 0-104), participants had reduced body weight (-5.1kg [95% CI-10.0;-0.2]; P=0.040) and body-fat percentage (-2.3%-points [-4.3 to-0.3]; P=0.026) compared with after termination of liraglutide alone. More participants who had previously received combination treatment maintained a weight loss of at least 10% of initial body weight one year after treatment termination (week-8 to 104) compared with participants who had previously received placebo (odds ratio [OR] 7.2 [2.4; 21.3]) and liraglutide (OR 4.2 [1.6; 10.8]). More participants who had previously received supervised exercise maintained a weight loss of at least 10% compared with placebo (OR 3.7 [1.2; 11.1]). During the year after termination of treatment (week 52-104), weight regain was 6.0kg [2.1; 10.0] larger after termination of liraglutide compared with after termination of supervised exercise and 2.5kg [-1.5 to 6.5] compared with after termination of combination treatment. The addition of supervised exercise to obesity pharmacotherapy seems to improve healthy weight maintenance after treatment termination compared with treatment termination of obesity pharmacotherapy alone. Body weight and body composition were maintained one year after termination of supervised exercise, in contrast to weight regain after termination of treatment with obesity pharmacotherapy alone. Helsefonden and the Novo Nordisk Foundation.