Long-term Weight Loss Research Articles

SP9.13 - Influence of Gastrojejunostomy Diameter on Weight Reduction Following Roux-En-Y Gastric Bypass Surgery

Abstract Introduction The debate on whether the diameter of the gastrojejunostomy in Roux-En-Y Gastric Bypass (RYGB) affects long-term weight loss was addressed in this study by comparing outcomes between two different anastomosis diameters. Methods This retrospective study analysed primary RYGB performed from January 2017 to July 2021, comparing 30mm and 45mm gastrojejunostomy diameters. Weight loss was assessed at 12, 24, and 60 months post-operatively. Results Of the 1,081 patients who had RYGB, 79.6% were female, with a median age of 48 (IQR 40-55). The median starting BMI was 44.6 Kg/m2 (IQR: 40.4-50.1). The 30mm group comprised 36.6% (396/1,081) of the participants. There were no notable differences in baseline demographics such as gender, age, ASA classification, and medical history between the groups. At the 12-month follow-up, the average BMI reduction was 12.8 Kg/m2 (IQR: 9.3-17.9), with no significant differences between the 30mm (median: 13.0 Kg/, IQR: 9.4-23.5) and 45mm groups (median: 12.6 Kg/m2, IQR: 9.1-16.9, p=0.053). At 24 months, the BMI reduction was more substantial in the 30mm group (median: -16.2 Kg/m2, IQR: 11.6-40.5) than in the 45mm group (median: -15.3 Kg/m2, IQR: 10.0-35.6, p=0.006). A greater divergence was observed at 60 months, with the 30mm group showing more weight loss (median: -17.2, IQR: 11.3-31.1) compared to the 45mm group (median: -15.8, IQR: 11.9-28.3, p=0.003). Conclusion A smaller gastrojejunostomy diameter of 30mm is linked with greater BMI reduction up to five years post-RYGB. Further study is necessary to evaluate the anastomosis size's impact on long-term weight maintenance and regain.

One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice

Limited data are available on long-term weight loss achieved with semaglutide or liraglutide for type 2 diabetes (T2D) or obesity in clinical practice. To document weight loss achieved with injectable forms of semaglutide or liraglutide and identify factors associated with weight reduction of 10% or greater at 1 year. This retrospective cohort study used electronic health records from a large, integrated health system in Ohio and Florida. Participants included adults with a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of at least 30.0 who initiated treatment with semaglutide or liraglutide between July 1, 2015, and June 30, 2022. Follow-up was completed July 28, 2023. Injectable forms of semaglutide or liraglutide approved for T2D or obesity. Percentage weight change and categorical weight reduction of 10% or greater at 1 year. A total of 3389 patients (mean [SD] age, 50.4 [12.2] years; 1835 [54.7%] female) were identified. Of these, 1341 patients received semaglutide for T2D; 1444, liraglutide for T2D; 227, liraglutide for obesity; and 377, semaglutide for obesity. Mean (SD) percentage weight change at 1 year was -5.1% (7.8%) with semaglutide vs -2.2% (6.4%) with liraglutide (P < .001); -3.2% (6.8%) for T2D as a treatment indication vs -5.9% (9.0%) for obesity (P < .001); and -5.5% (7.5%) with persistent medication coverage (ie, a cumulative gap of less than 90 days) at 1 year vs -2.8% (7.0%) with 90 to 275 medication coverage days and -1.8% (6.7%) with fewer than 90 medication coverage days (P < .001). In the multivariable model, semaglutide vs liraglutide (adjusted odds ratio [AOR], 2.19 [95% CI, 1.77-2.72]), obesity as a treatment indication vs T2D (AOR, 2.46 [95% CI, 1.83-3.30]), persistent medication coverage vs 90 medication coverage days (AOR, 3.36 [95% CI, 2.52-4.54]) or 90 to 275 medication coverage days within the first year (AOR, 1.50 [95% CI, 1.10-2.06]), high dosage of the medication vs low (AOR, 1.58 [95% CI, 1.11-2.25]), and female sex (AOR, 1.57 [95% CI, 1.27-1.94]) were associated with achieving a 10% or greater weight reduction at year 1. In this retrospective cohort study of 3389 patients with obesity, weight reduction at 1 year was associated with the medication's active agent, its dosage, treatment indication, persistent medication coverage, and patient sex. Future research should focus on identifying the reasons for discontinuation of medication use and interventions aimed at improving long-term persistent coverage.

Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy.

While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2years. We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage.

215 - Influence of Metabolic Profile on Long-term Weight Loss Maintenance

215 - Influence of Metabolic Profile on Long-term Weight Loss Maintenance

Nutritional Challenges and Treatment After Bariatric Surgery.

Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcers, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.

Predictive factors of weight loss in obese patients referred to an obesity specialized centre

In obese patients, long-term weight loss maintenance remains challenging. Identifying factors predicting adhesion to lifestyle therapy and weight loss would help optimizing obesity management. to identify predictive factors of weight loss after one year of medical therapy in obese patients (primary) and predictive factors of drop-out during the year of therapy (secondary). In this retrospective study, obese patients consulting for the first time in an obesity specialized center were included. All patients fulfilled the criteria for obesity surgery and were managed to change their lifestyle by following a 1-year therapeutical education program based on intuitive eating. Significant weight loss was defined by≥5 % after 1 year. Patients were considered as dropouts, i.e. absence of adhesion to therapy, once they missed one consultation without informing the unit. Stepwise multivariable analyses determined the predictive factors. Of the 310 patients (mean age, 44.5±11.9yr, 79% women) included, 155 (50%) maintained their follow-up at 1 year and 37 (24%) experienced weight loss ≥5%. Male gender (odds ratio (OR)=6.25 [95% confidence interval, 1.78; 21.92], P=0.004), ≥5 consultations with intuitive eating (OR=3.69 [1.14; 11.87], P=0.03), and tobacco addiction (OR=0.18 [0.04; 0.82], P=0.03) were associated to weight loss ≥5%. Older age (OR=0.97 [0.95; 0.99], P=0.014), physical activity (OR=0.11 [0.05; 0.24], P<0.0001) and the patient desire for obesity surgery (OR=0.22 [0.12; 0.41], P<0.0001) were associated with a better adhesion to therapy. The identified predictive factors would help identifying the patients with the greater chance of losing weight and adhering to therapy. Offering more therapeutic education sessions should increase therapy success in obese patients fulfilling the criteria for obesity surgery.

Association of normal body mass index and weight loss with long-term major cardiovascular events after PCI for myocardial infarction

Objectives: To investigate whether normal body mass index (BMI) shortly after percutaneous coronary intervention (PCI) for myocardial infarction is associated with increased risk of long-term major cardiovascular events (MACE), and to explore potential clinical determinants of long-term weight loss (WL) after PCI. Methods: Single-center cohort study with 5-year follow-up of patients treated with PCI for myocardial infarction between 2016 and 2018. Categorical WL was defined as > 0 kg body weight reduction from baseline to end of follow-up. Results: Of 236 patients (24% women), mean age was 64.9 ± 10.2 years and mean BMI within 4 days after PCI was 27.1 ± 4.3 kg/m2. Seventy-five patients (32%) had at least one MACE, equally distributed between those with normal weight (31%), overweight (32%), and obesity (31%). Patients with overweight or obesity had a lower crude mortality rate than their normal weight counterparts (7.4% vs 16.4%, p = 0.049), but the relative hazard of death did not differ from those with normal weight, HR 0.50, 95% CI 0.22-1.15. Patients with either a long-term WL (n = 112) or no WL (n = 95) had a comparable incidence of non-fatal MACE (27% vs 22%, p = 0.518). The proportion of patients reporting unintentional weight loss was significantly higher in the normal weight group (82%) compared with those with overweight (41%) or obesity (28%), p < 0.001. Conclusion: Our results did not confirm any association between normal BMI after PCI and long-term MACE. However, patients with normal BMI at baseline had a higher incidence of unintentional WL than those with elevated BMI. Trial registration: Current research information system in Norway (CRISTIN): ID 542528

The Efficacy of Roux-en-Y Gastric Bypass in Young-Onset Diabetes Mellitus: A Narrative Review.

Type 2 diabetes mellitus (T2DM) in youth is invading the communities because, if not controlled on time, the long-term complications include cardiovascular diseases, nephropathy, neuropathy, and retinopathy that cause immense mortality and morbidity. Lifestyle changes and antidiabetic drugs are considered the foundation of T2DM therapy. However, these adjustments usually do not effectively produce long-term glycemic regulation, especially in patients with obesity of the third and fourth degrees. Bariatric surgery has also been identified as an efficacious intervention for obesity and obesity-related complications such as T2DM. Roux-en-Y gastric bypass (RYGB) has proven to be one of the most effective procedures in causing considerable weight loss and enhancing glycemic changes. This review provides a comprehensive analysis of RYGB in patients with young-onset T2DM regarding the improvement of glycemic control, weight loss, and diabetes comorbidities. RYGB has been established as a practice in the treatment of T2DM and severe obesity. This narrative review underscores the various effects of RYGB, such as enhanced glycemic control, considerable and long-term weight loss, and reduced cardiovascular disease risks. However, the review also points toward the directions and the adverse effects of RYGB regarding metabolic and skeletal health. There are risks of nutritional deficiencies, increased fracture rates, and even relapse to diabetes, which make patient selection, proper pre and postoperative investigation, and critical monitoring.

Long-Term Effectiveness and Outcomes of Bariatric Surgery: A Comprehensive Review of Current Evidence and Emerging Trends.

Obesity is a global epidemic associated with an increased risk of severe health conditions such as type 2 diabetes, cardiovascular diseases, and certain cancers. Bariatric surgery has become a pivotal treatment for severe obesity, offering significant improvements in weight loss and comorbidity resolution. This comprehensive review aims to assess the long-term effectiveness and outcomes of various bariatric surgical procedures, highlighting current evidence and emerging trends in the field. We extensively reviewed the literature, including randomized controlled trials, cohort studies, and meta-analyses, to evaluate long-term weight loss, resolution of obesity-related comorbidities, quality of life (QoL), and complications associated with different bariatric procedures. Bariatric surgery has demonstrated substantial and sustained weight loss over the long term, with varying degrees of effectiveness among different procedures. Gastric bypass and sleeve gastrectomy are associated with significant improvements in comorbidities such as type 2 diabetes and hypertension. QoL outcomes are generally positive, improving physical health, mental well-being, and social functioning. However, long-term complications, including nutritional deficiencies and the need for reoperations, remain challenges. Emerging trends such as minimally invasive techniques and nonsurgical interventions show promise in enhancing patient outcomes. Bariatric surgery remains a highly effective intervention for managing severe obesity and its related health issues. While long-term outcomes are generally favorable, continued advancements in surgical techniques and postoperative care are crucial for optimizing results and minimizing complications. Future research should focus on personalized approaches to patient management and the development of novel treatment modalities to further improve outcomes in the long term.

Sociodemographic factors related to bariatric follow-up appointment attendance and weight outcomes

BackgroundFollow-up care after bariatric surgery is essential in preventing postsurgical complications and promoting long-term weight loss maintenance. However, many patients do not attend postsurgical appointments with the bariatric team, which may contribute to poor surgical outcomes. ObjectivesThis study sought to understand sociodemographic factors related to follow-up appointment attendance and weight outcomes. The first objective was to determine whether there was a relationship between 1-year follow-up appointment attendance and sociodemographic factors. The second objective was to determine whether patients from certain sociodemographic groups were more likely to attend a 2-year follow-up appointment. The third objective was to determine whether there were differences in weight outcomes for patients who attended follow-up appointments compared with those who did not attend. SettingUniversity hospital, United States. MethodsThis study was a retrospective observational study. Participants included 841 adult patients who underwent bariatric surgery, of whom 505 (60.05%) attended a 1-year appointment with the bariatric team (348 attended a follow-up visit with another medical provider), and 398 (47.32%) who had any follow-up medical visit at 2 years after surgery. Sociodemographic variables were collected during a presurgical psychological evaluation. Weight-related variables were obtained through patients’ electronic medical records 12 and 24 months after surgery. ResultsYounger patients and those with lower education levels were less likely to attend the 1-year follow-up appointment with the bariatric team. People who attend 1-year follow-up with bariatric team have more favorable weight outcomes at 1 year and 2 years after surgery. ConclusionsFollow-up appointment attendance with the bariatric team may be a critical factor in the effectiveness of bariatric surgery. Bariatric surgery teams should employ strategies to increase attendance at the 1-year follow-up visit with the surgical team. Additional strategies should be enacted to increase follow-up appointment attendance for patients with lower education levels.

Impact of a Health Coach-Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study.

Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. This study aims to assess whether a health coach-led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life-Lite-Clinical Trials Version, Loss of Control Over Eating Scale-Brief, Weight Efficacy Lifestyle Questionnaire-Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month1) and Barriers to Being Active Quiz (improvements at months3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. This study provides evidence that the health coach-led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606.

Migraine inhibitor olcegepant reduces weight loss and IL-6 release in SARS-CoV-2-infected older mice with neurological signs.

COVID-19 can cause neurological symptoms such as fever, dizziness, and nausea. However, such neurological symptoms of SARS-CoV-2 infection have been hardly assessed in mouse models. In this study, we infected two commonly used wild-type mouse lines (C57BL/6J and 129/SvEv) and a 129S calcitonin gene-related peptide (αCGRP) null-line with mouse-adapted SARS-CoV-2 and demonstrated neurological signs including fever, dizziness, and nausea. We then evaluated whether a CGRP receptor antagonist, olcegepant, a "gepant" antagonist used in migraine treatment, could mitigate acute neuroinflammatory and neurological signs of SARS-COV-2 infection. First, we determined whether CGRP receptor antagonism provided protection from permanent weight loss in older (>18 m) C57BL/6J and 129/SvEv mice. We also observed acute fever, dizziness, and nausea in all older mice, regardless of treatment. In both wild-type mouse lines, CGRP antagonism reduced acute interleukin 6 (IL-6) levels with virtually no IL-6 release in mice lacking αCGRP. These findings suggest that migraine inhibitors such as those blocking CGRP receptor signaling protect against acute IL-6 release and subsequent inflammatory events after SARS-CoV-2 infection, which may have repercussions for related pandemic or endemic coronavirus outbreaks.IMPORTANCECoronavirus disease (COVID-19) can cause neurological symptoms such as fever, headache, dizziness, and nausea. However, such neurological symptoms of severe acute respiratory syndrome CoV-2 (SARS-CoV-2) infection have been hardly assessed in mouse models. In this study, we first infected two commonly used wild-type mouse lines (C57BL/6J and 129S) with mouse-adapted SARS-CoV-2 and demonstrated neurological symptoms including fever and nausea. Furthermore, we showed that the migraine treatment drug olcegepant could reduce long-term weight loss and IL-6 release associated with SARS-CoV-2 infection. These findings suggest that a migraine blocker can be protective for at least some acute SARS-CoV-2 infection signs and raise the possibility that it may also impact long-term outcomes.

Impact of Simulated Caloric Reduction on Nutrient Adequacy Among U.S. Adults with Overweight or Obesity (National Health and Nutrition Examination Survey [NHANES] 2015–2018)

BackgroundCurrent guidelines for the treatment of obesity recommend dietary restriction to create a caloric deficit, and caloric reductions of 16% to 68% have been achieved in adults with overweight or obesity engaging in intentional weight loss programs. ObjectivesThis study models the impact of simulated caloric reduction on nutrient adequacy among U.S. adults ≥19 y with overweight or obesity using National Health and Nutrition Examination Survey data (2015–2018). MethodsFour levels of caloric reduction (20%, 30%, 40%, and 50%) were modeled by prorating daily calorie intake such that usual intakes of 14 nutrients were reduced proportional to caloric reduction. The percentages below the estimated average requirement (EAR) or above the adequate intake (AI) were estimated at each level of caloric reduction, with and without dietary supplement use. Differences across percentages of simulated caloric reductions were determined using nonoverlapping confidence intervals of the means (97.5th percentile confidence intervals were used to approximate P < 0.05). ResultsThere were significant differences (P < 0.05) in percentages below the EAR (above the AI) between sequential levels of simulated caloric reduction for most of the nutrients analyzed (protein, vitamins A, B-6, folate, and C, calcium, iron, magnesium, potassium, and zinc). For example, after a simulated 30% caloric reduction, 25%–40% of the population had intakes below the EAR for protein, vitamin B-6, and zinc, and 75%–91% of the population had intakes below the EAR for vitamin A, calcium, and magnesium (vs. 4%–18% and 45%–56%, respectively, without caloric reduction). With the inclusion of dietary supplements, percentages below the EAR for all nutrients (except protein) were lower than those for food alone. ConclusionsCaloric reduction may exacerbate nutrient inadequacies among adults with overweight or obesity. Inclusion of nutrient-dense foods, fortified foods, specially formulated products, and/or dietary supplements should be considered for those on calorie-restricted diets for long-term weight loss.

Sex-differential testosterone response to long-term weight loss

ObjectivesObesity-associated gonadal dysfunction is a common comorbidity in patients seeking weight loss interventions. We examined the incremental effect of weight loss on gonadal axes in men and women over 3 years. Changes in sex hormones were compared between dietary intervention (Diet) and bariatric procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB). Additional analysis assessed changes in corticotropic, somatotropic and thyroid axes after weight loss interventions.MethodsThis prospective, observational study included 61 adults with Body Mass Index >30 kg/m2, mean age 51 (SD = 11) years. Endocrine parameters were measured at baseline and at 6 timepoints over 36-months.ResultsFor each 1 kg of weight lost, between baseline and 36 months, total testosterone increased by 0.6% (95% CI: 0.2%, 1.0%, p = 0.002) in males and decreased by 0.8% (95% CI: −1.4%, −0.3%, p = 0.003) in females. These changes remained statistically significant when controlled for age and for menopausal status in females. At 36 months, in comparison with Diet, RYGB women had lower total testosterone by 54% (95% CI: −90%, −17%, p = 0.004), reduced free androgen index (FAI) by 65% (95% CI; −114%, −17%, p = 0.009) while SG had reduced FAI by 39% (95% CI; −77%, 0%, p = 0.05). No such differences between groups were noted for male subjects. Adrenocorticotropic hormone declined by 0.3% (95% CI: 0.0, −0.5%, p = 0.05), insulin-like growth factor-1 increased by 0.4% (95% CI; 0.2%, 0.7%, p = 0.005), without such thyrotrophin change for each 1 kg of weight loss, for entire cohort, over 36 months.ConclusionsThe testosterone changes observed in this study were proportional to the amount of weight loss. In females, reduction in androgens was independent of age and menopausal status and more pronounced after bariatric procedures. This study finding warrants further clinical research to explore an impact of androgen reduction on functional and cognitive status in postmenopausal women. The observed changes in pituitary hormones may contribute to the metabolic benefits of bariatric surgery.

Patient proximity to follow-up care after bariatric surgery: Does it matter?

One factor that may play a significant role in the follow-up care compliance and long-term weight loss of post-bariatric surgery patients is the geographical distance from the surgery center to the patient's home address. This is a retrospective review which aims to evaluate whether the distance from a patient's home address to two Gundersen Health System (GHS) facilities (La Crosse and Onalaska, Wisconsin) is predictive of follow-up appointment compliance and subsequent long-term weight loss. 1336 patients undergoing bariatric surgery at GHS between October 15, 2013 and Dec 31, 2022 were included. Patients were grouped according to the distance between their home addresses and GHS with 60 ​% of patients living less than 30 miles from GHS, 33 ​% living 30 to 60 miles from GHS, and the remaining 7.3 ​% living >60 miles away. No significant difference was observed in the distribution of patients falling short, meeting, or exceeding the recommended number of post-operative appointments with a surgery provider based on proximity (p ​= ​0.10). As distance increased, the number of nutrition and behavioral health appointments completed per year decreased [nutrition/dietary appointments (p ​= ​0.046); behavioral health appointments (p ​= ​0.040)]. The pattern of percent excess weight loss (%EWL) over time was significantly different based on distance from home (p ​< ​0.001). Specifically, we found a similar %EWL among all groups in the first year post-operatively but an 18.8 ​% higher %EWL in the >60-mile group compared to the <60-mile group at 5 years (SE ​= ​5.4, P ​= ​0.0014). The lower number of post-op nutrition and behavioral health visits among patients living farther from the surgery center was an expected result, given potentially greater inconvenience of follow-up appointments for these patients. However, there was a paradoxical finding of significantly increased %EWL among patients living >60 miles from the surgery center. Greater distance from the bariatric surgical center was therefore not found to represent a barrier to favorable weight loss outcomes.

Sexual Minority Women Report Higher Weight Stigma Levels Than Heterosexual Women in the National Weight Control Registry.

Little is known about weight stigma in sexual minority women, and even less is known about weight stigma in those who have attained substantial weight loss and maintenance. This study examined weight stigma experiences and internalization in sexual minority women from the National Weight Control Registry (NWCR) who had lost ≥30 pounds and maintained this weight loss for ≥1 year, and compared weight stigma levels between sexual minority women versus heterosexual women in the NWCR. NWCR participants completed an electronic survey. Women who identified as a sexual minority (n = 64; 98% White; MBMI = 29 ± 8; Mage = 47 ± 13) and heterosexual women matched on body mass index (BMI), age, and race (n = 64; 98% White; MBMI = 28 ± 7; Mage = 51 ± 13) were included. Participants completed assessments of experienced and internalized weight stigma. Generalized linear models showed that a significantly larger proportion of sexual minority women in the NWCR reported experiencing weight stigma in the past year (24.2%) compared with heterosexual women (4.7%; p < .05). Furthermore, sexual minority (vs. heterosexual) women reported significantly higher levels of internalized weight stigma (p < .001), and a greater proportion of sexual minority women (35%) reported clinically significant internalized weight stigma relative to heterosexual women (2%; p < .001). Sexual minority women are at greater risk for experienced and internalized weight stigma than their heterosexual counterparts among women who have attained significant long-term weight loss. It is critical to expand research on weight stigma in sexual minority women.

The Effect of a Vegan Diet on the Health Indicators and Outcomes of P atients with Type 2 Diabetes Mellitus.

Recently, there has been a notable increase in interest in various forms of vegetarianism, which may be due to the growing prevalence of health issues, such as Type 2 Diabetes Mellitus (T2DM). Adhering to a vegan diet may have positive health outcomes. As a result, we conducted a review article to gather data from previous research studies on the effects of a vegan diet on different aspects of managing patients with T2DM. We searched the PubMed website for research studies on how a vegan diet affects the outcomes of patients with T2DM. The research studies were categorized according to the type of data collected, such as prevalence, incidence, body weight, insulin resistance, glycemic control, and lipid profile. It was found that following a vegetarian diet can significantly reduce the risk of mortality from heart disease. Additionally, studies have demonstrated that a vegetarian diet is linked to several improvements in T2DM. However, long-term weight loss plans and managing T2DM is a comprehensive intervention that includes caloric restriction, exercise, and behavioral modification. Incorporating a vegan diet can be a valuable factor to consider in managing T2DM, as it can offer numerous benefits, such as increased insulin sensitivity, weight loss, and reduced blood sugar levels. It helps to reduce cholesterol levels, LDL, and triglyceride levels, which are all risk factors associated with T2DM. By reducing these risk factors, the vegan diet can improve the overall health of T2DM patients. </p>.

Implementation of a digital behavior change intervention (eCHANGE) for weight loss maintenance support: a service design and technology transfer approach.

Obesity is a chronic disease, and while weight loss is achievable, long-term weight loss maintenance is difficult and relapse common for people living with obesity. Aiming to meet the need for innovative approaches, digital behavior change interventions show promise in supporting health behavior change to maintain weight after initial weight loss. Implementation of such interventions should however be part of the design and development processes from project initiation to facilitate uptake and impact. Based on the development and implementation process of eCHANGE, an evidence-informed application-based self-management intervention for weight loss maintenance, this manuscript provides suggestions and guidance into; (1) How a service design approach can be used from initiation to implementation of digital interventions, and (2) How a technology transfer process can accelerate implementation of research-based innovation from idea to market.

The predictive relationship between early and long-term weight loss outcomes after one anastomosis gastric bypass

The predictive relationship between early and long-term weight loss outcomes after one anastomosis gastric bypass

Assessing Nutritional Deficiencies in Bariatric Surgery Patients: A Comparative Study of Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy.

Obesity is a worldwide epidemic, and bariatric surgery is considered the primary treatment for long-term weight loss and managing obesity-related health issues. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed procedures. Nutritional deficiencies are a significant concern following bariatric surgery and can have serious consequences. This study aims to compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. A retrospective analysis was conducted on the nutritional status of 505 consecutive patients who underwent either RYGB or SG between January and December 2019. Data were collected regarding vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin, and transferrin at preoperative, 6-month, and 12-month intervals post-surgery. The RYGB group showed significantly higher excess weight loss. Vitamin B12, hemoglobin, and ferritin levels were consistently higher in the SG group throughout the study. Vitamin D deficiency was prevalent, with no significant difference between the groups. Vitamin B12 deficiency was significantly more common in the RYGB group (6 months: 17.46% vs. 4.69%, p < 0.001; 12 months: 16.74% vs. 0.93%, p < 0.001). Despite differences in their mechanisms, bariatric surgeries were associated with nutritional deficiencies. It is crucial to efficiently assess, prevent, and manage these deficiencies tailored to each surgical procedure.