Non-surgical Obesity Treatment Research Articles

Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment.

Evidence on the long-term (≥10 years) development of health-related quality of life (HRQoL) following bariatric surgery is still limited and mainly based on small-scale studies. This study aimed to investigate (1) 15-year changes in mental, physical, social, and obesity-related HRQoL after bariatric surgery and non-surgical obesity treatment; and (2) whether sociodemographic factors and pre-operative health status are associated with 15-year HRQoL changes in the surgery group. Participants were from the non-randomized, prospective, controlled Swedish Obese Subjects study. The surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual obesity care. Recruitment took place in 1987-2001 and measurements (including six HRQoL scales) were administered before treatment and after 0.5, 1, 2, 3, 4, 6, 8, 10 and 15 years. Multilevel mixed-effect regression models using all observations for estimation were conducted. Surgical patients experienced greater 15-year improvements in perceived health and overall mood, and greater reductions in depression, obesity-related problems, and social interaction limitations than controls (all p < 0.001, adjusted for baseline differences). Effect size (ES) was classified as large only for obesity-related problems (ES = 0.82). At the 15-year follow-up, surgical patients reported better perceived health (p < 0.001) and less obesity-related problems (p = 0.020) than controls. In the surgery group, patients with baseline diabetes had smaller 15-year reductions in social interaction limitations (p < 0.001) and depression (p = 0.049) compared to those without baseline diabetes. Although surgical patients with a history of psychiatric disorder reported lower HRQoL than those without such history over the 15-year follow-up, there were no significant differences in the long-term improvements between the two groups (p = 0.211-0.902). Over 15 years, surgical patients experienced more positive development of HRQoL compared to those receiving usual care. This difference was large for obesity-related problems, but otherwise the differences were small. Patients with pre-operative diabetes might be at increased risk for smaller long-term HRQoL improvements.

Role of metabolic surgery in remission of type 2 diabetes mellitus in patients with obesity

Type 2 diabetes mellitus and obesity are two socially significant diseases, the prevalence of which has now assumed pandemic proportions. Obesity, as a rule, precedes the development of type 2 diabetes, being the most powerful risk factor for the development of this disease. In patients with obesity and type 2 diabetes with a BMI &gt;35 kg/m2, bariatric surgery is recommended if glycemic control cannot be achieved after several attempts at non-surgical treatment of obesity. There is no doubt the effectiveness of bariatric surgery not only in the treatment of obesity, but also in achieving remission of type 2 diabetes. It seems relevant to study the predictors of achieving remission of type 2 diabetes, as well as factors that can worsen the prognosis. The purpose of the review: to study the effectiveness of metabolic surgery in achieving remission of type 2 DM, as well as predictors of remission of type 2 DM in obese patients after bariatric surgery.

Four-year outcomes for endoscopic sleeve gastroplasty from a single centre in India.

Bariatric endoscopy has emerged for non-surgical treatment of obesity, providing a treatment option for weight loss and associated comorbidities. Outcomes of endoscopic sleeve gastroplasty (ESG) of 12 months have been published by our team and there is a need for longer follow-up period understanding the effects of ESG techniques. This report emphasises on weight loss pattern in follow-up time points and monitors the post-procedure improvement in comorbidities with minimum 4-year follow-up of patients undergoing ESG at a single academic centre in India. This was a prospective cohort study. All procedures were performed by the same surgeon. Patients with a body mass index of >30 kg/m2 (or >27 with comorbidities) underwent ESG for treatment of obesity. Patients were systematically followed yearly after their procedure. Data collected on the primary outcome and secondary outcomes were analysed and presented. 612 patients (69.3% female) with a mean age of 40.70 ± 12.66 years and mean body mass index of 34.30 ± 5.05 kg/m2 underwent ESG. Out of 612 patients, follow-up rates for a 1-2-3 and 4 years were 93.1%, 90.2%, 81.7% and 81.9%, respectively. The mean percentage total body weight loss was 18.19% (95% confidence interval [CI]: 17.72-18.57) and %EWL was 49.30% (95% CI: 48.91-49.68) with 90% of participants-maintaining a percentage of total weight loss of ≥5% and 70% of patients maintaining an EWL of ≥25% at 4 years, respectively. Resolution/improvement of comorbidities was 51.2% cases of T2DM, 65.8% cases of hypertension, 73.6% cases of dyslipidaemia and 89.9% remission were in obstructive sleep apnoea. No patient required an emergency intervention, and there was no mortality or significant morbidity. This study shows acceptable results with ESG at 4 years in our unit. Regular monitoring by a multidisciplinary nurtures weight loss, resolution or improvement of comorbidities and improvement of quality of life with low perioperative complications. There is a need for more reports with this approach to determine the amount and duration of weight loss outcome and medical intervention.

Intraoperative gastroscopy during laparoscopic sleeve gastrectomy after gastric band surgery with unrecognized hiatal hernia—a case report

Obesity is the civilizational disease of our era, and often leads to comorbidity, hypertension, diabetes and obstructive sleep apnea. Contemporary non-surgical treatment for obesity is frequently inefficient, resulting in the increased prominence of surgical procedures, specifically, laparoscopic sleeve gastrectomy (LSG). In our case report, we present a case in which LSG was not feasible in reference to the traditional surgical technique due to severe hiatal hernia (HH), which inexplicably went undetected during preoperative examinations, however, with the help of intraoperative gastroscopy, the problem was effectively solved. The patient, a middle-aged Caucasian male, underwent removal of a gastric band due to gastric band migration, and was presented for LSG due to repeated weight gain. During the operation, the insertion of the bougie proved unsuccessful after several attempts. Through intraoperative gastroscopy, a severe HH was discovered. The endoscope was inserted into the compromised passageway leading into the stomach, effectively substituting the role of bougie used in the traditional surgical procedure. Unexpected difficulty or inability to insert a bougie is rare in consideration of LSG, however, in this case, surgery could not have been performed in the conventional manner. During intraoperative gastroscopy, the gastroscope is inserted into the stomach using visual control, and effectively substitutes the bougie function. The likelihood of rare, yet severe, life-threatening complications from the insertion of a bougie is reduced and surgery can be performed in the traditional sense. We have no knowledge of cases in which a HH prevents the conventional surgical technique. However, in extreme cases in which the traditional non-surgical technique and other types of surgery are deemed unsuitable, intraoperative gastroscopy provides a simple and safe solution.

Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids

BackgroundLimited evidence suggests that surgical and non-surgical obesity treatment differentially influence plasma Lipoprotein (a) [Lp(a)] levels. Further, a novel association between plasma arachidonic acid and Lp(a) has recently been shown, suggesting that fatty acids are a possible target to influence Lp(a). Here, the effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) were compared, and it was examined whether the effects were mediated by changes in plasma fatty acid (FA) levels.MethodsThe study includes two independent trials of patients with overweight or obesity. Trial 1: Two-armed intervention study including 82 patients who underwent a 7-week low energy diet (LED), followed by Roux-en-Y gastric bypass and 52-week follow-up (surgery-group), and 77 patients who underwent a 59-week energy restricted diet- and exercise-program (lifestyle-group). Trial 2: A clinical study including 134 patients who underwent a 20-week very-LED/LED (lifestyle-cohort).ResultsIn the surgery-group, Lp(a) levels [median (interquartile range)] tended to increase in the pre-surgical LED-phase [17(7–68)-21(7–81)nmol/L, P = 0.05], but decreased by 48% after surgery [21(7–81)—11(7–56)nmol/L, P < 0.001]. In the lifestyle-group and lifestyle-cohort, Lp(a) increased by 36%[14(7–77)—19(7–94)nmol/L, P < 0.001] and 14%[50(14–160)—57(19–208)nmol/L, P < 0.001], respectively. Changes in Lp(a) were independent of weight loss. Plasma levels of total saturated FAs remained unchanged after surgery, but decreased after lifestyle interventions. Arachidonic acid and total n-3 FAs decreased after surgery, but increased after lifestyle interventions. Plasma FAs did not mediate the effects on Lp(a).ConclusionBariatric surgery reduced, whereas lifestyle interventions increased plasma Lp(a), independent of weight loss. The interventions differentially influenced changes in plasma FAs, but these changes did not mediate changes in Lp(a).Trial registrationTrial 1: Clinicaltrials.gov NCT00626964.Trial 2: Netherlands Trial Register NL2140 (NTR2264).Graphical abstract

Comorbidity and quality of life in obesity-a comparative study with the general population in Gothenburg, Sweden.

ContextObesity is considered to have a detrimental impact on health-related quality of life (HRQoL).ObjectiveTo compare HRQoL in a well-defined group of people with obesity with a population-based control group from the general public.DesignObservational cross-sectional cohort study with a reference population.SettingThe Regional Obesity Center at the Department of Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden.ParticipantsPeople with obesity (n = 1122) eligible for surgical and non-surgical obesity treatment in routine care were included consecutively between 2015 and 2017 into the BASUN study. Men and women from the WHO-MONICA-GOT project were used as a reference population (n = 414).Main outcome measuresHRQoL was measured with the RAND-36/Short Form-36 questionnaire (SF-36) and a Visual Analogue Scale (VAS) for self-related health (SRH). Prescription drugs for hypertension, diabetes mellitus, depression, and anxiety were taken as a proxy for these conditions.ResultsPeople with obesity rated their overall HRQoL lower than the reference population according to the SRH-VAS. Lower scores were reported on physical and social functioning, vitality, general and mental health after adjustment for age and use of prescription drugs (considered a proxy for burden of disease, or comorbidities) using the RAND-36/SF-36 questionnaire. Use of some psychopharmacological agents was more common in patients with obesity.ConclusionPeople with obesity seeking help with weight reduction are more likely to have lower physical and mental self-reported HRQoL than the general population.

Measures of glucose homeostasis during and after duodenal exclusion using a duodenal-jejunal bypass liner in a normoglycemic, nonobese canine model.

Discovering the role duodenal exclusion plays in weight loss and resolution of type 2 diabetes (T2D) may help refine the surgical and nonsurgical treatment of obesity and T2D. To assess changes in glucose homeostasis due to duodenal exclusion using a duodenal-jejunal bypass liner (DJBL) in a nonobese canine model. Academic laboratory setting. An intravenous glucose tolerance test (IVGTT), and a mixed-meal tolerance test (MMTT) at baseline, 1, and 6 weeks post DJBL implantation (I1 and I6, respectively), and 1 and 6 weeks post DJBL removal (R1 and R6, respectively) were done in canines (n = 7) fed a normal chow diet. Placement of the DJBL induced weight loss that was maintained until 4 weeks post removal (R4), despite normal food intake. Total bile acids (TBA) and glucagon-like peptide-1 (GLP-1) during the MMTT were significantly increased at I1 and were associated with increased lactate and free fatty acids. Hypoglycemia counter-regulation was blunted during the IVGTT at I1 and I6, returning to baseline at R1. While there were no changes to insulin sensitivity during the experiment, glucose tolerance was significantly increased following the removal of the DJBL at R1. These data show that in a normoglycemic, nonobese canine model, duodenal exclusion induces energy intake-independent weight loss and negative metabolic effects that are reversed following re-exposure of the small intestine to nutrients.

Impact of bariatric surgery on depression, anxiety and stress symptoms among patients with morbid obesity: international multicentre study in Poland and Germany.

There is a need to investigate how adopting different strategies for treating obesity in different countries in the European Union affects the psychological well-being of patients. The aim of this study was to perform a comparative evaluation of psychiatric symptoms (depression, anxiety and stress) in patients undergoing bariatric surgery versus patients receiving conservative treatment for morbid obesity in Poland and Germany. A multicentre international prospective cohort study with 155 patients who underwent bariatric surgery and 409 patients who received conservative weight reduction treatment. Evaluation of the psychiatric symptoms was carried out for each patient at baseline and after 12 months of active treatment using a standardised Depression Anxiety Stress Scale questionnaire (DASS-21) questionnaire. After 12 months of active treatment, the level of psychiatric symptoms (depression, anxiety and stress) significantly decreased in both groups of patients: surgically treated versus conservatively treated patients from Poland and also from Germany. The median change in level of psychiatric symptoms among patients from both countries was significantly higher among surgically treated patients compared with conservatively treated patients (Poland P < 0.0001; Germany P < 0.0001). Improvements in the patient's mental health as a consequence of treatment were dependent on the specific strategy for treating obesity adopted in the analysed countries, the percentage of total weight loss and on gender. The use of bariatric surgery in both Poland and Germany compared with non-surgical treatment for obesity resulted in more measurable benefits in the form of a decrease in psychiatric symptoms (depression, anxiety and stress) and reduction in body weight.

Interprofessional obesity treatment: An exploration of current literature and practice

It is unclear which professions, their roles, competencies, and necessary training, maximize the effectiveness of interprofessional non-surgical obesity treatment teams. This exploratory exercise was to gain an understanding of current literature and practice regarding adult interprofessional obesity treatment team practice. Synthesis of information from 87 articles and 9 websites identified through review of pertinent literature as well as qualitative analysis of transcripts from 15 one-on-one obesity treatment team member interviews. Teams vary in their make-up but most often include physicians, physician assistants, nurse practitioners, registered dietitian nutritionists, registered nurses, mental and behavioral health practitioners, and exercise specialists. The team leader sets the tone that can promote respectful exchange of opinions among team members. Decisions regarding which professions are represented on teams are driven by financial ability to support the provider's work. Well-functioning interprofessional teams are rare, possibly due to insufficient opportunities for training with well-functioning interprofessional obesity teams. Learning from other team members is believed to improve the patient experience and provider satisfaction. There are limited training opportunities for professionals to learn to function as members of obesity treatment teams. Few examples of well-functioning obesity treatment teams exist to act as role models and training sites. Some professions have competencies that could inform and develop profession-specific interprofessional training opportunities to prepare professionals to assume effective obesity treatment team roles. However, more work is needed to study how interprofessional obesity competencies and training, geared toward developing shared decision-making and shared goals, and could impact patient care and provider satisfaction. Furthermore, without adequate reimbursement for all the needed health professions to provide basic services to persons with obesity, expanding small programs will be an ongoing challenge.

A Subset of Roux-en-Y Gastric Bypass Bacterial Consortium Colonizes the Gut of Nonsurgical Rats without Inducing Host-Microbe Metabolic Changes.

ABSTRACTRoux-en-Y gastric bypass (RYGB) is an effective weight loss surgery, resulting in a characteristic increase of fecal Gammaproteobacteria. The contribution of this compositional change to metabolic benefits of RYGB is currently debatable. Therefore, this study employed 16S rRNA gene sequencing and metabolic profiling to monitor the dynamic colonization of the RYGB microbial consortium and their metabolic impact on the host. Eleven Wistar rats received vancomycin and enrofloxacin, followed by fecal microbiota transplantation (FMT) of cecal slurry obtained from either RYGB- or sham-operated rats. Urine and feces from the microbiota recipients (RYGB microbiota recipients [RYGBr], n = 6; sham microbiota recipients [SHAMr], n = 5) were collected pre- and post-antibiotics and 1, 3, 6, 9, and 16 days post-FMT. No significant differences in body weight and food intake were observed between RYGBr and SHAMr. While neither group reached the community richness of that of their donors, by day 6, both groups reached the richness and diversity of that prior to antibiotic treatment. However, the typical signature of RYGB microbiome—increased Enterobacteriaceae—was not replicated in these recipients after two consecutive FMT, suggesting that the environmental changes induced by the anatomical rearrangements of RYGB could be key for sustaining such a consortium. The transplanted bacteria did not induce the same metabolic signature of urine and feces as those previously reported in RYGB-operated rats. Future work is required to explore environmental factors that shape the RYGB microbiota in order to further investigate the metabolic functions of the RYGB microbiota, thereby teasing out the mechanisms of the RYGB surgery.IMPORTANCE Roux-en-Y gastric bypass (RYGB) surgery results in a long-term gut bacterial shift toward Gammaproteobacteria in both patients and rodents. The contribution of this compositional shift, or the RYGB bacterial consortium, to the metabolic benefit of the surgery remains debatable. It is unclear how well these bacteria colonize in an anatomically normal gut. This is a fundamental question in both defining the function of the RYGB microbiota and evaluating its potential as a nonsurgical treatment for obesity. We monitored the dynamic colonization of the RYGB bacterial consortium and observed that while approximately one-third of the bacterial taxa from the RYGB donor colonized in the gut of the nonoperated recipients, Gammaproteobacteria were unable to colonize for longer than 3 days. The study highlighted that a successful long-term colonization of Gammaproteobacteria-rich RYGB microbiota in nonsurgical animals requires key environmental factors that may be dictated by the intestinal anatomical modification by the surgery itself.

2397-PUB: PowerHouse: A Lifestyle Intervention for Youth at Risk for Type 2 Diabetes (T2D)

The prevalence of T2D is increasing in youth partly because of the lack of effective prevention strategies. Lifestyle intervention is established for adult T2D prevention and family-based lifestyle intervention is the most efficacious non-surgical treatment of obesity in youth. We developed a 16-wk family-based program modeled after the U.S. Diabetes Prevention Program, using Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity. Sessions included physical activity, separate adult/youth nutrition education and goal setting, and a shared meal. Youth inclusion criteria were age 7-18 y, BMI &amp;gt; 85th %ile, a caregiver to participate, and ≥ 2 risk factors: family history of T2D, maternal history of gestational diabetes, minority race/ethnicity. Paired t-tests were used to compare BMI and HbA1c at baseline (BL) and 4 months (M4) and at BL and 12 months (M12, data set currently incomplete). Between Feb 2017 and Nov 2018, 79 eligible youth enrolled (Table) the majority of whom had government-issued health insurance. Youth HbA1c was maintained at M4 (p = 1.0) and M12 (p = 0.45). Similarly, BMI SDS were stable at M4 (p = 0.67) and M12 (p = 0.12) while BMI scores increased at M4 (p = 0.007), but not at M12 (p = 0.23). As excessive weight-gain is correlated with T2D development, programs that maintain BMI could have significant impact on preventing or delaying T2D in youth. Disclosure H.K. El Mikati: None. J. Pike: None. K. Haberlin-Pittz: None. L. Yazel-Smith: None. B.M. McKinney: None. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company. Funding Indiana University School of Medicine; Indiana University

Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity

Background: Bariatric surgery is associated with greater and more sustainable weight loss compared with lifestyle intervention programs. On the other hand, bariatric surgery may also be associated with physical and psychosocial complications. The influence of psychological evaluation on treatment choice, however, is not known. We aimed to examine variables associated with treatment choice and, specifically, if self-reported lifetime adversity influenced obesity treatment, i.e. bariatric surgery, high-intensive lifestyle treatment or low-intensive lifestyle treatment in primary care. Methods: We consecutively included 924 patients from the registry study of patients with morbid obesity at Akershus University Hospital, Lørenskog, Norway. Treatment selection was made through a shared decision-making process. Self-reported lifetime adversity was registered by trained personnel. Logistic regression models were used to assess the associations between obesity treatment and possible predictors. Results: Patients who chose bariatric surgery were more likely to have type 2 diabetes (DM2) compared with patients who chose lifestyle treatment (bariatric surgery: 35%, high-intensive lifestyle treatment: 26%, and low-intensive lifestyle treatment: 26%; p = 0.035). Patients who chose bariatric surgery were less likely than patients who chose lifestyle intervention to report lifetime adversity (bariatric surgery: 39%, high-intensive lifestyle treatment: 47%, and low-intensive lifestyle treatment: 51%; p = 0.004). After multivariable adjustments, increasing BMI, having DM2, and joint pain were associated with choosing bariatric surgery over non-surgical obesity treatment (odds ratio [95% CI]: BMI 1.03 [1.01–1.06], DM2 1.47 [1.09–1.99], and joint pain 1.46 [1.08–1.96]). Self-reported lifetime adversity was furthermore associated with lower odds of choosing bariatric surgery in patients with morbid obesity (0.67 [0.51–0.89]). Conclusion: This study shows that increasing BMI, DM2, and joint pain were all associated with treatment choice for obesity. In addition, self-reported lifetime adversity was associated with the patients’ treatment choice for morbid obesity. Consequently, we suggest that decisions concerning obesity treatment should include dialogue-based assessments of the patients’ lifetime adversity.

PROTEIN MALNUTRITION SYNDROME AFTER BILIOPANCREATIC SHUNTING IN HESSMARCEAU MODIFICATION

Morbid obesity is a chronic disease resulting in progressing comorbidities, socioeconomic problems, reduced quality of life, and earlier death. Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. Protein malnutrition with its classic symptoms is the most serious complication of bliopancreatic diversion (BPD). The objective of the study is analysis of the incidence of protein malnutrition syndrome in patients after biliopancreatic diversion with duodenal switch (BPD\DS), possible causes of development, and to analyze the results of treatment. 100 obese patients underwent BPD\DS. The average age of patients was 45±8.2 years – from 29 to 64 years (40 men and 60 women). The average body weight before the operation was 157.8±26.1 kg (106 to 246 kg), the average excessive weight was 91.8±21.6 kg (46 to 169 kg). The average body mass index (BMI) before surgery was 52.8±7.2 kg/m2 (40 to 75.4 kg/m2). Protein malnutrition syndrome occurred in 12 (12%) patients within the period of 9-24 months after surgery. The treatment of all the patients began with conservative therapy. The indications for surgical treatment of this complication were considered to be a serious condition of a patient during hospitalization to the clinic due to systemic metabolic disorders and multiple organ failure, insufficient or unstable conservative therapy, re-development (second episode) of protein malnutrition syndrome after successful primary conservative therapy. Surgical treatment was performed in 7 (58,3%) patients by the formation of additional proximate side-to-side small bowel anastomosis. The total length of the small intestine in patients with protein malnutrition syndrome was 622±91.5 cm, the length of the alimentary loop was 282±35.1 cm, the biliopancreatic loop was 339±71,7 cm, the common loop – 100 cm. In patients without protein malnutrition syndrome – the total length was 568±92.3 cm, the alimentary loop – 269±35.3 cm, the biliopancreatic loop – 298±71.9 cm, the common loop – 100 cm (p&gt;0,05). The development of the syndrome did not depend on the current BMI after the BPD\DS and the starting lengths of the alimentary, common and bialiopancreatic loops. Protein malnutrition syndrome occurred in patients with reduced compliance and was dependent on the individual adaptive capacity of the ileum.

Skin in the game: Does paying for obesity treatment out of pocket lead to better outcomes compared to insurance coverage?

To determine whether insurance coverage for medical weight loss treatment was associated with different program engagement and weight loss outcomes compared to those who paid out of pocket. One-year outcomes from an academic medical weight management program were used to compare two groups: employees (n = 480) with insurance coverage ("covered") versus nonemployees (n = 463) who paid out of pocket ("self-pay"). Demographics and weight were abstracted from medical records. Socioeconomic status was estimated using neighborhood demographics. Group differences in weight were analyzed using generalized linear modeling adjusted for age, baseline BMI, sex, program type, and neighborhood socioeconomic status. Covered patients were younger (46.5 ± 10.6 vs. 51.6 ± 12.5) with a lower BMI (38.5 ± 7.5 vs. 41.3 ± 9.9) compared to self-pay (P < 0.001). Self-pay patients resided in higher annual per capita income neighborhoods (+$4,545, P < 0.001). Program dropout was lower for covered patients (12.7% vs. 17.6%, P = 0.03). There was no significant difference in 12-month weight loss between groups in adjusted models; covered patients lost 13.4%, compared to 13.6% for self-pay. Data from an academic medical weight management program suggest that individuals with access to insurance coverage for nonsurgical obesity treatment have lower levels of attrition and similar levels of participation and outcomes as those who pay out of pocket.

Evaluation of a multiprofessional, nonsurgical obesity treatment program: which parameters indicated life style changes and weight loss?

BackgroundAccording to the current evidence, behavior modifications are an effective part of a non-surgical multiprofessional obesity treatment program (MOTP). The purpose of the present study was to report changes in weight as well in psychological variables during a one year MOTP. We aimed to identify the associations of emotional state and patients’ emotion regulation skills with weight change.MethodsProspective interventional study. Data of participants attending the one year obesity treatment in either a group or individual structured MOTP were analyzed. Weight, BMI (Body Mass Index) and measures on psychosomatic variables, emotion regulation skills, affective state, shame and guilt were collected at baseline, after three months and after one year. Mixed-effects models were used for the statistical analysis of BMI.ResultsWe included 238 patients at baseline (t1), 234 after three months (t2) and 179 after one year (t3). A drop in BMI measurements of at least 5% was observed in 20.6% of participants at t2 and 41.4% of participants at t3. After three months, participants showed significant improvements in the following psychosomatic variables: somatisation (p < 0.001), interpersonal sensitivity (p < 0.001), emotion regulation skills (p < 0.01), and attention to emotions (p < 0.05). Most of the improvements could be maintained after one year. BMI reduction was associated with a positive change in emotions, improvements in emotion regulation skills, and a reduction of depressive symptoms, disgust and shame.ConclusionsThe results indicate that the assessment and treatment of psychological aspects like depression, emotion regulation skills, body awareness, and acceptance should be a vital part of an interdisciplinary MOPT.Trial registrationEthical approval for the present study was obtained from the Bern Kantonal Ethics Committee (KEK-Bern-Study Nr 258/14), Bern, Switzerland.

Evaluation of Metabolic Syndrome in morbidly Obese Patients Submitted to Laparoscopic Bariatric Surgery: Comparison of the Results between Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

Morbid obesity is a state of insulin resistance combined with excess of visceral fat, which contributes to the development of metabolic syndrome (MetS). Nonsurgical treatment of obesity usually improves MetS, but there is no ultimate resolution and weight regain is common. Surgical options like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) result in a significant and sustained weight loss accompanied by improvement of MetS. The aim of this study was to compare the weight loss and improvement of MetS parameters between degree II and III obese patients with MetS undergoing RYGB or SG in a period of 12months. Analysis of medical records of 102 patients diagnosed with MetS (63 undergoing RYGB and 39 undergoing SG) in a reference center (CTO ISCMPA) between 2010 and 2013. After 1-year follow-up, an excess weight loss (EWL) of 77.2±22.5% and of 63.4±20.1% (p=0.033) was observed in the RYGB and SG groups, respectively. The rate of MetS resolution was very similar (87.3 and 84.6%, respectively; p=0.971). The percentage of patients with type 2 diabetes was 3.3% for RYGB and 15.4% for SG (p=0.025). Fasting blood glucose levels followed the same trend with mean values reaching 87.6±16.9 mg/dl in the RYGB group and 97.7±35.5mg/dl in the group undergoing SG (p=0.023). Among the patients studied, both surgical techniques were safe and effective for MetS resolution in 12months. However, RYGB was more effective for EWL and improvement of some parameters related to glucose metabolism.

A139 - Intragastric Balloon: Initial Experience with 160 Patients at a Multicenter Bariatric Practice

The ReShapeTM Integrated Dual Balloon (IDB) is a safe and effective nonsurgical treatment for obesity recently introduced in the United States. We report on our initial experience to date with over 160 subjects treated with the IDB in a large multicenter bariatric practice.

The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials.

BackgroundBariatric surgery has emerged as a competitive strategy for obese patients. However, its comparative efficacy against non-surgical treatments remains ill-defined, especially among nonseverely obese crowds. Therefore, we implemented a systematic review and meta-analysis in order for an academic addition to current literatures.MethodsLiteratures were retrieved from databases of PubMed, Web of Science, EMBASE and Cochrane Library. Randomized trials comparing surgical with non-surgical therapies for obesity were included. A Revised Jadad's Scale and Risk of Bias Summary were employed for methodological assessment. Subgroups analysis, sensitivity analysis and publication bias assessment were respectively performed in order to find out the source of heterogeneity, detect the outcome stability and potential publication bias.Results25 randomized trials were eligibly included, totally comprising of 1194 participants. Both groups displayed well comparability concerning baseline parameters (P > 0.05). The pooled results of primary endpoints (weight loss and diabetic remission) revealed a significant advantage among surgical patients rather than those receiving non-surgical treatments (P < 0.05). Furthermore, except for certain cardiovascular indicators, bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters (P < 0.05). Additionally, the pooled outcomes were confirmed to be stable by sensitivity analysis. Although Egger's test (P < 0.01) and Begg's test (P<0.05) had reported the presence of publication bias among included studies, “Trim-and-Fill” method verified that the pooled outcomes remained stable.ConclusionBariatric surgery is a better therapeutic option for weight loss, irrespective of follow-up duration, surgical techniques and obesity levels.

Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success.

Background and study aims: Bariatric endoscopy has emerged as an aid in the nonsurgical treatment of obesity. The objective of this study is to critically provide the results and follow-up of endoscopic sleeve gastroplasty 1 year after the procedure. Patients and methods: Prospective single-center follow-up study of 25 patients (5 men, 20 women) who underwent flexible endoscopic suturing for endoluminal gastric volume reduction. A multidisciplinary team provided post-procedure care. Patient outcomes were recorded at 1 year after the procedure. Linear regression analysis was done to evaluate the variables associated with best results at 1 year of follow-up. Results: Mean body mass index (BMI) was 38.5 ± 4.6 kg/m2 (range 30 – 47) and mean age 44.5 ± 8.2 years (range 29 – 60). At 1 year, 22 patients continued with the follow-up (2 dropped out at 6 months and 1 at 3 months). There were no major intra-procedural, early, or delayed adverse events. Mean BMI loss was 7.3 ± 4.2 kg/m2, and mean percentage of total body weight loss was 18.7 ± 10.7 at 1 year. In the linear regression analysis, adjusted by initial BMI, variables associated with %TBWL involved the frequency of nutritional (β = 0.563, P = 0.014) and psychological contacts (β = 0.727, P = 0.025). The number of nutritional and psychological contacts were predictive of good weight loss results. Conclusions: Endoscopic sleeve gastroplasty is a feasible, reproducible, and effective procedure to treat obesity. Nutritional and psychological interaction are predictive of success.

Review: Bariatric surgery increases weight loss and diabetes remission more than nonsurgical treatment

Source Citation Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. 24149519