Non-surgical Weight Loss Interventions Research Articles

How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence.

The prevalence of obesity is increasing worldwide, with a corresponding increase in overweight and obese patients referred with infertility. This systematic review aimed to determine whether non-surgical weight reduction strategies result in an improvement in reproductive parameters affected by obesity, e.g. delayed time to pregnancy, oligozoospermia and azoospermia. No prior reviews have examined this within the general fertility population, or in both sexes. Our objective was to answer the question: 'In overweight and obese women, men and couples seeking fertility treatment, what non-surgical weight-loss interventions have been used, and how effective are they at weight loss and improving reproductive outcomes?' An electronic search of MEDLINE, EMBASE and the Cochrane Library was performed for studies between January 1966 and March 2016. Text word and MESH search terms used related to infertility, weight and barriers to weight loss. Inclusion criteria were an intervention to change lifestyle evaluated in any study design in participants of either gender with an unfulfilled desire to conceive. Studies were excluded if they included participants not attempting pregnancy, with illnesses that might cause weight fluctuations, or studies evaluating bariatric surgery. Two reviewers performed data extraction and quality assessment using the Cochrane Risk of Bias Tool for randomized trials, and a ratified checklist (ReBIP) for non-randomized studies. A total of 40 studies were included, of which 14 were randomised control trials. Primary outcomes were pregnancy, live birth rate and weight change. In women, reduced calorie diets and exercise interventions were more likely than control interventions to result in pregnancy [risk ratio 1.59, 95% CI (1.01, 2.50)], and interventions resulted in weight loss and ovulation improvement, where reported. Miscarriage rates were not reduced by any intervention. Overweight and obese persons seeking fertility should be educated on the detrimental effects of fatness and the benefits of weight reduction, including improvement in pregnancy rates. A combination of a reduced calorie diet, by reducing fat and refined carbohydrate intake, and increased aerobic exercise should form the basis of programmes designed for such individuals. A lack of randomized studies in men and couples, and studies evaluating barriers to undertaking weight loss in infertile populations is evident, and future research should examine these issues further.

Does intentional weight loss improve daytime sleepiness? A systematic review and meta-analysis.

Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea-hypopnoea index) and other co-factors (e.g. baseline demographics). Forty-two studies were included in the review. Fifteen before-and-after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of -0.97 (95% confidence interval [CI] -1.21 to -0.72). Twenty-seven studies on non-surgical weight loss interventions showed small-to-moderate improvement in daytime sleepiness, with a standardized effect size of -0.40 (95%CI -0.52 to -0.27), with no difference between controlled and before-and-after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose-response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.

Weight loss and carotid intima-media thickness-a meta-analysis.

Obesity is a risk factor for clinical cardiovascular disease, putatively via increased burden of atherosclerosis. It remains contentious as to whether weight loss in people with obesity is accompanied by a reduction in intima-media thickness, a noninvasive marker of subclinical atherosclerosis, consistent with a lowering of risk of cardiovascular events. A systematic literature search was performed to identify all surgical and nonsurgical weight loss interventions that reported intima-media thickness. A meta-analysis was undertaken to obtain pooled estimates for change in intima-media thickness. From the 3,197 articles screened, 9 studies were included in the meta-analysis, with a total of 393 participants who lost an average of 16 kg (95% CI 9.4-22.5) of body weight over an average follow-up of 20 months. The pooled mean change in carotid intima-media thickness was -0.03 mm (95% CI -0.05 to -0.01), which was similar between surgical and nonsurgical interventions. In people with obesity, weight loss was associated with a reduction in carotid intima-media thickness, consistent with a lowering in risk of cardiovascular events.

Efficacy and Safety of Non-surgical Bariatric Therapies for Non-alcoholic Steatohepatitis and Metabolic Syndrome: A Comparative Meta-Analysis

Introduction: While non-alcoholic steatohepatitis (NASH) and metabolic syndrome (METS) have a multidimensional etiology, weight loss remains at the forefront of current therapies. Recent data suggests that a greater than 10% weight loss is associated with a significant decrease in hepatic steatosis, necroinflammation, and fibrosis. Several non-surgical weight loss interventions have been investigated, but it is unclear whether one is better than the others. The aim of this study was to perform a systematic review and structured meta-analysis to evaluate the comparative effectiveness and safety of non-surgical weight loss therapies. Methods: A comprehensive search of PubMed and EMBASE was performed through November 2015 to identify studies in adults with NASH or METS and minimum one-month follow-up involving nonsurgical bariatric therapies. Interventions included lifestyle modification, Optifast weight loss program, FDA approved weight loss medications (orlistat, lorcaserin, phentermine plus topiramate, naltrexone plus bupropion, and liraglutide), and the OrberaTM intragastric balloon [IGB]). Primary outcome measures were: percent weight loss, early treatment discontinuation, and serious adverse events. A proportion meta-analysis was performed. The individual study proportion was first transformed into a quantity using the Freeman-Tukey variant of the arcsine square root transformed proportion. The pooled proportion was then calculated as the back transform of the weighted mean of the transformed proportion, using inverse arcsine variance weights for the fixed effects model and DerSimonian-Laird weights for the random effects model. Publication bias was evaluated by visual inspection of funnel plots. Results: We analyzed data from 193 studies that met inclusion criteria: 41 studies on lifestyle modification (n=7,612), 7 studies on the Optifast program (n=932), 89 studies on FDA approved weight loss pharmacotherapy (n=31,752), and 56 studies on IGB therapy (n=6,160). Table 1 summarizes the outcomes of all non-surgical weight loss therapies.Table 1: Characteristics and outcomes of all non-surgical weight loss therapies.Conclusion: Only Optifast weight loss program, phentermine plus topiramate, and IGB therapy showed a meaningful ≥10% weight loss associated with potential for NASH fibrosis reversal. IGB therapy was the most effective non-surgical weight loss treatment and is relatively safe. Expanded use of this treatment modality is indicated to combat the rising epidemic of NASH and METS.

Social facilitation maintenance treatment for adults with obesity: study protocol for a randomised-controlled feasibility study (SFM study)

IntroductionThe long-term success of non-surgical weight loss treatment in adults with obesity is limited by substantial relapse, and only a few evidence-based weight loss maintenance treatments exist. This clinical trial...

Abstract 2614: Surgical weight loss via sleeve gastrectomy, but not a low-fat diet, reverses the pro-tumorigenic effects of obesity

Abstract Background: Obesity is associated with increased incidence of basal-like breast cancer (BLBC), the most aggressive and lethal breast cancer subtype. Epidemiological data is conflicting regarding whether weight loss offers protection against BLBC in obese women; only interventions that typically result in significant sustained weight loss, such as bariatric surgery, produce a consistent anti-cancer benefit. Purpose: We sought to determine the differential effects of surgical and non-surgical weight loss interventions on inflammation, metabolic hormones and tumor burden in a mouse model of pre-menopausal breast cancer. Methods: Mice were fed a low fat control or high fat diet-induced obesity (DIO) regimen for 15 weeks to model chronic obesity. Diet-induced obese mice (n = 75) were randomized to receive either a surgical weight loss intervention (sleeve gastrectomy) or dietary weight loss intervention (switch to low fat control diet), resulting in formerly obese (FOb)-Surg or FOb-Diet mice, respectively. Additionally, a subset of mice remained on the DIO diet (Obese, n = 25), with another subset of normoweight control mice (Con, n = 25) maintained on a low fat diet throughout the study. FOb-Surg and FOb-Diet mice lost a nearly identical amount of weight and body fat; both groups had significantly lower weight and percent body fat than Con. Four weeks after weight stabilized, all mice on study were orthotopically injected with E0771 mammary tumor cells, which model BLBC. Results: At study endpoint, the average tumor weight in FOb-Surg mice was statistically equivalent to normoweight control mice. However, the average tumor weight in FOb-Diet mice was significantly greater than controls and statistically equivalent to the Obese mice. Furthermore, FOb-Surg mice had statistically lower levels of serum interleukin-6 and insulin compared to FOb-Diet, suggesting that in obese mice sleeve gastrectomy, relative to diet-induced weight loss, more effectively reduced obesity-associated inflammation, hyperinsulinemia and mammary tumor growth. Conclusion: Our results suggest that the strong anti-cancer benefits seen with bariatric surgery may be related to a significant reduction in systemic inflammation and growth factor signaling, which did not occur with non-surgical weight loss despite an equivalent amount of weight and body fat loss in FOb-Diet mice. Identifying the mechanisms underlying the protective effects of bariatric surgery against breast cancer could help identify new targets and strategies for breaking the obesity-cancer link. Citation Format: Emily L. Rossi, Laura W. Bowers, Subreen A. Khatib, Laura A. Smith, Steven S. Doerstling, Alfor Lewis, Randy J. Seeley, Stephen D. Hursting. Surgical weight loss via sleeve gastrectomy, but not a low-fat diet, reverses the pro-tumorigenic effects of obesity. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2614.

Effects of Surgical vs. Non-Surgical Weight Loss on Mammary Tumor Burden

Abstract Background: Obesity is associated with increased incidence of basal-like breast cancer (BLBC), the most aggressive and lethal breast cancer subtype. Epidemiological data is conflicting on whether weight loss offers protection against BLBC in obese women; only interventions that typically result in significant sustained weight loss, such as bariatric surgery, produce a consistent anti-cancer benefit. Purpose: We sought to determine the differential effects of surgical and non-surgical weight loss interventions on inflammation, metabolic hormones and tumor burden in a mouse model of pre- menopausal breast cancer. Methods: Mice were fed a low fat control (Con) or high fat diet-induced obesity (DIO) regimen for 15 weeks to model chronic obesity. Obese mice were then randomized to continue the DIO diet (Obese) or receive a surgical or diet weight loss intervention, resulting in formerly obese (FOb)-Surg or FOb-Diet, respectively. FOb-Surg mice were subject to sleeve gastrectomy (∼70% of the stomach excised), while FOb-Diet mice received a low fat diet. FOb-Surg and FOb-Diet mice normalized body weight and body fat percentage to levels seen in the Con group. After weights stabilized, all mice were orthotopically injected with E0771 mammary tumor cells, which model BLBC. Results: At study endpoint, the average tumor weight in FOb-Surg mice was statistically equivalent to Con mice that maintained a healthy weight throughout study. However, the average tumor weight in FOb-Diet mice was statistically equivalent to Obese mice, both groups significantly greater than Con mice. Additionally, FOb-Surg had statistically lower serum insulin and interleukin-6 compared to FOb-Diet and Obese mice, suggesting that the sleeve gastrectomy more effectively reduced obesity-associated inflammation. Conclusion: Our results suggest that the anti-cancer benefit seen with bariatric surgery may be related to a significant reduction in systemic inflammation and growth factor signaling, which did not occur with non-surgical weight loss despite an equivalent amount of weight and body fat loss in FOb-Diet mice. Identifying the mechanisms underlying the protective effects of bariatric surgery against breast cancer could help identify new targets and strategies for breaking the obesity-cancer link.

Effect of non-surgical, non-pharmacological weight loss interventions in patients who are obese prior to hip and knee arthroplasty surgery: a rapid review.

BackgroundOf the more than 104,000 Canadians who underwent elective total joint arthroplasty (TJA) surgery in 2012–2013 for hip and knee osteoarthritis (OA), 40 and 60 %, respectively, were obese. Obesity is associated with increased risks for receiving TJA, post-operative complications and delayed functional recovery. Current guidelines for patients with a body mass index (BMI) of ≥30 kg/m2 are to participate in a weight management programme and to lose weight prior to TJA surgery. As part of a larger project, a rapid review was conducted to examine the effects of short-term non-pharmacological and non-surgical weight loss interventions in adults in the year prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA) on surgical and patient outcomes, and adverse events.MethodsWe performed a rapid review and searched seven electronic databases for English language articles published between 1990 and February 2015. Observational studies evaluating the association between pre-operative weight loss and short- and long-term outcomes, and controlled trials of non-pharmacological and non-surgical weight loss interventions were considered for inclusion. Two reviewers independently screened and selected articles, assessed methodological quality and extracted data.ResultsOf 263 articles identified, a total of four studies met our inclusion criteria. In one of two high-quality retrospective cohort studies, weight loss ≥5 % of body weight in the year prior to TJA and maintained in the year after surgery was associated with a higher likelihood of deep surgical site infection in THA patients and 90-day readmission in TKA patients. No significant differences were reported in incidence of superficial surgical site infections in THA or TKA patients who lost weight pre-operatively compared to those who maintained their weight in either study. Two abstracts of randomized controlled trials were included; however, despite contacting the authors, full-length articles were not available. The limited information from the trials suggested that short-term dietician-supervised weight loss interventions were effective in weight loss prior to TJA.ConclusionsThere is limited evidence to support the recommendation of weight loss in the year prior to TJA and to determine the effectiveness of short-term non-pharmacological, non-surgical weight management interventions on patient and surgical outcomes.

Risk of an asthma exacerbation after bariatric surgery in adults

Research on nonsurgical weight loss interventions has failed to demonstrate consistent efficacy on asthma control, although these interventions resulted in only modest weight reductions. We sought to test the hypothesis that bariatric surgery is associated with a rapid and sustained decrease in risk of asthma exacerbation. We performed a self-controlled case series study of 2261 obese patients with asthma aged 18 to 54 years who underwent bariatric surgery using the population-based emergency department (ED) and inpatient sample in 3 states (California, Florida, and Nebraska). The primary outcome was an ED visit or hospitalization for asthma exacerbation from 2005 through 2011. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods using presurgery months 13 to 24 as the reference period. During the reference period, 22.0% (95% CI, 20.3% to 23.7%) of patients had an ED visit or hospitalization for asthma exacerbation. In the subsequent 12-month presurgery period, the risk did not materially change (21.7%; 95% CI, 20.0% to 23.4%), with an odds ratio (OR) of 0.98 (95% CI, 0.85-1.13) compared with the reference period. By contrast, significantly fewer ED visits or hospitalizations for asthma exacerbation occurred within 12 months after bariatric surgery (10.9%; 95% CI, 9.6% to 12.2%), corresponding to an OR of 0.42 (95% CI, 0.35-0.50). Similarly, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly lower (10.9%; 95% CI, 9.6% to 12.2%), corresponding to an OR of 0.42 (95% CI, 0.35-0.50). In obese patients the risk of an ED visit or hospitalization for asthma exacerbation decreased by half after bariatric surgery. This reduction suggests the effectiveness of significant weight loss on asthma morbidity.

Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses.

Obstructive sleep apnoea (OSA) is a well-recognised complication of obesity. Non-surgical weight loss (medical, behavioural and lifestyle interventions) may improve OSA outcomes, although long-term weight control remains challenging. Bariatric surgery offers a successful strategy for long-term weight loss and symptom resolution. To comparatively appraise bariatric surgery vs. non-surgical weight loss interventions in OSA treatment utilising body mass index (BMI) and apnoea-hypopnoea index (AHI) as objective measures of weight loss and apnoea severity. A systematic literature review revealed 19 surgical (n = 525) and 20 non-surgical (n = 825) studies reporting the primary endpoints of BMI and AHI before and after intervention. Data were meta-analysed using random effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m(2) weighted decrease in BMI (95%CI [11.91, 16.44]), with a 29/h weighted decrease in AHI (95%CI [22.41, 36.74]). Non-surgical patients had a mean pre-intervention BMI of 38.3 and achieved a significant weighted decrease in BMI of 3.1 kg/m(2) (95%CI [2.42, 3.79]), with a weighted decrease in AHI of 11/h (95%CI [7.81, 14.98]). Heterogeneity was high across all outcomes. Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction. However, bariatric surgery may offer markedly greater improvement in BMI and AHI than non-surgical alternatives. Future studies must address the lack of randomised controlled and comparative trials in order to confirm the exact relationship between metabolic surgery and non-surgical weight loss interventions in OSA resolution.

The effect of non‐surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta‐analysis

Although the aetiology of urinary incontinence can be multifactorial, in some cases weight loss could be considered as a part of the therapeutic approach for urinary incontinence in people who are overweight. The objective of this study was to review and meta-analyse the effect of non-surgical weight loss interventions on urinary incontinence in overweight women. Web of Science, PubMed, Pedro, SPORTDiscus and Cochrane were systematically searched for clinical trials that met the a priori set criteria. Data of women who participated in non-surgical weight loss interventions (diet, exercise, medication or a combination) were included in the meta-analysis. After removing duplicates, 62 articles remained for screening on title, abstract and full text. Six articles (totalling 2,352 subjects in the intervention groups) were included for meta-analysis. The mean change in urinary incontinence (reported as frequency or quantity, depending on the study) after a non-surgical weight loss intervention, expressed as standardized effect size and corrected for small sample sizes (Hedges' g), was -0.30 (95%CI = -0.47 to -0.12). This systematic review and meta-analysis shows evidence that a non-surgical weight loss intervention has the potential to improve urinary incontinence and should be considered part of standard practice in the management of urinary incontinence in overweight women.

Oesophageal function in morbidly obese adolescents after gastric banding

Bariatric surgery is the most effective treatment to induce significant and sustained weight loss in morbidly obese subjects. However, there is emerging evidence that bariatric, particularly malabsorptive (Roux-en-Y bypass; RYGB) surgery, may reduce bone mineral density (BMD). Whether such effects differ by procedure or are due to the amount of weight loss per se is unknown. We compared the effects of ∼20% weight loss induced by RYGB, sleeve gastrectomy (SG) or gastric band (Band) on lumbar spine and femur BMD in women. Twenty-two morbidly obese women (BMI = 41.8± 7.4 kg/m2; Age = 46.6± 12.3 y) underwent RYGB (n = 6), SG (n = 9) or Band (n = 7). The groups were similar in age and BMI. Lumbar spine and femur BMD (DXA, Lunar) were measured at baseline, 6 and 18 months. Mixed model analyses were performed to examine the effects of time and surgery group on BMD. Body weight loss was 33.6± 1.7, 34.5± 7.3 and 18.3± 6.3% eighteen months after RYGB, SG and Band, respectively. Mixed modelling analyses revealed a significant effect of time (P = 0.006), but not surgery group, on Femur BMD (Baseline = 1.10± 0.02; 6 months = 1.08± 0.02; 18 months = 1.01± 0.03 g/cm2). There were no significant effects of time or surgery group on lumbar BMD. Next, we matched for equivalent weight loss in the 3 surgery groups. Women in the RYGB, SG and Band groups lost 18.1± 3.9, 17.4± 5.2 and 18.1± 5.5% of their body weight by 14± 3, 14± 3 and 72± 4 weeks after surgery, respectively. After equivalent weight loss, there were no differences in Lumbar or Femur BMD between the 3 surgery groups. In conclusion, we observed 9% decrease in femur bone mineral density 18 months after bariatric surgery. Further studies comparing the effects of surgical and non-surgical weight loss interventions on bone density are required.

Mechanisms underlying weight loss after bariatric surgery

The clinical efficacy of bariatric surgery has encouraged the scientific investigation of the gut as a major endocrine organ. Manipulation of gastrointestinal anatomy through surgery has been shown to profoundly affect the physiological and metabolic processes that control body weight and glycaemia. The most popular bariatric surgical procedures are gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy. Even though these procedures were designed with the aim of causing restriction of food intake and nutrient malabsorption, evidence suggests that their contributions to weight loss are minimal. Instead, these interventions reduce body weight by decreasing hunger, increasing satiation during a meal, changing food preferences and energy expenditure. In this Review, we have explored these mechanisms as well as their mediators. The hope is that that their in-depth investigation will enable the optimization and individualization of surgical techniques, the development of equally effective but safer nonsurgical weight-loss interventions, and even the understanding of the pathophysiology of obesity itself.

Screening for and Management of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for obesity and overweight in adults. The USPSTF reviewed new evidence on the benefits and harms of screening and primary care–feasible or referable nonsurgical weight-loss interventions. The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index of 30 kg/m(2) or higher to intensive, multicomponent behavioral interventions (B recommendation).

Weight loss: a neglected intervention in the management of chronic kidney disease

Obesity is being increasingly implicated as an independent risk factor for the development of chronic kidney disease (CKD), raising the question whether reversing obesity can be utilized as a mainstay or an adjunct therapy for CKD and possibly for its prevention. The purpose of this review is to examine the impact of treatment of obesity on renal outcomes. Many observations have pointed to improvement in renal parameters following weight loss. In fact, both surgical and nonsurgical approaches appear to be effective at reducing blood pressure and proteinuria. Weight loss has also been shown to lower glomerular filtration rate (GFR) in obese patients, not an insignificant benefit considering that intra-glomerular hypertension and the subsequent hyperfiltration in the setting of obesity might be a main driver for the development of CKD. Urinary protein excretion, blood pressure, and GFR improve with surgical and nonsurgical weight loss interventions. Whether improvements in these surrogate outcomes after weight loss actually translate into a reduction in the risk of CKD or amelioration in the rate of progression of established CKD is yet to be determined.

Effectiveness of long-term (twelve months) nonsurgical weight loss interventions for obese women with polycystic ovary syndrome: a systematic review

Polycystic ovary syndrome (PCOS) affects 2%–26% of women of reproductive age and is often accompanied by obesity. Modest weight loss reduces health risks and ameliorates effects of the syndrome. Weight loss interventions are mainly of short duration and have limited success. A systematic review of the literature was carried out to assess the efficacy of long-term (12 months), nonsurgical weight loss interventions for women with PCOS. Fifteen databases were searched, resulting in eight papers that met the search criteria. Comparison of results and meta-analysis was difficult due to heterogeneity of studies. Behavioral components of interventions were poorly described, and compliance was difficult to ascertain. The results suggested that the inclusion of a lifestyle component improves outcomes, but protocols must be clearly described to maintain study validity and to identify successful behavioral strategies.

Influence of depressive and eating disorders on short- and long-term course of weight after surgical and nonsurgical weight loss treatment

Objective To investigate the influence of depressive and eating disorders on short- and long-term weight loss after surgical and non-surgical weight-reduction treatment. Covariations between the disorders were considered. Method In a longitudinal naturalistic study, current diagnoses at baseline and lifetime diagnoses of depressive and eating disorders were assessed in participants who were undertaking a very-low-calorie diet (n = 250) and in bariatric surgery patients (n = 153). Lifetime diagnosis of a mental disorder was defined as presence of a mental disorder only in the past. Body weight was measured at baseline, 1 year after baseline, and 4 years after baseline. Mental comorbidity was assessed through use of standardized interviews at baseline. A structural equation modeling procedure was applied to test the associations between course of weight and mental disorders. Analyses were based on the intention to treat samples. Missing values were replaced by use of multiple imputation procedures. Results Neither depression nor eating disorders were associated with weight changes at the 1-year follow-up, but a specific effect emerged for bariatric surgery patients after 4 years: depression (current and lifetime) predicted smaller body mass index loss, whereas lifetime diagnosis of eating disorder was associated with greater weight loss. Conclusions Individuals who report depressive disorders prior to bariatric surgery should be monitored more closely in order to identify patients who would benefit from additional therapy with the goal of improving weight-loss outcome.

Weight Loss Interventions in Chronic Kidney Disease

Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration. We searched MEDLINE, SCOPUS, and conference proceedings for randomized, controlled trials and observational studies that examined various surgical and nonsurgical interventions (diet, exercise, and/or antiobesity agents) in adult patients with CKD. Results were summarized using random-effects model. Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] -3.67 kg/m(2); 95% confidence interval [CI] -6.56 to -0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD -1.31 g/24 h; 95% CI -2.11 to -0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. In morbidly obese individuals (BMI >40 kg/m(2)) with glomerular hyperfiltration (GFR >125 ml/min), surgical interventions decreased BMI, which resulted in a decrease in GFR (WMD -25.56 ml/min; 95% CI -36.23 to -14.89), albuminuria, and systolic BP. In smaller, short-duration studies in patients with CKD, nonsurgical weight loss interventions reduce proteinuria and BP and seem to prevent further decline in renal function. In morbidly obese individuals with glomerular hyperfiltration, surgical interventions normalize GFR and reduce BP and microalbuminuria. Larger, long-term studies to analyze renal outcomes such as development of ESRD are needed.

A Comparison of Eating Disorders among Patients Receiving Surgical vs Non-surgical Weight-loss Treatments

Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients. Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n = 54) or non-surgical (n = 46) WLT. Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment. Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.

Assessment and Preparation of Patients for Bariatric Surgery

The number of bariatric surgical procedures performed in the United States has increased steadily during the past decade. Currently accepted criteria for consideration of bariatric surgery include a body mass index (calculated as weight in kilograms divided by the square of height in meters) of 40 kg/m2 or greater (or >35 kg/m2 with obesity-related comorbidities), documented or high probability of failure of nonsurgical weight loss treatments, and assurance that the patient is well informed, motivated, and compliant. Appropriate patient selection is important in achieving optimal outcomes after bariatric surgery. In this article, we review our approach to the medical and psychological assessment of patients who want to undergo bariatric surgery. The medical evaluation is designed to identify and optimally treat medical comorbidities that may affect perioperative risks and long-term outcomes. The psychiatric and psychological assessment identifies factors that may influence long-term success in maintaining weight loss and prepares the patient for the lifestyle changes needed both before and after surgery.