Obesity-related Comorbidities Research Articles

A year of public laparoscopic sleeve gastrectomy

Bariatric surgery is becoming increasingly prominent in Australia, however over 90% is still performed in the private sector. We examined the outcomes of the first year of our publicly funded bariatric surgery program, which includes regular review in a metabolic clinic by an Endocrinologist and Allied Health. The characteristics and outcomes of 22 consecutive patients who underwent publicly funded Laparoscopic Sleeve Gastrectomy with a single surgeon at a South-West Sydney public hospital between March 2023 and May 2024 were retrospectively collected. Data on patient characteristics, operative details and post-operative outcomes was collected and analysed. The majority of patients were women (77%), with a mean age of 48±10.6. Mean initial weight at program commencement was 136.7±25.7 kg, and mean BMI 49±6 kg/m2. All patients had >2 obesity related comorbidities; 45% were diabetic. There were no complications or re-admissions. At 6 months post-op, mean weight loss from baseline weight was 34.3±17 kg, with mean TBWL 24.8% ± 9.6% and EBWL 52%±17.7%. For patients with 12 month follow up data, mean weight loss was 46.6 kg±27.9, with mean TBWL of 33%±14% and EBWL of 68 %±23%. Our first year of public Laparoscopic Sleeve Gastrectomy, in conjunction with a comprehensive metabolic program, has been shown to be safe and effective, with preliminary data demonstrating outcomes equivalent to those previously published.

Risk Factors for Metabolic Disease in Veterans

This cross-sectional study uses data from the Veterans Health Administration’s Corporate Data Warehouse to identify individuals whose risk for obesity-related metabolic comorbidity may be misclassified by standard body mass index (BMI) thresholds.

PHYSICAL REHABILITATION FOR YOUNG MEN WITH GRADE I AND II OBESITY

The goal of this study is to study the role of exercise and dietary modification in the treatment of obesity in young men. Materials and methods. A study was conducted with 10 young men aged 25 to 30 who had a body mass index (BMI) exceeding 30 kg/m², indicative of obesity. The primary intervention combined diet therapy with increased physical activity. Most participants also had obesity-related comorbidities, including arterial hypertension, autonomic-vascular dystonia, type II diabetes, and spinal osteochondrosis. Patient motivation was considered crucial in program development, and thus only individuals with a high motivation level were selected for participation. Results and discussion. Based on data from dynamic observations, we can state that the physical therapy program studied has a positive effect on body weight reduction in cases of mild forms of alimentary obesity. After three months of participation, an average weight loss of 8.5% was observed, which represents a very favorable outcome. The results indicate that physical exercises combined with dietary adjustments positively influence weight loss dynamics in young men with grade 1 alimentary obesity. Weight loss occurred most rapidly during the first month of the program. Conclusion. The physical therapy program for grade 1 obesity involves a comprehensive approach, combining physical exercises conducted in a medical rehabilitation department with a specially designed dietary plan. This program is recommended for individuals with mild forms of alimentary obesity and a body mass index (BMI) up to 35 kg/m². After three months of implementing this approach, participants showed an average reduction in excess body weight of 8.5%. This physical therapy program may be effectively used for managing grade I obesity.

Improving obesity management: Insights from the ACTION Switzerland survey of people with obesity, physicians and dietitians.

ACTION Switzerland (NCT05232786) examined obesity-related perceptions, attitudes, behaviours and potential barriers to treatment among people with obesity (PwO) and healthcare professionals (HCPs). In March/April 2022, adult PwO (body mass index ≥30 kg/m2, per self-reported height/weight) and physicians/certified dietitians who manage PwO in Switzerland completed online surveys in a cross-sectional design. Overall, 1002 PwO, 125 physicians and 25 dietitians completed the survey. Most physicians (97%) and dietitians (100%), but only 57% of PwO, recognized obesity as a chronic disease. Only 42% of PwO considered themselves to have obesity/extreme obesity, while 61% who had discussed weight with an HCP reported receiving an obesity diagnosis. Many PwO (76%) believed weight loss was entirely their responsibility; physicians were less likely than dietitians to agree it was completely their patients' responsibility (28% vs. 68%). Physicians and dietitians report primarily initiating conversations about weight when patients have obesity-related comorbidities (85% and 64%); their top reasons for not discussing obesity were patients' perceived lack of motivation (76% and 60%) or interest (72% and 64%) in losing weight. In conclusion, some PwO are not aware that obesity is a chronic disease and incorrectly assume complete responsibility for weight loss. Improved communication between PwO and HCPs is required.

Safety and Effectiveness of Naltrexone-Bupropion in Korean Adults with Obesity: Post-Marketing Surveillance Study.

To investigate the safety and effectiveness of naltrexone-bupropion in Korean adults with obesity. This was a prospective, observational multicenter study from April 29, 2016, to April 28, 2022. Individuals with obesity with a body mass index of ≥30 kg/m2 or ≥27 kg/m2 who had obesity-related comorbidities were included. The naltrexone-bupropion dose was gradually titrated weekly from 8/90 to 32/360 mg and maintained at the maximum tolerated dose. In total, 612 and 300 individuals were evaluated for safety and effectiveness, respectively. In total, 41.34% individuals reported drug-related adverse reactions, such as nausea (19.12%), headache (7.68%), and dizziness (5.23%). Older age and comorbidities were significantly associated with adverse events. At 12weeks after reaching the maintenance dose, naltrexone-bupropion 32/360 mg resulted in the greatest weight reduction (-7.21%) compared with other doses, which persisted at week 24 (-7.69%). The naltrexone-bupropion 16/180 mg resulted in significant weight reduction, achieving -5.99% and -9.18% reductions at weeks 12 and 24, similar to that with naltrexone-bupropion 32/360 mg. Young age and no comorbidities were significantly associated >5% weight reduction. Naltrexone-bupropion demonstrated marked stability and weight loss effectiveness, particularly in young individuals with obesity without comorbidities. Therefore, individualized treatment is necessary when prescribing naltrexone-bupropion.

IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management.

Obesity is a significant global health issue. Metabolic and bariatric surgery (MBS) is the gold standard in the treatment of obesity due to its proven effectiveness and safety in the short and long term. However, MBS is not suitable for all patients. Some individuals are at high surgical risk or refuse surgical treatment, while others do not meet the criteria for MBS despite having obesity-related comorbidities. This gap has driven the development of endoscopic solutions like endoscopic sleeve gastroplasty (ESG), which offers a less invasive alternative that preserves organ function and reduces risks. A recent IFSO International Delphi consensus study highlighted that multidisciplinary experts agree on the utility of ESG for managing obesity in patients with class I and II obesity and for those with class III obesity who do not wish to pursue or qualify for MBS. This IFSO Bariatric Endoscopy Committee position statement aims to augment these consensus statements by providing a comprehensive systematic review of the evidence and delivering an evidence-based position on the value of ESG within the spectrum of obesity management. A comprehensive systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Systematic Review: The systematic review included 44 articles encompassing 15,714 patients receiving ESG. The studies varied from large case series to cohort studies and a randomized controlled trial (RCT). The mean baseline BMI was 37.56kg/m2. The review focused on weight loss outcomes and safety data. Time point Mean %EWL Mean %TBWL 6months 48.04 15.66 12months 53.09 17.56 18months 57.98 16.25 24months 46.57 15.2 36months 53.18 14.07 60months 45.3 15.9 These results demonstrate significant weight loss following ESG. The pooled serious adverse event (SAE) rate was 1.25%. This low rate of SAEs indicates that ESG is a relatively safe procedure. The quality of evidence from the included observational studies was assessed as very low, primarily due to the inherent limitations associated with observational study designs, such as potential biases and lack of randomization. In contrast, the quality of evidence from the single randomized controlled trial was rated as MODERATE, reflecting a more robust study design that provides a higher level of evidence despite some limitations. The IFSO Bariatric Endoscopy Committee, after conducting a comprehensive systematic review and meta-analysis, endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. ESG provides significant weight loss outcomes and demonstrates a favorable safety profile with a low rate of serious adverse events. Despite the limitations of the included observational studies, the randomized controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement. Thus, the IFSO position statement supports and provides an evidence base for the role of ESG within the broader spectrum of obesity management.

Systematic Review and Meta-analysis of the Impact of Metabolic Surgery on Hepatic Stiffness.

Bariatric surgery is one of the effective therapeutic options for people with obesity and obesity-related co-morbidities. In addition to weight-related co-morbid diseases, including diabetes, hypertension, and hypercholesterolemia, non-alcoholic fatty liver disease (NAFLD) is common in patients with morbid obesity. Bariatric surgery is one of the therapeutic options in the management of NAFLD. Hence, this review focused on the potential role of bariatric surgery on hepatic elasticity measured through shear wave elastography. A systematic literature search was performed, and the studies regarding heterogeneity were evaluated using the random-effects model. The meta-analysis on 6 trials (3-12 months follow-up) including 350 participants showed a significant reduction of liver elasticity after surgery (WMD: -1.149, 95% CI: -1.767, -0.532, p < 0.001; I2:81.55%). Bariatric surgery is associated with decreased liver elasticity. This improvement could be related to weight loss or other mechanisms of bariatric surgery.

Epidemiology and Trends of Obesity and Bariatric Surgery in Korea.

The prevalence of obesity in Korea has steadily increased over the past decade, reaching 38.4% in 2021. Notably, the rate of class II- III obesity, defined as a body mass index (BMI) of 30 kg/m2 or higher, exceeded 7% in the same year. Since January 2019, the National Health Insurance Service (NHIS) has provided coverage for bariatric surgery (BS) for eligible patients. Coverage is available for individuals with a BMI of 35 kg/m2 or higher, or those with a BMI of 30 kg/m2 or higher who also have obesity-related comorbidities. Additionally, partial reimbursement is offered for BS in patients with type 2 diabetes mellitus who have BMI values between 27.5 and 30 kg/m2. From 2019 to 2022, the NHIS recorded 9,080 BS procedures, with sleeve gastrectomy being the most commonly performed. The average percentage of weight loss 198±99.7 days post-surgery was 17.9%, with 80.0% of patients losing more than 10% of their body weight. This article presents the trends in obesity and BS in Korea.

Laparoscopic Roux-en-Y gastric bypass versus single anastomosis sleeve ileal bypass for the treatment of morbidly obese patients: a prospective randomized comparative study

Background: Bariatric surgery has proven to be the most effective long-term treatment of morbid obesity, after bariatric surgery, weight loss and remission of obesity-related comorbidities is significantly higher than after non-surgical measures. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, remission of comorbidities, complications, and nutritional status. Methods: This prospective randomized comparative study was carried out at gastrointestinal and laparoscopic surgery unit, General Surgery Department, Tanta University Hospitals, during the period from October 2020 to October 2022 and included 40 morbidly obese patients who accepted to participate in the study and signed an informed consent. Patients were randomly assigned into 2 equal groups by the closed envelope method, group I: were submitted to laparoscopic RYGB, group II: were submitted to laparoscopic SASI bypass. Results: The mean age of RYGB group was 39.20±6.56 years, compared to 34.75±7.91 in SASI group. A highly statistically significant difference was present in operative time between both groups; RYGB Group had operative time mean of 194.25±27.11 minutes, compared to 153.15±23.74 minutes in SASI group. Both procedures were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. Conclusions: RYGB and SASI bypass cause weight loss by both restriction and malabsorption mechanisms. Early results with the two procedures are encouraging with acceptable weight loss, comorbidity improvement rates with disadvantages as malnutrition, biliary reflux and dumping, yet the risk of malnutrition was more likely after SASI bypass.

Effects of a multidisciplinary program with physical exercise in pediatric obesity

Abstract Background Childhood obesity is a growing public health concern worldwide, with prevalence rates increasing in recent decades. This epidemic not only predisposes children to immediate health risks such as cardiovascular disease and musculoskeletal problems but also significantly increases their risk of obesity-related comorbidities in adulthood. Recognizing the multifactorial nature of pediatric obesity, interventions targeting lifestyle modifications are crucial to its control. Among these interventions, physical exercise emerges as a cornerstone in combating pediatric obesity. Purpose Our study examines the effectiveness of a twelve-week online physical exercise program on body composition and functional capacity in children and adolescents with obesity. Methods The sample consists of 30 participants (9 girls and 21 boys, aged 11-17 y) from the Pediatrics Department of Senhora da Oliveira Hospital in Guimarães (HSOG). Using standardized protocols, anthropometric measures (body weight and waist circumference) were measured. Functional capacity was assessed through squats, push-ups, and elbow plank tests (maximum repetitions in 60 seconds). All analyses were done using SPSS software, and the alpha level was 5%. Results Significant impacts of the exercise program were observed in body weight and waist circumference variables. Multivariate tests indicated a statistically significant interaction between the Moment*Groups factors (weight p = 0.040; waist circumference p = 0.007). Moreover, functional capacity was also influenced by the exercise program (squat p = 0.034; push-ups p = 0.013; and elbow plank p = 0.025). Conclusions Our results underscore the significant public health impact of integrating physical exercise into a multidisciplinary program for pediatric obesity. Innovative use of online interventions facilitated broader reach and accessibility, resulting in measurable improvements in body weight, waist circumference, and functional capacity among participants. Key messages • Integrating exercise into multidisciplinary programs improves pediatric obesity outcomes. • Online interventions broaden accessibility and effectiveness in preventing childhood obesity.

Narrative Review of Lifestyle Interventions in Breast Cancer Survivors: Current Evidence and Future Directions.

One in eight females will be diagnosed with breast cancer in their lifetime. While medical advances have increased the likelihood of survival, up to 90% of females will gain weight during and after treatment increasing the risk of breast cancer recurrence and obesity related co-morbidities in survivorship. Behavioral lifestyle interventions focused on diet with or without physical activity can provide breast cancer survivors non-pharmacological options to decrease weight gain and cardiometabolic risk. A PubMed search was conducted to identify all behavioral lifestyle interventions focused on diet or diet combined with physical activity longer than 4 weeks of duration in breast cancer survivors that included body weight as an outcome. This review aims to summarize the effects on body weight, body composition and cardiometabolic risk markers are summarized. Based on the review, there is high heterogeneity in type and duration of the intervention to affect weight and cardiometabolic risk in survivorship. Calorie restriction with and without physical activity appears to promote weight loss among breast cancer survivors. However, the effects on cardiometabolic factors are less clear. Future studies should be powered for both body weight and cardiometabolic effects. Researchers should also consider interventions that are: 1) less complex, 2) recruit a more racially and ethnically diverse sample, 3) integrate resistance training, 4) implement the intervention in closer proximity to diagnosis, 5) target weight management in this population before it occurs and 6) analyze body composition in addition to body weight measurements.

SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m2), metabolic bariatric surgery can be a valid therapeutic option. Many different types of surgical procedures have been developed in last decades, mainly performed via laparoscopic approaches. However, clinical indications for metabolic and bariatric surgery (MBS) and the choice of the most appropriate type of procedure have not been clarified so far.The Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to design and develop the updated version of the Italian guidelines aimed at assisting healthcare professionals in the choice of the surgical option for the treatment of obesity and related conditions. Between June and October 2022, a panel of 24 experts and an evidence review team (ERT, 10 members), participated in the definition of clinical questions, outcomes, and recommendations and collected and analyzed all the available evidence on the basis of pre-specified search strategies. GRADE methodology and PICO (Patient, Intervention, Comparison, Outcome) conceptual framework have been adopted for the development of the present guidelines. Aim of the present guideline is to verify indications to surgery with respect to the presence of comorbid conditions, evaluate the different types of surgical approaches and endoscopic bariatric procedure and revise indication to revision surgery and postoperative procedures.

Recorded diagnosis of overweight/obesity in primary care is linked to obesity care performance rates.

Periodical BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. The aim was to evaluate among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care. The electronic database of the largest health maintenance organization in Israel was searched for all patients aged 2-18 years with BMI recorded at a visit with the PCP during 2017-2023. Among children with BMI percentiles consistent with overweight/obesity, performance rates of obesity care were compared between those with a recorded diagnosis of "overweight"/"obesity" placed by the PCP, and those with similar BMI percentiles without these recorded diagnoses. Among children with versus without recorded diagnoses of overweight/ obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, of performing subsequent BMI measurements, and of prescribing anti-obesity medications (p < 0.001 for all). Obesity-related comorbidities were more prevalent among those with than without recorded diagnoses (P < 0.001). Beyond BMI measurement, a recorded diagnosis of overweight/obesity by a PCP is linked to higher rates of obesity care performance and interventions, which may improve clinical outcomes. BMI measurement during visits with primary care pediatricians (PCP) can be central to diagnosing, managing, and treating overweight/obesity. We evaluated among children and adolescents with similar BMI percentiles, whether recording a formal diagnosis by PCP, of overweight/obesity is associated with improved performance rates of obesity-related care. We found that among children with versus without recorded diagnoses of overweight/obesity, rates were higher of referrals for screening measurements for obesity-related comorbidities, for dietitian and endocrine counseling, and of prescribing anti-obesity medications. Therefore, PCP should increase rates of recording diagnoses of overweight/obesity, to promote screening for obesity-related comorbidities, and aim to treat obesity as a chronic disease.

8731 Glucose homeostasis remains normal across a range of adiposity in fit men and women

Abstract Disclosure: A.W. Potter: None. G.C. Chin: None. J.I. Jacques: None. L.J. Nindl: None. D.P. Looney: None. W.J. Tharion: None. C.L. Chapman: None. E.N. Halford: None. K.E. Friedl: None. Introduction. Glucose dysregulation is a major obesity-related comorbidity, affecting mental and physical performance. Glycated hemoglobin (HbA1c) is a validated and stable biomarker representing glucose regulation over 2-3 months. Nearly half of American adults (41%) have elevated HbA1c concentrations representing prediabetes (≥5.7%). In a large cross-sectional sampling of the American population, HbA1c becomes elevated in 33% of individuals at &amp;gt;24% body fat (BF) (men) and &amp;gt;38%BF (women). However, daily physical activity is an important moderator of metabolic health and adiposity - the “fit fat” concept. We evaluated this effect in physically active men and women. Methods. Body composition and metabolic health data were obtained from 36,392 adults (18,130 men and 18,262 women) in the National Health and Nutrition Examination Survey (NHANES) from 1999-2018, for comparison of %BF and HbA1c relationships. Body composition and HbA1c data were obtained from 220 healthy and physically fit active-duty military men and women (188 men, mean ± SD (range): age 25.7 ± 5.9 (18-53) years; height 176.3 ± 7.7 (154.0-201.1) cm; body mass 85.3 ± 11.9 (55.7-134.7) kg, maximal oxygen uptake (VO2max) 49.1 ± 11.9 (33.8-62.5) ml/kg/min; 32 women, age 26.5 ± 7.0 (19-45) years; height 161.4 ± 5.9 (147.1-172.8) cm; body mass 63.9 ± 8.3 (46.7-86.6) kg, VO2max 42.5 ± 8.3 (29.1-52.6) ml/kg/min). Body composition was measured using DXA (iDXA, General Electric Healthcare, Madison, WI) and HbA1c was measured from capillary blood samples using a validated point-of-care analyzer (DCA Vantage Analyzer, Siemens Medical Solutions USA, Inc, Malvern, PA). Results. HbA1c remained within the normal range (&amp;lt;5.7%) for 98% (216/220) of a relatively wide range of %BF in a group of men (9-36%) and women (21-46%) who engaged in daily physical activity. This sample included 64 men (34%) and 4 women (12.5%) that exceeded the 24 and 38%BF thresholds where clinically high HbA1c concentrations have been observed in the civilian population. From this subset, none of the assessed women had HbA1c ≥5.7%. Three men had HbA1c 5.7-5.8% and also high measured physical fitness (VO2max, 50.1-62.5 ml/kg/min) and low %BF (15-17%); while one had lower physical fitness (VO2max 43.87 ml/kg/min) and higher body fat (26%) (HbA1c 6%). Conclusion. Glucose homeostasis remains within normal values across a range of adiposity in fit men and women. These data support the importance of daily physical activity in mitigating elevations in HbA1c, even in individuals with increased relative body fat. Physical activity appears to have a protective effect for metabolism. Presentation: 6/3/2024

Matched Comparison Examining the Effect of Obesity on Clinical, Economic, and Humanistic Outcomes in Patients with BipolarI Disorder.

BipolarI disorder (BD-I) is associated with an increased risk of obesity, but few studies have evaluated the real-world clinical, humanistic, and economic effects associated with obesity in people with BD-I. This was a retrospective, cross-sectional analysis of responses to the 2016 and 2020 National Health and Wellness surveys. Respondents (18-64years) with a self-reported physician diagnosis of BD-I were matched to controls without BD-I based on demographic and health characteristics. Respondents were categorized by body mass index as underweight/normal weight (< 25kg/m2), overweight (25 to < 30kg/m2), or obese (≥ 30kg/m2). Multivariable regression models were used to compare obesity-related comorbidities, healthcare resource utilization (HCRU), health-related quality of life (HRQoL), work productivity, and indirect and direct costs. Before matching, the BD-I cohort was younger than the non-BD-I cohort and included more female and white respondents and a greater proportion covered by Medicaid or Medicare. After matching, the BD-I and non-BD-I cohorts had similar characteristics. A total of 5418 respondents (BD-I, n = 1806; matched controls, n = 3612) were analyzed. Obese respondents with BD-I reported the highest adjusted prevalences of high blood pressure (50%), high cholesterol (35%), sleep apnea (27%), osteoarthritis (17%), type2 diabetes (12%), and liver disease (4%). Obesity in respondents with BD-I was associated with the lowest HRQoL scores. Measures of work impairment were highest in respondents with BD-I and obesity, as was HCRU. Respondents with BD-I and obesity had the highest associated total indirect and direct medical costs ($25,849 and $44,482, respectively). Obese respondents with BD-I had greater frequencies of obesity-related comorbidities, higher HCRU, lower HRQoL, greater work impairments, and higher indirect and direct medical costs. These findings highlight the real-world burden of obesity in people with BD-I and the importance of considering treatments that may reduce this burden.

S2115 The Effects of Endoscopic Gastric Remodeling on Obesity-Related Comorbidities: A Systematic Review and Meta-Analysis

S2115 The Effects of Endoscopic Gastric Remodeling on Obesity-Related Comorbidities: A Systematic Review and Meta-Analysis

"Metabolic Bridge Therapy Prior to Microvascular Breast Reconstruction in the Morbidly Obese: A Proof-of-Concept Risk Analysis".

Obese patients experience more complications after autologous breast reconstruction. This study evaluates how bariatric surgery modulates risk of complications in the setting of microvascular breast reconstruction. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) databases were queried for patients with body mass index (BMI) ≥35 kg/m2 undergoing bariatric surgery from 2017-2022. Outcomes included BMI and obesity-related comorbidities before and 1 year after bariatric surgery. Paired Breast Reconstruction Risk Assessment (BRA) scores were analyzed to evaluate risk modulation before and after bariatric surgery in the setting of microvascular breast reconstruction. A total of 1,026 patients were included with an average age of 47 and BMI of 44.7 kg/m2. Comorbidities included hypertension (601, 59%), type 2 diabetes (291, 28%), and cardiovascular disease (10, 1%). One-year outcomes after bariatric surgery included an average BMI of 32.7 kg/m2, with remission of type 2 diabetes in 29% of patients. Paired BRA risk analysis for microvascular breast reconstruction before and after bariatric surgery showed reduction in 30-day surgical complications (40.4% vs. 24.8%, P<0.0001), with an absolute risk reduction (ARR) of 15%, relative risk reduction (RRR) of 36%, and a number needed to treat (NNT) of 7. Each 1 kg/m2 reduction in preoperative BMI was associated with a 3.4% reduction in surgical complications (P<0.0001). There is potential efficacy for metabolic bridge therapy in reducing complications for obese patients undergoing microvascular breast reconstruction.

Relationships Between Hepatic Steatosis and Frailty Differ by HIV Serostatus.

Frailty is associated with obesity-related comorbidities, but the relationship with nonalcoholic fatty liver disease (NAFLD) in people with HIV has been incompletely described. Our objective was to assess the associations between NAFLD and frailty. Cross-sectional and longitudinal analysis of men in the Multicenter AIDS Cohort Study. NAFLD was defined as a liver/spleen ratio <1.0 on abdominal computed tomography scans; frailty was defined by the frailty phenotype as having 3 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Men without (n = 200) and with HIV (n = 292) were included. NAFLD prevalence was 21% vs 16% and frailty 12% vs 17%, respectively. Among men with NAFLD, frailty was more prevalent in men without HIV (21% vs 11%). In multivariate analysis, NAFLD was significantly associated with frailty after controlling for significant variables. Men without HIV and NAFLD had 2.6 times higher probability [95% confidence interval (CI): 1.2- to 5.7] of frailty relative to men with neither HIV nor NAFLD. This association was not seen in men with HIV. The probability of frailty was higher among men without HIV with NAFLD (27% vs 10% in men without NAFLD) but lower among men with HIV with NAFLD (14% vs 19% in men without NAFLD). No significant relationships were found in longitudinal analyses. NAFLD was independently associated with frailty among men without HIV but not men with HIV, despite increased prevalence of frailty among men with HIV. The mechanisms of the muscle-liver-adipose tissue axis underlying NAFLD might differ by HIV serostatus.

Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery

BackgroundIn the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery. MethodsSubgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with >80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA). ResultsFollowing three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care. ConclusionAs a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.

Nissen sleeve gastrectomy: 5-year follow-up results

BackgroundNissen sleeve gastrectomy is a new bariatric procedurebased on the combination of two well-known surgical techniques (vertical sleeve gastrectomy and Nissen fundoplication). It was conceived as a means of preventing the major drawback of the sleeve gastrectomy (SG), the gastroesophageal reflux disease (GERD), while preserving the advantages of SG in terms of weight loss and remission of obesity-related comorbidities. ObjectivesThe objectives of this study are to present the long-term (5 years) follow-up results on weight loss, evolution of GERD and other comorbidities and the complication rate of the Nissen sleeve gastrectomy. SettingMontpellier University Hospital, France. MethodsThis is a prospective analysis of patients who underwent Nissen sleeve gastrectomy as a first-line bariatric procedure between January 2018 and February 2019. A subgroup analysis of patients with no further surgery during follow-up was also performed. ResultsA total of 144 patients underwent a Nissen sleeve gastrectomy: After adjusting for exclusion criteria, 133 patients comprised the initial study population, 81.9% of whom had complete follow-up for weight and GERD clinical symptom outcomes at 5 years. The mean total weight loss (TWL%) was 22 (± 12.3)% and the mean excess weight loss percentage (EWL%) was 59.4% (± 34.2)%. Of the 63 patients with preoperative clinical symptoms of GERD, we observed an 85.5% 5-year clinical remission rate; however only 25 patients had a gastroscopy at 5 years. The cumulative short- and long-term reoperation rate was 8.1% and the mortality rate was zero. ConclusionsThe Nissen sleeve gastrectomy achieves a satisfactory long-term TWL% and a significant improvement in comorbidities, particularly regarding the incidence of GERD. The rate of complications requiring surgical reoperation is low.