Percentage Of Total Body Weight Research Articles

Association between neighborhood food environments and bariatric surgery outcomes.

Individual characteristics associated with weight loss after bariatric surgery are well established, but the neighborhood characteristics that influence outcomes are unknown. The objective of this study was to determine if neighborhood characteristics, including social determinants and lifestyle characteristics, were associated with weight loss after bariatric surgery. Single university healthcare system, United States. In this retrospective cohort study, all patients who underwent primary bariatric surgery from 2008 to 2017 and had at least 1 year of follow-up data were included. Patient-level demographics and neighborhood-level social determinants (area deprivation index, urbanicity, and walkability) and lifestyle factors (organic food use, fresh fruit/vegetable consumption, diet to maintain weight, soda consumption, and exercise) were analyzed. Median regression with percent total body weight (%TBW) loss as the outcome was applied to examine factors associated with weight loss after surgery. Of the 647 patients who met inclusion criteria, the average follow-up period was 3.1 years, and the mean %TBW loss at the follow-up was 22%. In adjusted median regression analyses, Roux-en-Y gastric bypass was associated with greater %TBW loss (11.22%, 95% confidence interval [8.96, 13.48]) compared to sleeve, while longer follow-up time (-2.42% TBW loss per year, 95% confidence interval [-4.63, -0.20]) and a preoperative diagnosis of diabetes (-1.00% TBW loss, 95% confidence interval [-1.55, -0.44]) were associated with less. None of the 8 neighborhood level characteristics was associated with weight loss. Patient characteristics rather than neighborhood-level social determinants and lifestyle factors were associated with weight loss after bariatric surgery in our cohort of bariatric surgery patients. Patients from socioeconomically deprived neighborhoods can achieve excellent weight loss after bariatric surgery.

IBCOx-12 The Endoscopic Sleeve Gastroplasty Produces Durable Physiologic Changes: Results from a Randomized US Clinical Trial

Abstract Background Obesity is associated with faster gastric emptying and altered appetite. Endoscopic sleeve gastroplasty (ESG) has gained global adaptation, but our understanding of its physiologic mechanism of action and durability is limited. We sought to determine changes in gastric emptying, weight loss, and eating behaviors after ESG when compared to moderate-intensity lifestyle interventions (LS) in the short and long-term. Methods This is an a priori designed sub-study of a large ongoing multicenter US RCT (MERIT trial), where adults with BMI 30-40 kg/m2 were randomized to ESG versus moderate-intensity LS alone. We measured gastric emptying (T1/2) using a 4- hour gastric emptying breath test at baseline, 3 and 12 months into the study. We reported weight loss outcomes as percent total body weight lost (%TBWL). Changes in three eating behaviour domains (Cognitive Restraint [CR], Emotional Eating [EE], Uncontrolled Eating [UE]) were assessed using the Three-Factor Eating Questionnaire (TFEQ) at 6 months. The primary outcome was the change in T1/2 (minutes) at 3 months, and secondary outcomes were changes in T1/2 at 12 months, %TBWL, and eating behaviours. We used the t-test for the analyses. Linear regression was performed to determine the association between gastric emptying and weight loss. Results 46 patients were randomized in the study (ESG n=26; LS n=20). Baseline characteristics were similar between the two groups. Out of n=46, n=43, and n=31 subjects have reached 3 and 12 months, respectively. Three patients dropped out of the study. At 3 months, T1/2 (minutes) was delayed in the ESG group (n=24) compared to the LS group (n=19) (170.8 vs. 87.5; p<0.0001). At 12 months, T1/2 was still delayed in the ESG group (n=17) vs. control group (n=14) (133.4 vs. 87.6; p=0.0005), and delayed compared to baseline. %TBWL in the ESG group was 12.3%, 15.1% and 15.7% at 3, 6 and 12 months (p <0.01 compared to baseline), while it was 2.3%, 2.2% and 0.3% (p>0.05 compared to baseline) in the LS group. Greater delays in gastric emptying at 3 months correlated with weight loss at all time points. (Figure 1) At 6 months, significant improvements in the EE and UE domains were seen in both groups, but for CR, only significant improvements were seen in the ESG group. Percent total fasting ghrelin, GLP-1, and PYY increased at 12 months in the ESG group compared to LS control (51%, 51%, 6.3% vs. -9%, 4%, -10.5%). Only 1 SAE managed endoscopically with full recovery was reported in the ESG group. Conclusions ESG produces sustained physiologic alterations in appetite regulatory pathways and durable weight-loss. This provides further evidence supporting the clinical adoption of the technique as a durable and effective obesity therapy.

RF12 | PSUN118 Diet Quality and Energy Intake Mediate the Association of Food Insecurity with Adiposity

Abstract Food insecurity, the lack of consistent access to sufficient food for an active and healthy life, is associated with lower diet quality, higher BMI and adiposity, and poor metabolic health. Although lower diet quality is assumed to be responsible for the impact of food insecurity on adiposity, this hypothesis has not been previously investigated. To test the hypothesis that diet quality mediates the association of food insecurity with adiposity, we used data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES, age ≥18 years, n=5821, weighted N=233,636,542). Anthropometrics included BMI, waist circumference and fat mass (measured by dual X-ray absorptiometry and expressed as percentage of total body weight). Food insecurity was assessed with the 10-item NHANES Food Security Survey Module and defined as ≥3 affirmative responses. Nutrition information was derived from 24h food recalls obtained on 2 separate occasions. Diet quality was estimated by the Healthy Eating Index-2015 (HEI), which includes a total score for overall diet quality, and sub-scores for several dietary components. Mediation analysis was conducted with the Baron and Kenny approach. A p-value <0.05 was considered statistically significant. The cohort included 52% women, 11% non-Hispanic Black and 15% Hispanic participants. Eighteen percent were food insecure. They reported a lower energy intake compared to food secure participants, although the difference was not significant after adjusting for demographics and income (difference [95% confidence interval] -84 [-207.36, 38.91] kcal/day, p=0.15). Total HEI and fruit scores were lower in food insecure individuals, suggesting lower diet quality (adjusted difference -1.70 [-3.09, -0.32], p=0.03; and -0.28 [-0.53, -0.02], p=0.04, respectively). Obesity was 22% more prevalent in food insecure individuals (p<0.01). Fat mass and waist circumference were also higher in individuals with food insecurity (adjusted difference 0.95 [0.19, 1.7] %, p=0.02; and 3.81 [1.3, 6.31] cm, p=0.01, respectively). Mediation analysis revealed that total energy intake mediated the effect of food insecurity on fat mass but not BMI or waist circumference, while total HEI partially mediated the effect of food insecurity on waist circumference but not BMI or percent fat mass. No mediation of total fruit score on BMI or adiposity was observed. In summary, our results confirm a greater prevalence of obesity and higher adiposity in food insecure individuals, despite a similar reported energy intake compared to food secure individuals. Energy intake and measures of diet quality appear to mediate some of the effect of food insecurity on overall and central adiposity, but not on BMI. This suggests that other factors, including the social determinants of health, may also play a role. Presentation: Saturday, June 11, 2022 1:18 p.m. - 1:23 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Effects on physiologic measures of appetite from intragastric balloon and endoscopic sleeve gastroplasty: results of a prospective study.

Background:Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods:We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results:The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion:IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

Prospective Multicenter Study of the Primary Obesity Surgery Endoluminal (POSE 2.0) Procedure for Treatment of Obesity

The Primary Obesity Surgery Endoluminal (POSE) 2.0 procedure involves a novel pattern of full-thickness gastric body plications to shorten and narrow the stomach using durable suture anchor pairs. Our prospective, multicenter trial examined the safety, efficacy, durability, and physiologic effects of POSE 2.0 in adults with obesity. Adults with obesity underwent POSE 2.0 at 3 centers. Primary outcomes were percent total body weight loss (%TBWL) and proportion of patients achieving >5% TBWL at 12 months. Secondary outcomes included change in obesity comorbidities, satiety, quality of life at 6 months, and durability of plications at 12 and 24 months. Subjects were followed for adverse events throughout the study duration. 44 patients (61% female; mean age, 45 ± 9.7 years; mean body mass index, 37 ± 2.1 kg/m2) were enrolled. This procedure used an average of 19 suture anchor pairs, with a mean duration of 37 ± 11 minutes, and was technically successful in all subjects. Mean %TBWL at 12 months was 15.7% ± 6.8%. At 12 months, %TBWL >5%, >10%, and >15% was achieved in 98%, 86%, and 58% of patients, respectively. Improvements in lipid profile, liver biochemistries, and hepatic steatosis were seen at 6 months. Improvements in hepatic steatosis persisted for 24 months in a subgroup of patients (P < .01). POSE 2.0 reduced maximum tolerated meal volume (P= .03) and was associated with increased fullness (P < .01) and improved eating behavior (P < .01) at 6 months. Impact of weight on quality-of-life questionnaire improved at 6 months (2.23 vs 1.23; P < .01). Repeat assessment at 24 months (n= 26) showed fully intact plications. No serious adverse events occurred. POSE 2.0 is an effective and durable endoscopic bariatric therapy which may influence physiologic pathways impacting satiety. Larger comparative studies are needed to further elucidate these initial findings. gov Identifier: NCT03721731.

Prevalence of Upper Gastrointestinal Inflammation in Teens With Obesity Prior to Sleeve Gastrectomy

Upper gastrointestinal (UGI) pathologies are common in adolescents with obesity. This study aims to determine the prevalence of UGI inflammation on preoperative esophagogastroduodenoscopy (EGD) in adolescents undergoing sleeve gastrectomy (SG) and to assess weight loss outcomes. This is a retrospective analysis of pathology reports from EGD biopsies performed prior to SG from September 2017 to August 2020. Percentage weight loss was measured at 3, 6, and 12mo after surgery. Percent total body weight loss (TBWL) was compared between patients with and without UGI inflammation. Thirty adolescents underwent laparoscopic SG. Mean TBWL was 22% of total body weight 12mo after surgery. Preoperative EGD identified 9 (30%) patients with esophagitis, 10 (33%) with gastritis, and 9 (30%) with duodenitis. Twenty-one patients (70%) had inflammation of at least one area, 5 (17%) were Helicobacter pylori positive, and 1 (3%) had a gastric ulcer that delayed surgery. Five (17%) patients were taking antacids prior to EGD. Patients with preoperative gastric or duodenal inflammation had significantly less TBWL 12mo after SG compared to patients without gastric (24.6% versus 16.7%, P=0.04) or duodenal inflammation (25.7% versus 14.1%, P=0.02). There is a high prevalence of UGI inflammation in adolescents undergoing SG. Gastric and duodenal inflammation is associated with less TBWL after SG.

Static Body Weight Distribution and Girth Measurements Over Time in Dogs After Acute Thoracolumbar Intervertebral Disc Extrusion.

Dogs with thoracolumbar intervertebral disc extrusion (TL-IVDE) can exhibit variable neurologic deficits after decompressive surgery. The objectives of this study were to quantify changes in static weight distribution (SWD) and limb and body circumference over time in dogs recovering from surgery for TL-IVDE. Dogs with acute TL-IVDE were prospectively evaluated at baseline (48–72 h post-operatively), 2, 4, 8, and 12 weeks post-operatively. Commercially-available digital scales were used to measure weight distributed to the pelvic limbs (PL%) and asymmetry between left and right pelvic limbs (LRA), each expressed as a percentage of total body weight. Trunk and thigh circumference measurements were performed using a spring-loaded tape measurement device. Measurements were performed in triplicate, compared to neurologically normal small breed control dogs and analyzed for changes over time. P <0.05 was significant. Twenty-one dogs were enrolled; 18 regained ambulation and 3 did not by study completion. PL% increased from 27.6% at baseline to 30.7% at 12 weeks but remained lower than in control dogs (37%) at all time points (p < 0.0001), even excluding dogs still non-ambulatory at 12 weeks (p < 0.025). LRA was similar to the control dogs, and did not have an association with surgical side. Caudal trunk girth decreased over time to 95% of baseline (p = 0.0002), but this was no longer significant after accounting for reductions in body weight (p = 0.30). Forward shifting of body weight persisted in dogs with TL-IVDE 12 weeks after surgery even among ambulatory dogs. SWD and circumference measurements could provide additional objective measures to monitor recovery.

34. Differences in Medical Outcomes and Triggers for Disease Based on Pre-Morbid Weight Status in Adolescents With Anorexia Nervosa

Youth with obesity who experience unsafe weight loss represent an under-diagnosed population in the eating disorder (ED) field. However, differences in medical outcomes and triggers for disease between those whose pre-morbid weights were classified as "overweight/obese" vs. “normal” are poorly understood, interfering with optimizing prevention and treatment. We aimed to examine the differences in medical complications and reported triggers for ED onset based on pre-morbid weight in adolescents with anorexia nervosa (AN). We performed a retrospective, electronic chart review of patients aged 9-19 admitted for complications of malnutrition due to AN or atypical AN (AAN) at a large, urban pediatric hospital from January 2015 to February 2020. Comparison groups were divided by their pre-morbid growth trajectories: “normal” [<85th percentile body mass index (BMI)] vs. “overweight/obese” (≥ 85th percentile). Demographic and outcome data (e.g., weight, vital signs, triggers for ED behaviors) were obtained. Reported triggers for disease were acquired, coded, and categorized into main themes via qualitative thematic analysis and then treated as binary variables. Binary logistic and linear regression analyses were conducted. 150 patients were identified. Mean (SD) age was 14.1 (2.3) years. 86% were female, 80% white, and 92% non-Hispanic/Latinx. 23% had pre-morbid weight in the overweight/obese category. We found no difference in age or length of stay between those with overweight/obesity vs. not. However, those with overweight/obesity had lost a significantly higher mean percentage of total body weight (%TBW) (22.3% vs. 17.9% [p=0.04]) and at a higher rate (11.4 vs. 5.7 pounds/month [p=0.18]) compared to those without overweight/obesity. Previous weight status was not a significant predictor for the presence of bradycardia, hypotension, or orthostasis. However, higher %TBW lost was significantly associated with the presence of bradycardia, when controlling for previous weight status and rate of weight loss (p<0.001). Furthermore, those with pre-morbid overweight/obesity had 7.6x the odds of reporting positive reinforcement about weight loss as a trigger for their ED (p=0.004) and 3.9x the odds of reporting weight-related teasing (p=0.003) compared to those without pre-morbid overweight/obesity when controlling for age and length of symptoms. Patients with AN/AAN who had pre-morbid overweight/obesity have significantly higher %TBW lost and rates of weight loss than those who were normal-weighted, which can place them at risk of dangerous complications, such as bradycardia. These patients are also more likely to report weight-related teasing and positive reinforcement for weight loss as triggers for disease. Understanding these data can help optimize prevention, assessment, and treatment of EDs in this under-diagnosed population.

Robotic Revisional Single Anastomosis Duodenoileal Bypass After Sleeve Gastrectomy.

Introduction: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a metabolic operation emerging as an option for patients with morbid obesity. It is a promising revisional procedure for weight regain or suboptimal weight loss after sleeve gastrectomy (SG). Currently, there is limited literature describing robotic revisional SADI-S. This study describes the safety, feasibility, and early outcomes of robotic revisional SADI-S after previous SG. Methods: This is a retrospective review from May 26 2019 to January 31 2021. Perioperative outcomes were analyzed. Results: A total of 16 patients underwent the procedure. There were 11 females (69%) with a mean age of 39 ± 11 years. Mean body mass index (BMI) was 44.0 ± 5.1 kg/m2 and median ASA was two. Comorbidities included hypertension (25%), hyperlipidemia (19%), and obstructive sleep apnea (13%). Mean interval from primary to revisional surgery among patients was 5.5 ± 1.4 years. Median operative console time was 110 minutes (IQR = 103-137). There were no intraoperative complications. The median hospital stay was 2 days (IQR = 2-3). Perioperative outcomes included no reoperations, perioperative complications, or deaths. There were two (12.5%) emergency department visits for wound checks without infection but no readmissions. At a median follow-up of 4.5 months (IQR = 1-10), patients had a mean BMI of 38.3 ± 7.3 kg/m2 and a mean percent total body weight loss (%TBW) of 12.7%. Conclusions: Initial outcomes suggest that robotic revisional SADI-S after previous SG is feasible and safe. Future studies are needed to evaluate intermediate- and long-term postoperative outcomes.

689-P: Association of Preoperative Glycemic Response to GLP-1 Receptor Agonists (GLP-1RA) and Outcomes of Bariatric Surgery

Background: GLP1RAs are an increasingly common treatment in the setting of type 2 diabetes mellitus (T2DM). One hypothesized mechanism by which bariatric surgery contributes to T2DM remission is by increasing intestinal GLP-1 secretion. We aimed to evaluate the association of the response to GLP1RA pre-operatively on hemoglobin A1c (HbA1c) level and weight loss after bariatric surgery. Methods: The NorthShore bariatric surgery database was retrospectively queried for patients with T2DM who had taken a GLP1RA prior to Roux-en-Y gastric bypass (N=38) or gastric sleeve surgery (N=9). GLP1RA response was measured by change in HbA1c from initiation of therapy to 6mo. Outcomes included HbA1c level and percent total body weight loss (TBWL) at 6mo, 1 and 2yr post-op. The association between GLP1RA response and post-operative outcomes was evaluated with partial correlation coefficients adjusted for baseline HbA1c with/without baseline weight. Results: The average HbA1c at initiation of therapy was 8.3±1.4% and decreased by 1.1±1.5% on GLP1RA treatment with liraglutide being most commonly prescribed (44.7%). A greater decrease in HbA1c from GLP1RA was correlated with a lower HbA1c at 6mo (r=0.38, p=0.02), and 2yr (r=0.43, p=0.03), but not 1yr (r=0.35, p=0.06) or TBWL. After adjustment for baseline weight, the association remained at 6mo (r=0.37, p=0.02). Stratification by procedure noted a strong association between GLP1RA response and reduced post-operative HbA1c at 6mo (r=0.99, p&amp;lt;0.01) and TBWL at 1yr (r=0.82, p=0.02) and 2yrs (r=0.99, p=0.01) for patients who had undergone gastric sleeve, but not gastric bypass. Conclusion: To our knowledge, this is the first study examining the association of GLP1RA response on glycemic and weight outcomes post-bariatric surgery in people with T2DM. Despite a number of limitations, results from this small cohort suggest the need for further evaluation of this relationship as a potentially useful predictor of surgical outcomes. Disclosure D. Amusin: None. K. Kuchta: None. T. Ewing: None. L. Tucker: None. M. Campbell: None. M. Ujiki: Advisory Panel; Self; Boston Scientific Corporation, Consultant; Self; Cook Medical, Speaker’s Bureau; Self; Medtronic. L. K. Billings: Advisory Panel; Self; Bayer Inc., Lilly Diabetes, Novo Nordisk, Sanofi.

Sleeve Gastrectomy Failure-Revision to Laparoscopic One-Anastomosis Gastric Bypass or Roux-n-Y Gastric Bypass: a Multicenter Study.

Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications. Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss. During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19-72) and 40.6 ± 5.9 kg/m2 (range 35-71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7-78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018). Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.

Development of a simple method to measure static body weight distribution in neurologically and orthopedically normal mature small breed dogs

BackgroundObjective outcome measures capable of tracking different aspects of functional recovery in dogs with acute intervertebral disc herniation are needed to optimize physical rehabilitation protocols. Normal, pre-injury distribution of body weight in this population is unknown. The aims of this study were to quantify static weight distribution (SWD) using digital scales and to establish the feasibility of different scale methods in neurologically normal, mature, chondrodystrophic small breed dogs predisposed to intervertebral disc herniation.ResultsTwenty-five healthy, mature dogs were enrolled with a mean age of 4.6 years (SD 2.7) and a mean total body weight of 11.5 kg (SD 3.6). SWD for the thoracic and pelvic limbs and between individual limbs was acquired in triplicate and expressed as a percentage of total body weight using commercially available digital scales in four combinations: two bathroom, two kitchen (with thoracic and pelvic limbs combined), four bathroom and four kitchen (with limbs measured individually). SWD was also obtained using a pressure sensing walkway for comparison to scale data. Feasibility for each method was determined and coefficients of variation were used to calculate inter-trial variability. Mean SWD values were compared between methods using an ANOVA. The two bathroom scales method had the highest feasibility and lowest inter-trial variability and resulted in mean thoracic and pelvic limb SWD of 63 % (SD 3 %) and 37 % (SD 3 %), respectively. Thoracic limb mean SWD was higher for the PSW compared to any of the scale methods (p < 0.0001).ConclusionsSWD in a population of healthy chondrodystrophic dogs was simple to obtain using inexpensive and readily available digital scales. This study generated SWD data for subsequent comparison to dogs recovering from acute intervertebral disc herniation.

Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes.

Objective:To compare outcomes after bariatric surgery between Medicaid and non-Medicaid patients and assess whether differences in social determinants of health were associated with postoperative weight loss.Background:The literature remains mixed on weight loss outcomes and healthcare utilization for Medicaid patients after bariatric surgery. It is unclear if social determinants of health geocoded at the neighborhood level are associated with outcomes.Methods:Patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2008 to 2017 and had ≥1 year of follow-up within a large health system were included. Baseline characteristics, 90-day and 1-year outcomes, and weight loss were compared between Medicaid and non-Medicaid patients. Area deprivation index (ADI), urbanicity, and walkability were analyzed at the neighborhood level. Median regression with percent total body weight (TBW) loss as the outcome was used to assess predictors of weight loss after surgery.Results:Six hundred forty-seven patients met study criteria (191 Medicaid and 456 non-Medicaid). Medicaid patients had a higher 90-day readmission rate compared to non-Medicaid patients (19.9% vs 12.3%, P < 0.016). Weight loss was similar between Medicaid and non-Medicaid patients (23.1% vs 21.9% TBW loss, respectively; P = 0.266) at a median follow-up of 3.1 years. In adjusted analyses, Medicaid status, ADI, urbanicity, and walkability were not associated with weight loss outcomes.Conclusions:Medicaid status and social determinants of health at the neighborhood level were not associated with weight loss outcomes after bariatric surgery. These findings suggest that if Medicaid patients are appropriately selected for bariatric surgery, they can achieve equivalent outcomes as non-Medicaid patients.

Effect of Conventional Medical Therapy or Laparoscopic Sleeve Gastrectomy on Urinary Albumin in Japanese Subjects with Severe Obesity: An Observational Study

Introduction: In patients with severe obesity, albuminuria can be improved by both conventional medical therapy and bariatric surgery. The purpose of this study was to compare the impact of weight loss achieved through conventional medical therapy or laparoscopic sleeve gastrectomy (LSG) on albuminuria in Japanese subjects with severe obesity and identify the factors involved. Methods: We retrospectively evaluated the clinical characteristics including the urinary albumin/creatinine ratio (UACR) of 340 consecutive subjects with a body mass index ≥35 who received LSG (n = 242) or medical therapy (n = 98) between 2010 and 2018 and were followed for at least 12 months. Results: The baseline of the UACR was not different between the 2 groups. At the 12-month follow-up, total weight loss (TWL) and decreases in glycosylated hemoglobin (HbA1c) and log_e UACR were greater in the LSG group than in the medical therapy group (body weight; −35.7 kg vs. −8.0 kg, p < 0.001, HbA1c; −1.4% vs. −0.7%, p < 0.001, log_e UACR; −0.3 vs. 0.9, p < 0.001). The rate of complete remission of diabetes was significantly higher in the LSG group than in the medical therapy group. At 12 and 36 months (n = 111 in the medical therapy group, n = 56 in the LSG group at 36 months), log_e UACR increased in the medical therapy group, while it remained unchanged or decreased in the LSG group. In subjects with microalbuminuria and macroalbuminuria, changes in the log_e UACR correlated with percent total body weight loss (%TWL) in both groups at 12 months. Percent TWL contributed independently to the change in the log_e UACR, irrespective of whether LSG was performed. In receiver-operating characteristic analysis, a weight loss of 7.8% predicted a decrease in the UACR (∆UACR <0 at 12 months). Conclusion: Our analysis suggests that albuminuria may increase over time if only medical therapy is continued. To improve albuminuria, weight loss may be more important than whether LSG is performed.

A longitudinal study to investigate the effects of a 12-week comprehensive lifestyle weight management program on body weight and quality of life

The majority of Americans now have overweight or obesity. With limited resources to treat all patients, group programs are emerging as an efficient method for dissemination of evidence-based lifestyle information. The objective of this study was to evaluate change in body weight, biochemical parameters, and quality of life among individuals after completion of a 12-week comprehensive group weight management program at an obesity medicine clinic. 204 patients were recruited for the study after enrolling in the Healthy Habits for Life program at the Massachusetts General Hospital Weight Center in Boston and Danvers, MA. Prior to the program, patients met individually with a dietitian and baseline data was collected. Primary outcome measures collected were weight and BMI change over the course of the program. Secondary measures collected included biochemical parameters and quality of life. Weekly group visits consisted of primary outcome collection and 1.5h of instruction on various lifestyle- and nutrition-related topics. Secondary outcome measures were reassessed at an individual visit with the dietitian after the program concluded. 142 participants were adherent to the protocol (attended 9 out of 12 classes). On average, patients lost 6.4kg (14.1 lbs.), representing a percent total body weight loss of over 5%. Average BMI decrease was significant at 5.35±4.61%. Improvements were seen in physical function, self-esteem, and sexual life; total QOL scores also improved by a significant 5.79% on average. There were also significant improvements in total cholesterol, triglycerides, and HbA1c. The Healthy Habits for Life group program was an effective treatment for obesity and related health concerns, including overall quality of life. Group programs of this style may be a more efficient was to disseminate evidence-based lifestyle information and affect change for patients with overweight or obesity.

Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss

Endoscopic sleeve gastroplasty (ESG) has been shown to be effective for inducing weight loss. The efficacy of liraglutide, a glucagon-like peptide-1 agonist, to augment weight loss after ESG is unknown. This study aims to evaluate the efficacy of ESG and liraglutide (ESG-L) compared with ESG alone. This was a retrospective study of prospectively collected data from patients undergoing ESG at 3 outpatient clinics in Brazil between November 2017 and July 2018. Liraglutide was offered to all patients 5 months after ESG. Patients who opted to take liraglutide (ESG-L) were matched 1:1 to patients who declined it (ESG). The primary outcome was percent total body weight loss (%TBWL), and percent excess weight loss (%EWL) 7 months after initiation of liraglutide (12 months after ESG). The secondary outcome was change in percent body fat 12 months after ESG. ESG technique and postprocedure follow-up were identical at all 3 sites. Propensity score matching yielded 26 matched pairs. Adjusted comparisons between the 2 groups showed that patients who opted to take liraglutide had a superior mean %TBWL 7 months after initiation of liraglutide (ESG-L) compared with those who declined it (ESG) (24.72% ± 2.12% vs 20.51% ± 1.68%, respectively; P< .001). ESG-L had a statistically greater reduction in percent body fat compared with ESG (7.85% ± 1.26% vs 10.54% ± 1.88%, respectively; P< .001) at 12 months. Addition of liraglutide at 5 months results in superior weight loss and improved efficacy as demonstrated by decreased body fat 12 months after ESG. Further studies are imperative to determine optimal dose, timing, and duration of liraglutide.

S1202 The Origin of Obesity Does Not Affect Short Term Weight Loss After Vertical Sleeve Gastrectomy

INTRODUCTION: sychosocial factors (i.e. diet/physical activity/stress), genetic risk, and obesogens (early life endocrine disruptors) have each been suggested to be major underlying mechanisms involved in the obesity pandemic. Vertical sleeve gastrectomy (VSG) has emerged as the preferred weight loss surgery worldwide; VSG has an improved safety profile and good long term outcomes. Since genetic risk and obesogens are pathophysiological factors independent of an individual’s control, our hypothesis is that VSG will result in better weight loss in subjects whose obesity is related to psychosocial factors, compared to subjects with genetic risk or exposure to obesogens. METHODS: This is a retrospective review of 84 new obese subjects, who live in urban and suburban locations, who were seen in a community teaching hospital bariatric GI clinic from Oct 2018 to June 2019 and underwent VSG with at least 6 months of follow up. Obesogen (O) exposure is defined by: mother and father normal weights; subject had body mass index (BMI) of ≥ 30 kg/m2 at age 18. Genetic risk (GR) is defined by: mother and/or father obese; subject had BMI of ≥ 30 at age 18. Psychosocial (PS) factors are defined by: subject with BMI < 30 at age 18. RESULTS: As shown in Table1/Table2, subjects with genetic risk are significantly younger, while subjects with exposure to obesogens or with genetic risk have higher weights and higher BMIs at presentation. Percent total body weight loss at 6 months was not different among the three groups, but few men were seen for 6 months of follow up. Higher BMI individuals did not demonstrate a reduction in mean weight loss. CONCLUSION: This study did not support improved short term weight loss after VSG in individuals with obesity related to psychosocial factors. Potential difference in results among the three groups will need to be examined in long term studies, in which additional men are available for analysis. Further prospective studies are needed to evaluate the potential clinical significance of subjects exposed to obesogens.Table 1.: DemographicsTable 2.: Statistical analysis

Sa1947 DOES FUNDAL SUTURING AFFECT OUTCOMES OF ENDOSCOPIC SLEEVE GASTROPLASTY?

The endoscopic sleeve gastroplasty (ESG) is a neoteric minimally invasive bariatric procedure that has gained recent acclaim in the management of obesity. However, there is heterogeneity regarding technical aspects such as plication of the gastric fundus. Fundal suturing (FS) is avoided due to the belief that suturing the anatomically thin fundus would significantly increase the risk of complications, however, there is a paucity of literature pertaining to fundal suturing. We sought to determine whether suturing the gastric fundus affects weight loss outcomes and adverse event rate when compared to ESG without fundal suturing. We conducted a two-center retrospective analysis of prospectively maintained data of 247 patients who underwent ESG with or without fundal suturing between January 2016 and August 2019. Endoscopist A had trained endoscopist B to perform ESG. Endoscopist A conducted ESG with suturing of the fundus at center A (group A), while endoscopist B conducted ESG without fundal sutures at center B (group B). The primary outcome was the mean absolute weight loss (AWL), percent excess weight loss (%EWL) and percent total body weight loss (%TBWL) at 3, 6 and 12 months post ESG. Secondary outcomes included severe adverse event (SAE) rate and procedure duration. Uni-variable and multivariable analyses were used to compare outcomes of ESG with and without fundal suturing. Baseline demographic characteristics were similar, except for a significantly greater proportion of females in group B (85.7% vs 71.8 %) (p=0.017). A total of 178, 131, and 66 patients completed follow up at 3, 6 and 12 months respectively. At 3 months group A had a significantly greater mean %TBWL, 13.81 ± 4.55 % compared to 11.71 ± 3.60 % in group B (p = 0.001), and a higher %EWL(44.17± 21.24% vs. 37.72 ± 16.10% )(p=0.025). This remained significant on multiple regression analysis after controlling for other covariates. However, this difference did not remain significant at 6 and 12 month. The SAE rate was comparable in group A (n=4;2.6%) and group B (n=2; 2.0%) (p=1) (Table 1). The mean procedure time was significantly longer in the group A, 92.96 ± 35.5 vs. 59.13 ± 32.7 minutes (p<0.001) , in the setting of a greater mean number of sutures 8.41 ± 1.58 vs 5.72 ± 1.10 (p<0.001). This is the first study to date comparing outcomes of ESG with fundal suturing versus ESG without fundal suturing. Although, fundal suturing adds procedure time, it does not increase the adverse event rate, while achieving significantly greater %TBWL and %EWL at 3 months. There is a need for a larger multicenter comparative study that may demonstrate that early %EWL could translate to superior weight loss outcomes in the long term.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Weight Change in Kidney Transplant Recipients: An Academic Medical Center-Based Study

Abstract Objectives Kidney transplant recipients often experience weight gain in the first year after transplantation and this weight gain is associated with higher rates of cardiovascular disease, new-onset diabetes, metabolic syndrome and loss of graft function. The purpose of this study was to examine the characteristics of transplant recipients at our institution and describe post-transplant weight change. Methods Utilizing the institution's research data repository, we searched for adult kidney transplant patients from January 2014 through February 2019. Percent weight change at 6 and 12 months was calculated as a percentage of total body weight from time of transplant. Weight gain was defined as an increase of 5% or more while weight stable was classified as no weight change or less than 5% gain. Weight loss was defined as losing 5% or more of body weight from baseline. Results Of 598 cases, the sample was predominantly male (n = 361; 60%), married (n = 355; 59%) and white (n = 415; 69%). At transplant, mean age was 51.3 ± 13.5 years and mean weight was 85.26 ± 20.10 kg (males = 90.62 ± 20.73 kg; females = 77.53 ± 16.33 kg). At 6 months post-transplant, 87% of recipients (n = 518) had recorded weights. Of those individuals, 26% (n = 133) experienced weight gain (mean + 11.9%; median + 9.9%), gaining on average 8.9 ± 5.09 kg. Thirty one % (n = 163) lost weight (mean −10.3%; median - 8.8%), and 43% (n = 222) were weight stable. At 12 months post-transplant, 78.1% (n = 467) of patients had recorded weights. Of those individuals, 42% (n = 195) experienced weight gain (mean + 13%, median + 10%), 18% (n = 86) lost weight (mean −10.95%, median - 8.94%), and 40% (n = 185) maintained baseline weight. Those who gained weight during this period experienced a 10.16 ± 6.00 kg increase. Conclusions Post-transplant weight gain is a critical issue among our institution's kidney transplant recipients with more than 40% gaining significant weight, placing them at risk for early mortality and decreased graft survival. Healthcare professionals should continue to educate and direct recipients to weight management programs to control the amount of weight gained following transplantation. Helping kidney transplant recipients prevent unnecessary weight gain is essential to their prolonged survival and quality of life. Funding Sources None.

Intragastric Balloon Placement Induces Significant Metabolic and Histologic Improvement in Patients With Nonalcoholic Steatohepatitis

Obese patients with nonalcoholic steatohepatitis (NASH) are at risk for cirrhosis if significant weight loss is not achieved. The single fluid-filled intragastric balloon (IGB) induces meaningful weight loss and might be used in NASH treatment. We performed an open-label prospective study to evaluate the effects of IGB placement on metabolic and histologic features of NASH. Twenty-one patients with early hepatic fibrosis (81% female; mean age, 54 years; average body mass index, 44 kg/m2) underwent magnetic resonance elastography (MRE) and endoscopic ultrasound with core liver biopsy collection at time IGB placement and removal at a single center from October 2016 through March 2018. The primary outcome measure was the changes in liver histology parameters after IGB, including change in nonalcoholic fatty liver disease activity score (NAS) and fibrosis score. We also evaluated changes in weight, body mass index, waist to hip ratio, aminotransaminases, fasting levels of lipids, fasting glucose, glycosylated hemoglobin, and MRE-detected liver stiffness. Six months after IGB, patients' mean total body weight loss was 11.7% ± 7.7%, with significant reductions in HbA1c (1.3% ± 0.5%) (P = .02). Waist circumference decreased by 14.4 ± 2.2 cm (P = .001). NAS improved in 18 of 20 patients (90%), with a median decrease of 3 points (range, 1-4 points); 16 of 20 patients (80%) had improvements of 2 points or more. Fibrosis improved by 1.17 stages in 15% of patients, and MRE-detected fibrosis improved by 1.5 stages in 10 of 20 patients (50%). Half of patients reached endpoints approved by the Food and Drug Administration of for NASH resolution and fibrosis improvement. Percent total body weight loss did not correlate with reductions in NAS or fibrosis. Other than post-procedural pain (in 5% of patients), no serious adverse events were reported. In a prospective study, IGB facilitated significant metabolic and histologic improvements in NASH. IGB appears to be safe and effective for NASH management when combined with a prescribed diet and exercise program. ClinicalTrials.gov no: NCT02880189.