Weight Regain Research Articles

What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery.

This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.

Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study.

Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently. Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. Ten Italian high-volume BS centers (university hospitals and private centers). Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients. A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers. Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.

FRI074 Rise In Fasting Ghrelin Level In Response To Weight Loss Predicts Future Weight Regain In The POUNDS LOST Trial

Abstract Disclosure: J. Tong: None. Y. Heianza: None. E.A. Schur: None. F. Sacks: None. L. Qi: None. E.J. Boyko: None. Weight loss maintenance is a challenging problem commonly encountered in obesity management. The biological mechanism for weight regain following diet-induced weight loss is not well understood. The orexigenic gut hormone ghrelin increases appetite and food intake and promote positive energy balance. We aim to investigate whether weight-loss induced fasting ghrelin changes predict subsequent weight regain in the POUNDS LOST trial. Methods: This study included 244 overweight or obese adults (age: 52.9±8.8 yr; 66% female; BMI 32.4±3.9 kg/m2 [mean ± SD]) randomly assigned to 1 of 4 weight-loss diets varying in macronutrient intake who had fasting plasma total ghrelin levels measured at baseline, 6 and 24 months after the intervention. We examined associations between fasting ghrelin levels changes between baseline and 6-months (weight change: -7.1±5.3 kg) and body weight change between 12 and 24 months (3.2±3.9 kg). Results: Fasting plasma ghrelin level increased significantly at 6 months (from 487.3±251.1 to 574.0±274.5 pg/mL) and remained elevated at 24 months despite weight regain (684.0±411.0 pg/mL). Increases in ghrelin level from baseline to 6 months (86.7±167.4 pg/mL) were correlated with weight regain from 12 to 24 months (p=0.018). The association was unchanged after adjustment for age, sex, race, and diet assignment at baseline; fat and carbohydrate craving scores, hunger and fullness ratings, dietary restraint and disinhibition scores measured at 6 months, prior to onset of weight regain. Conclusions: Fasting ghrelin levels rose in response to diet-induced weight loss and persisted for 2 years despite weight regain. Ghrelin change during the weight loss phase predicts subsequent weight regain independent of appetite and craving measures. Understanding the mechanistic connection between ghrelin action and weight regain may shed light on novel approaches to weight loss maintenance. Presentation: Friday, June 16, 2023

FRI075 Single Center Retrospective Matched Cohort Study Of glp1ra-induced Weight Loss In Patients With Post-bariatric Weight Regain Vs Non-surgical Controls

Abstract Disclosure: A. Rivadeneira: None. M. Walker: None. R. Gallop: None. A. Amaro: Advisory Board Member; Self; Novo Nordisk. Research Investigator; Self; Eli Lilly & Company, Novo Nordisk. Background: Obesity prevalence worldwide is increasing. By 2030, almost one-fourth of US population will have severe obesity (BMI >35 mg/kg2). Bariatric surgery (BS) is an effective intervention for weight loss (WL) in patients with severe obesity; weight regain (WR) remains a concern. Over one-third of patients will regain more than 25% of total WL. GLP-1 receptor agonists (GLP1RA) have been effective for WL in patients with obesity. Effectiveness and safety of liraglutide and semaglutide in patients with WR after BS were observed in several retrospective studies. The difference in response to GLP1RA in patients with and without a history of bariatric surgery has not been assessed. Objectives: We aimed to retrospectively compare amount of WL and time to nadir in BMI matched individuals with history of WR following BS and without history of surgery treated with GLP1RA. Methods: Retrospective matched cohort study of the patients referred to Penn Metabolic Medicine (PMM) clinic for non-surgical weight management. We analyzed 63 patients with history of RYGB or VSG seen between 8/2015-8/2021 for WR and who received GLP1RA. BMI matched non-surgical (NS) cohort (N=60) treated with GLP1RA was built from the PMM patients of the same period for comparison. Results: Mean weight on presentation at PMM in surgical group (SG) was 273.1 lbs, (BMI 43.5 kg/m2), and in non-surgical one (NS) 264.9 lbs (BMI 43.3 kg/m2). Nadir weight after initiation of GLP1RA in SG 241.1 lbs and controls 244 lbs, with percentage WL of 11.8% in SG and 7.86% in NS controls (p-value 0.0081). Mean time to nadir weight after initiation of GLP1RA was 17.2 months for SG, and 9.2 months in NS controls (p-value <0.0001). Discussion: When treated with GLP1RA, patients with post-bariatric WR lost on average 12% of their weight and achieved nadir around 17 months. Weight matched NS controls lost less weight and entered a plateau phase faster, suggesting enhanced GLP1RA efficacy after bariatric surgery. Significant WL response to GLP1RA was similar in RYGB and VSG groups, supporting previously demonstrated GLP1RA efficacy for post-bariatric WR. Larger prospective trials are needed for confirmation. Reports suggest both RYGB and VSG increase postprandial GLP-1. Proposed WR mechanisms include hormonal changes, nutritional non-adherence, physical inactivity and maladaptive eating. Hormonal mechanisms include increase in ghrelin, decrease in GLP-1 and peptide YY, post-bariatric hypoglycemia and other pathways. Further studies are needed to elucidate the mechanism of enhanced GLP-1 RA efficacy in patients with WR after BS. The limitations of our study include a retrospective nature, modest sample size and the choice of GLP1RA limited to liraglutide, exenatide and semaglutide and guided by the subjects’ insurance plans. In the future, dual incretins will need to be studied in patients with WR after bariatric surgery. Presentation: Friday, June 16, 2023

SAT655 Modifying Effects Of Dash Diet On Food Addiction Two Years After Sleeve Gastrostomy: A Randomized Controlled Clinical Trial

Abstract Disclosure: S. Ariyanfar: None. M. Tabesh: None. M. Noormohammadi: None. S. Razeghi Jahromi: None. E. Rashidbeigi: None. In morbid obese individuals, bariatric surgery is considered an effective intervention due to failure of non-surgical weight management strategies. Sleeve gastrostomy (LSG) accounts for over half of bariatric surgeries. The prevalence of weight regains is 76% over 2-6 years after LSG due to binge eating disorder and food addiction. In our previous study, one-fifth of patients with LSG fulfilled the criteria for food addiction (FA). Various dietary patterns have been studied for their potential benefits in controlling FA in non-surgical weight loss programs. Among them, DASH diet attracted our attention, because, besides its effect on FA, the nature of this diet fully addresses other prevalent complications of patients with morbid obesity who undergoes LSG more than two years ago, i.e., vascular problems and gut microbiota changes. To study the effect of the DASH diet on food addiction after LSG we recruited 100 individuals with LSG two years prior to the study who had mild to moderate FA according to DSM-IV criteria and Yale Food Addiction Scale (YFAS) and weight regain of more than 25% of excess weight loss. Participants were randomly assigned to a calorie-restricted DASH diet (1000-1200 calories, containing 2-3 servings of whole grain, 3-4 servings of vegetables, 3 servings of fruit, 2 servings of skim or low-fat dairy products, 1-2 servings of meat, poultry, and fish, 3 servings of nuts, seeds, and legumes, 2 servings of oil) or a calorie-restricted diet (1000-1200 calories, 3-4 servings of whole grain, 3-4 servings of vegetables, 2 servings of fruit, 2 servings of skim or low-fat dairy products, 2-3 servings of meat, poultry, and fish, 1 serving of nuts, seeds, and legumes, 2 servings of oil, and 1 serving of sugar.) for 16 weeks. Food addiction, serum levels of FBS and insulin were assessed. No significant differences in calorie and macronutrient intake, BMI, amount of excess weight before surgery, physical activity level, depression, anxiety level, and YFAS mean were observed between to studied groups After 16 weeks, individuals in DASH diet group reported a significant reduction in YFAS (from3.64±0.63 to 2.66±0.63, P.Value < 0.001), also Insulin levels and FBS decreased from 12.22±3.13 to 10.12±2.3 mcU/ml (P.Value< 0.001) and from 91.92±8.9 to 86.98±6.8 mg/dl (P.Value< 0.001), respectively. A significant reduction of insulin (13.21±2.97 to11.15±2.18 mcU/ml, P.Vaue< 0.001) and FBS level (92.31±7.5 to 87.63±5.9 mg/dl) was observed among controls. A significantly higher reduction of insulin levels in DASH group was noticed at the endpoint (P.Value: 0.026). It could be concluded that adherence to DASH diet, 2 years after SLG, can combat food addiction by modifying serum insulin levels. Presentation: Saturday, June 17, 2023

S2920 Endoscopic Management of Weight Regain Due to Staple-Line Dehiscence in a Patient With a Vertical Banded Gastroplasty

S2920 Endoscopic Management of Weight Regain Due to Staple-Line Dehiscence in a Patient With a Vertical Banded Gastroplasty

S1633 Weight Regain After Total Meal Replacement Very Low-Calorie Diet Program With and Without Anti-obesity Medications

S1633 Weight Regain After Total Meal Replacement Very Low-Calorie Diet Program With and Without Anti-obesity Medications

High-dose liraglutide improves metabolic syndrome in poor responders to bariatric surgery.

Bariatric surgery (BS) represents the most effective therapy for obesity class III, or class II with at least one weight-related comorbidity. However, some patients have insufficient weight loss or clinically relevant weight regain after a successful primary procedure. This study aimed to assess the efficacy of liraglutide treatment on weight loss, body composition and improvement of metabolic syndrome (MS) in patients defined as poor responders after BS. The study involved 59 non-diabetic adults with obesity (M/F: 17/42, age: 38.6 ± 11.8 years, BMI 38.3 ± 5.5 kg/m2) who had been treated with BS and experienced a poor response, categorized as either IWL (insufficient weight loss) or WR (weight regain). All patients were prescribed pharmacological therapy with liraglutide and attended nutritional counseling. Anthropometric and clinical measurements, body composition and the presence of MS defined according to the ATP-III classification were evaluated before starting liraglutide and after 24 weeks of treatment. After 24 weeks of treatment with liraglutide, the mean weight loss was 8.4% ± 3.6% with no difference between gender, bariatric procedure, or type of poor response (IWL or WR). A significant decrease in fat mass, free-fat mass and total body water was documented. After 24 weeks, patients presented significantly lowered fasting glucose, total cholesterol, triglycerides, AST and ALT. The prevalence of MS was reduced from 35% at baseline to 1.6% after 24 weeks. No patients discontinued the treatment during the study. In patients who experience poor response after BS, liraglutide is well tolerated and promotes significant weight loss, ameliorates cardiometabolic comorbidities, and reduces the prevalence of MS.

Weight Regain and Ingestive Behavior in Women after Metabolic Surgery.

This study investigated associations between maladaptive ingestive behaviors and weight regain in women who underwent metabolic surgery 2-10 years ago. Using a web-based survey, we assessed emotional, external, and restrained eating (Dutch Eating Behavior Questionnaire-DEBQ), food cravings (Food-Craving Inventory-FCI), and other behaviors (e.g., Eating Disorder Examination Questionnaire-EDE-Q; Alcohol Use Disorder Identification Test-Concise-AUDIT-C) in 36 women (42.9 ± 9.5 years old) post-surgery. We found that weight regain was specifically associated with increased frequency of cravings for sweets (r = 0.43), higher global scores in the EDE-Q (r = 0.38), and time elapsed since surgery (r = 0.35; all p's < 0.04). Multiple regression analysis revealed that the association between weight regain and sweet cravings interacted with time after surgery (p = 0.04), with the strongest association observed in women assessed closer to the surgery (i.e., 2.0-2.8 years). The combination of time after surgery and its interaction with sweet cravings accounted for 31% of the individual variations in weight regain (p = 0.005). Notably, among participants who reported alcohol consumption (31 of 36), 55% had an AUDIT-C score indicating hazardous drinking. These findings highlight the relevance of attending to patients' reports of frequent sweet cravings and screening for alcohol use to enhance strategies tailored to prevent weight regain and alcohol-related health problems post-surgery.

Comparative analysis of sleeve conversions of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2020 Database

BackgroundAlthough the sleeve gastrectomy (SG) is the dominant bariatric procedure, studies have shown conversion rates of up to 30%. These conversions are generally for weight regain (WR), insufficient weight loss (IWL) or gastroesophageal reflux disease (GERD). Before 2020, details on why conversions were being performed were not collected in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File (PUF). Now, the indication for sleeve conversion is noted in the PUF, allowing identification and reporting sleeve conversion reasons. ObjectiveWe aimed to examine the reasons for SG conversions nationwide. SettingThe 2020 MBSAQIP PUF. MethodsThe 2020 MBSAQIP PUF was examined to determine the reasons why SG were converted to other operations. The data field of “Revision/Conversion Final Indication” was used along with “Procedure type.” Primary bariatric operations were excluded. Descriptive statistics were applied. Different reasons for conversion and operations were compared by preoperative characteristics and operative outcomes. ResultsThere were 103,782 primary SG reported in the 2020 PUF. There were 7181 SG that were converted to other operations. The most common conversion (86.2%) was to Roux-en-Y gastric bypass (RYGB). The main reason for SG conversion was GERD at 48.4%, followed by WR/IWL (41.9%). Biliopancreatic diversion with duodenal switch and single-anastomosis duodenoileal bypass with sleeve patients differed significantly from RYGB patients in specific preoperative characteristics and operative outcomes. ConclusionThe most common procedure SG is converted to is the RYGB. GERD was the most common reason for SG conversion, followed by WR/IWL.

Exploratory analysis of reflective, reactive, and homeostatic eating behaviour traits on weight change during the 18-month NoHoW weight maintenance trial

Behaviour change interventions for weight management have found varied effect sizes and frequent weight re-gain after weight loss. There is interest in exploring whether differences in eating behaviour can be used to develop tailored weight management programs. This secondary analysis of an 18-month weight maintenance randomised controlled trial (RCT) aimed to investigate the association between individual variability in weight maintenance success and change in eating behaviour traits (EBT). Data was analysed from the NoHoW trial (Scott et al., 2019), which was designed to measure processes of change after weight loss of ≥5% body weight in the previous year. The sample included 1627 participants (mean age = 44.0 years, SD = 11.9, mean body mass index (BMI) = 29.7 kg/m2, SD = 5.4, gender = 68.7% women/31.3% men). Measurements of weight (kg) and 7 EBTs belonging to domains of reflective, reactive, or homeostatic eating were taken at 4 time points up to 18-months. Increases in measures of ‘reactive eating’ (binge eating, p < .001), decreases in ‘reflective eating’ (restraint, p < .001) and changes in ‘homeostatic eating’ (unlimited permission to eat, p < .001 and reliance on hunger and satiety cues, p < .05) were significantly and independently associated with concomitant weight change. Differences in EBT change were observed between participants who lost, maintained, or re-gained weight for all EBTs (p < .001) except for one subscale of intuitive eating (eating for physical reasons, p = .715). Participants who lost weight (n = 322) exhibited lower levels of reactive eating and higher levels of reflective eating than participants who re-gained weight (n = 668). EBT domains can identify individuals who need greater support to progress in weight management interventions. Increasing reflective eating and reducing reactive eating may enhance weight management success.

Treatment with Antiobesity Drugs in Weight Regain After Bariatric Surgery: a Retrospective Cohort Study.

Bariatric surgery is the most efficient treatment for obesity. However, in some cases, weight regain can occur. Currently, it is unknown the best antiobesity medication (AOM) for such clinical situation. This study aims to evaluate the effect of AOM in patients with weight regain after bariatric surgery. A retrospective cohort study from December 2010 to July 2019 with patients submitted to bariatric surgery that had weight regain and received AOM for at least 2 years. Of 96 patients that had weight regain in the analyzed period and received AOM, 16 were excluded from the analysis due to non-compliance (n = 7), treatment failure (n = 5), intolerable side effects with all available AOM (n = 2), or interaction with other medications (n = 2). Eighty patients were included in the analysis. The mean age was 59.0 ± 10.1 years, 88.8% were female, 91.2% white, and most of them were submitted to gastric bypass (87.6%). The mean preoperative and nadir weight after surgery were 127.9 ± 25.5 kg and 84.7 ± 22.8 kg, respectively. At the initiation of AOM, the mean baseline weight was 99.4 ± 23.1 kg. After 2 years of follow-up, there was significant weight loss in the groups treated with topiramate-alone (- 3.2 kg), topiramate plus sibutramine (- 6.1kg), and orlistat-alone or in combination (- 3.9kg). No statistical difference was observed in the sibutramine-alone group. Topiramate (alone or associated with sibutramine) and orlistat (alone or in combination) promoted significant weight loss after 2 years of use in patients submitted to bariatric surgery with weight regain.

Management of Leak After Revision of Roux-en-Y Gastric Bypass for Weight Regain by Internal Pigtail Drainage

Management of Leak After Revision of Roux-en-Y Gastric Bypass for Weight Regain by Internal Pigtail Drainage

Patients’ Perspectives on Dietary Patterns and Eating Behaviors During Weight Regain After Gastric Bypass Surgery

PurposeFood quality, energy intake, and various eating-related problems have been highlighted as some of the components influencing weight after bariatric surgery. This study aimed to increase our knowledge of patients’ perspectives on dietary patterns and eating behaviors during weight regain after bariatric surgery.Materials and MethodsWe recruited 4 men and 12 women with obesity and the experience of weight regain after bariatric surgery at an obesity clinic in Stockholm, Sweden. Data were collected during 2018–2019. We conducted a qualitative study, carried out individual semi-structured interviews, and analyzed the recorded and transcribed interview data with thematic analysis.ResultsParticipants had regained 12 to 71% from their lowest weight after gastric bypass surgery performed 3 to 15 years before. They perceived their dietary challenges as overwhelming and had not expected weight management, meal patterns, increasing portion sizes, and appealing energy-dense foods to be problematic after surgery. In addition, difficulties with disordered eating patterns, emotional eating, and increased alcohol intake further contributed to the weight management hurdles. Insufficient nutritional knowledge and lack of support limited participants’ ability to avoid weight regain, leading to restrictive eating and dieting without sustained weight loss.ConclusionEating behavior and dietary factors such as lack of nutritional knowledge, emotional eating, or disorganized meal patterns contribute to difficulties with weight management after gastric bypass surgery. Improved counseling may help patients prepare for possible weight regain and remaining challenges with food and eating. The results highlight the importance of regular medical nutrition therapy after gastric bypass surgery.Graphical

Sustained weight loss with semaglutide once weekly in patients without type 2 diabetes and post-bariatric treatment failure.

About 20%-25% of patients experience weight regain (WR) or insufficient weight loss (IWL) following bariatric surgery (BS). Therefore, we aimed to retrospectively assess the effectiveness of adjunct treatment with semaglutide in patients without type 2 diabetes (T2D) with post-bariatric treatment failure over a 12 months period. Post-bariatric patients without T2D with WR or IWL (n = 29) were included in the analysis. The primary endpoint was weight loss 12 months after initiation of adjunct treatment. Secondary endpoints included change in body mass index, HbA1c, lipid profile, high sensitive C-reactive protein and liver enzymes. Total weight loss during semaglutide treatment added up to 14.7% ± 8.9% (mean ± SD, p < .001) after 12 months. Categorical weight loss was >5% in 89.7% of patients, >10% in 62.1% of patients, >15% in 34.5% of patients, >20% in 24.1% of patients and > 25% in 17.2% of patients. Adjunct treatment with semaglutide resulted in sustained weight loss regardless of sex, WR or IWL and type of surgery. Among patients with prediabetes (n = 6), 12 months treatment led to normoglycemia in all patients (p < .05). Treatment options to manage post-bariatric treatment failure are scarce. Our results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients over a 12 months follow-up period.

Effect of Transoral Outlet Reduction on Hepatic Fibrosis in Roux-en-Y Gastric Bypass Patients with Weight Regain and Non-alcoholic Fatty Liver Disease.

Weight regain after Roux-en-Y gastric bypass (RYGB) is associated with worsening of liver outcomes. However, the effect of transoral outlet reduction (TORe) on liver fibrosis in RYGB patients with weight regain and possible advanced fibrosis remains unknown. This was a retrospective analysis of prospectively collected data of RYGB patients who underwent TORe for weight regain. Only patients with possible advanced fibrosis were included. TORe was performed using either an endoscopic suturing device (S-TORe) or plication device (P-TORe) to reduce the gastrojejunal anastomosis (GJA) and pouch sizes. Primary outcomes included changes in non-invasive tests (NITs) for fibrosis at 6-12months. Secondary outcomes included weight loss and changes in insulin resistance and lipid profile at 6-12months. Fifty RYGB patients were included. Baseline age and BMI were 55 ± 11years and 40.1 ± 7.3kg/m2. Baseline GJA and pouch sizes were 20 ± 7mm and 5 ± 2cm, respectively. Thirty patients (60%) underwent S-TORe and 20 patients (40%) underwent P-TORe. At 12months following TORe, there were statistically significant improvements in NITs for fibrosis, including ALT, AST and FIB-4. There was a trend towards significant improvement in liver stiffness measurement on transient elastography. Patients experienced 8.8 ± 11.2% total weight loss (TWL) (p < 0.0001), with 60% experiencing at least 10% TWL. Additionally, there was a significant improvement in HbA1c and a trend toward significant improvement in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), suggestive of improved insulin sensitivity. TORe is associated with an improvement in hepatic fibrosis in patients with NAFLD and possible advanced fibrosis.

369-OR: Continued Weight Loss with Semaglutide Once-Weekly in Patients without Type 2 Diabetes and Postbariatric Treatment Failure

Purpose: Recently, we published promising retrospective 6-months follow-up data on the effectiveness of semaglutide 0.5mg once-weekly in patients with weight regain (WR) or insufficient weight loss (IWL) following bariatric metabolic surgery (BS). Therefore, we aimed to investigate whether weight loss was sustained over a 12-months period with semaglutide in patients without type 2 diabetes (T2D) with WR or IWL. Materials and Methods: Postbariatric patients without T2D with WR or IWL (n=29) were included in the analysis. The primary endpoint was weight loss 12 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP and liver enzymes. Results: Total weight loss during semaglutide treatment added up to 14.7±8.9% (mean±SD, p&amp;lt;0.001) after 12 months. Categorical weight loss was &amp;gt;5% in 89.7% of patients, &amp;gt;10% in 62.1% of patients, &amp;gt;15% in 34.5% of patients, &amp;gt;20% in 24.1% of patients and &amp;gt;25% in 17.2% of patients. Among patients with prediabetes at baseline (n=6), 12-months treatment led to normoglycemia in all patients (p&amp;lt;0.05). Conclusion: Treatment options to manage postbariatric treatment failure are scarce, weight loss medications are not approved for use in the postbariatric patient population. Our results imply a clear benefit of adjunct treatment with semaglutide in postbariatric patients. Disclosure A.Lautenbach: Other Relationship; Novo Nordisk, Lilly. J.Wagner: None. F.D.Stoll: None. J.Aberle: Advisory Panel; Novo Nordisk, Speaker's Bureau; Novo Nordisk.

Pouch Resizing for Weight Regain after Roux-En-Y Gastric Bypass: Results from a High-Volume Single Center

Abstract Background The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, weight regain is reported in 10-30% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Pouch resizing (PR), the resizing of an enlarged gastric pouch, is commonly performed as a low-risk secondary surgery to stabilize or even reduce the regained weight. However, the effectiveness of PR lacks scientific evidence. Aims To analyze the effect of PR after RYGB on long-term weight loss, course of comorbidities, complication rates and patient satisfaction. Methods Forty-eight patients undergoing PR between January 2016 and December 2020 were included. Data were collected retrospectively from a prospective database. PR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, thirty-seven patients participated in a survey evaluating postoperative patient satisfaction. Results Nadir-weight after RYGB was reached after 26.3 ± 19.4 months; PR was performed after a mean time of 106.2 ± 45.5 months. Mean follow-up after PR was 55.9 ± 18.5 months. Mean BMI before PR was 39 ± 5.4 kg/m2. Mean BMI at 1, 3 and 5 years after PR was 37 ± 5.5 kg/m2, 35 ± 7.6 kg/m2 and 35 ± 7.5 kg/m2 respectively. Obesity-associated comorbidities were resolved in 53% of patients five years after PR. Postoperative complications analog grade ≤2 of the Clavien-Dindo classification occurred in 12.5% while complications grade ≥3 occurred in 10.4% of patients. There was no mortality. The postoperative survey showed high levels of satisfaction after PR. Conclusions PR for weight regain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. PR is thus a valuable option to at least stop weight regain after primary RYGB in well-selected patients leading to high levels of patient satisfaction.

A002 Duodenal-Ileal Diversion with Self-Assembling Magnets in Patients with Inadequate Weight Loss or Weight Regain following Sleeve Gastrectomy: Feasibility and Nine-Month Results

A002 Duodenal-Ileal Diversion with Self-Assembling Magnets in Patients with Inadequate Weight Loss or Weight Regain following Sleeve Gastrectomy: Feasibility and Nine-Month Results

A070 Treatment of Hiatal Hernia, Reflux, and Weight Regain in Patients with Previous Sleeve Gastrectomy

A070 Treatment of Hiatal Hernia, Reflux, and Weight Regain in Patients with Previous Sleeve Gastrectomy