Resolution Of Comorbidities Research Articles

BS SO08 - Prospective audit of weight loss and resolution co-morbidities of various bariatric surgeries and Comparisions of weight loss and ORM resolution between bypass and sleeve-1 years follow up- Audit outcomes from Jan 2019-2023

Abstract Background Bariatric surgery is the gold standard in managing bariatric patients. There are various bariatric surgeries that have been approved. Sleeve gastrectomy is the most common procedure to be done globally. RYGB is considered the gold standard surgery as it gives the best weight loss and comorbidity resolution. OAGB is now a well-established procedure. Other procedures which are offered to the patients are duodenal switch and SADIS. Method We prospectively analysed the patients who underwent bariatric surgery at our center. All the bariatric surgery patients were included. Aim To calculate EBWL at 6 m, 1 year Resolutions of obesity related morbidity Comparision of the outcomes between Sleeve and Bypass Results 1024 patients underwent bariatric surgery. All the patients undergo MDT discussion and the decision of choice of surgery is made based on MDT discussion and patients' preference. For the first 6 months both sleeve and bypass fair equal in terms of weight loss and resolution of comorbidities. Subsequently weight loss is better with bypass. It is also better sustained with the bypass. Resolution of comorbidities is the best within the first 6 months post-surgery. Conclusion There is a direct relationship between weight loss and resolution of co-morbidities. These patients are under follow up for outcomes at 2 years. Results will be published at the time of conference presentation

BS O04 - Audit of outcome of SADIS- Results from a single Bariatric center

Abstract Background SADIS- Single anastomosis Duodeno-ileal switch is a bariatric procedure that has been accepted widely as a bariatric procedure. Literature has shown that it gives good outcomes in terms of weight loss and resolutions of obesity related morbidity. There has been criticism about the nutritional deficiencies associated with SADIS. It is a technically challenging procedure, so it is not extremely popular in the bariatric world where sleeve is the most done procedure and RYGB is the gold standard. Method All the patients at our centre undergo MDT assessment. Based on the MDT discussion and the patient preference, the decision of surgery is made. All the patients who underwent SADIS were included in the study Primary aim: Weight loss at 6 months, 1 year, 2 years and 6-10 years ORM resolution at 6 months, 1 year, 2 years and 6-10 years Nutritional deficiencies in the short term and long term. Results 17 patients underwent SADIS. Average BMI 55, it is higher than the usual BMI cohort, saying that higher BMI patients were offered SADIS as compared to the lower BMIs, who were offered Sleeve, Bypass. The weight loss pattern followed by SADIS patients was more than bypass patients over 6 m, 1 y and 2 y. The SADIS patients had better sustained weightloss over 6-10 y. One crucial factor in patient profile is the ratio of psychological vs physiological co-morbidities is higher than the average; which corresponds to our findings of the feasibility study for bariatric surgery for BMI >65 Conclusion SADIS gives good outcomes in terms of weight loss and resolution of co-morbidities. Long term results with SADI in terms of sustained weight loss are better than bypass. It did not lead to increased nutritional deficiencies.

Gastric Pouch Resizing for Recurrent Weight Gain After Roux-en-Y Gastric Bypass-Does It Have Its Rational?

The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, recurrent weight gain is reported in up to 40% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Gastric pouch resizing (GPR) is performed as a low-risk secondary surgery to cease weight regain. We herewith analyzed the effect of GPR after primary RYGB on long-term weight loss, course of comorbidities, safety, and patient satisfaction. Forty-eight patients undergoing GPR between 2016 and 2020 at the University Hospital of Zurich were included. Data were collected from a prospective database. GPR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, 37 patients participated in a survey to evaluate PROMs (patient-reported outcome measures). GPR followed RYGB after a mean time of 106.2 ± 45.5months at a mean BMI of 39 ± 5.4kg/m2. Mean follow-up was 55.9 ± 18.5months with a mean BMI 1- and 5-years postoperative of 37 ± 5.5kg/m2 and 35 ± 7.5kg/m2, respectively. Obesity-associated comorbidities were resolved in 53% of patients at follow-up (p < 0.05). Minor postoperative complications occurred in 12.5% while major complications occurred in 10.4% of patients. The PROMs showed high levels of satisfaction after GPR. GPR for recurrent weight gain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. It is thus a valuable surgical option in well-selected patients.

Bariatric Surgery in Adolescent Age Group

Obesity in children is a problematic condition which interfere with physical and mental health. It is a complicated disorder with interwoven environmental, genetic, biological components, developmental, and behavioral. A combination of medical treatment and behavioral and lifestyle modifications was typically what causes poor short-term weight loss and long-term failure. For this reason, adolescents who suffer from moderate to severe obesity and have attempted lifestyle interventions in the past but had no success should think about having bariatric surgery. Specifically, laparoscopic sleeve gastrectomy is thought to be the most often carried out bariatric procedure globally. The technique is safe and doable. It has been demonstrated that this surgical weight loss procedure is effective in young patients. However, there are obstacles that need to be removed at the levels of patients, providers, and the healthcare system. Above all, for ensuring successful long-term treatment and permit healthy growth, more should be done to stop the nutritional status decline that frequently follows bariatric surgery, as well as to prevent insufficient weight loss and weight regain. With a focus on LSG, nutritional management, and the resolution of metabolic comorbidities, we examined the clinical indications, surgical treatment options, and outcomes in adolescents with severe obesity in this narrative review.

A Unique Case of Hypervirulent Klebsiella Pneumoniae Invasive Syndrome with Endogenous Endophthalmitis and Left Renal Vein Thrombosis without Liver Abscess.

This case report presents a rare instance of hypervirulent Klebsiella pneumoniae invasive syndrome (KPIS) without hepatic involvement. It highlights an atypical presentation as this syndrome is characterized by liver abscesses. A 54-year-old female of South Asian descent presented to the emergency department with abdominal pain, fever, chills, nausea, and vomiting. Lab investigations showed hyperglycaemia, leukocytosis, and elevated procalcitonin. Imaging revealed bilateral acute pyelonephritis with early abscess formation in the left kidney, bilateral pleural effusions, diffuse multi-lobar consolidations, minimal ascites, and left renal vein thrombosis. The patient was treated as a case of septic shock secondary to hypervirulent K. pneumoniae with complications evolving into acute pyelonephritis and endogenous endophthalmitis. K. pneumoniae, known for its polysaccharide capsule, can lead to severe complications in immunocompromised patients, such as endogenous endophthalmitis, liver abscess, and pyelonephritis. Endophthalmitis, a critical ocular emergency, can result in permanent vision loss. The patient's ocular outcomes remain uncertain due to a lack of follow-up, but prompt interdisciplinary intervention led to the resolution of other comorbidities. This case highlights the importance of considering hypervirulent K. pneumoniae as a cause of severe infection without liver abscess. It also underscores the importance of immediate multidisciplinary management to address the systemic complications associated with this infection and the importance of connecting different symptoms to one aetiology. Klebsiella pneumoniae invasive syndrome (KPIS) should be considered in patients with positive Klebsiella pneumoniae infection affecting more than one organ system.KPIS may present atypically, such as in the absence of liver abscesses and with the presence of thrombosis.Hypervirulent and hypermucoviscous strains of Klebsiella pneumoniae should be considered in cases of KPIS.

Long-Term Weight Loss and Comorbidity Resolution of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass and the Impact of Preoperative Weight Loss on Overall Outcome.

The impact of preoperative weight loss on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported. Understanding this relationship is necessary to guide surgeons toward appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes and comorbidity resolution following LSG and LRYGB and investigates the effect of preoperative variables on long-term outcomes. All patients who underwent LSG and LRYGB (2008-2022) in a tertiary referral centre were followed up prospectively. From 2010, a 12-week intensive preoperative information course (IPIC) became standard practice to optimize preoperative weight loss. Excess weight loss outcomes (EWL≥50% and ≥70%) were compared between LSG and LRYGB using multivariate logistic regression and the effect of preoperative weight loss on weight loss and comorbidity resolution, improvement, and exacerbation were reported. A total of 319 patients (median age: 49y; M:F, 75:244) were included (158 LSG: 161 LRYGB). During follow-up, 260 (81.5%) and 163 patients (51.1%) achieved EWL≥50% and ≥70%, respectively. Those with sustained EWL≥50% and EWL≥70% at the end of follow-up were more likely to have underwent a LRYGB versus a LSG (59.6% vs. 40.4%, P=0.002; 61.7% vs. 38.3%, P<0.001). IPIC and higher preoperative weight loss (HR: 2.59 to 3.72, P<0.001) increased rates of EWL≥50% and EWL70% for both procedures. Improvement or resolution of type-2 diabetes were significant (72.7%), but up to 27.3% of patients developed or suffered an exacerbation of a psychiatric illness. Excess weight loss outcomes are similar for LSG and LRYGB but LRYGB results in higher rates of sustained excess weight loss during long-term follow-up. Preoperative weight loss improves long-term weight loss. Comorbidity resolution is significant but rates of psychiatric illness exacerbation are high following metabolic and bariatric surgery.

Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study.

Obesity is a chronic disease that is significantly linked to metabolic syndrome. Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have demonstrated the overall cost effectiveness of bariatric surgery; however, there is little data regarding direct pharmaceutical costs. The objective of this population-based study is to compare the cost of dispensed common prescription medications for metabolic syndrome before and after bariatric surgery. All patients that were enrolled in the Center for Metabolic and Bariatric Surgery who underwent gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Basic demographic information and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy. Specific drug categories that were reviewed for costs 5years before and after surgery included Antihypertensives, Lipid Lowering Agents, Insulin and Non-insulin Diabetic Drugs. One thousand one hundred and eighty four patients were included in this review. Comparing the 5-yearpre- and post-surgery, there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the 5years following surgery. These categories included Antihypertensives ($506,268.8), Lipid Lowering Agents ($173,866.48), Insulin ($549,305.92), and Other Diabetes Drugs ($513,371.1). Additionally, older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30-49year old grouping. This is the first Canadian study to use accurate dispensing data from a provincial administrative prescription database to capture long-term cost savings for metabolic prescriptions after bariatric surgery. The results are consistent with the existing literature for prescriptions post-bariatric surgery. Future study will include subgroup analysis by patient age, gender, income quintile, and geography.

Metabolic and bariatric surgery outcomes in adolescents: a single center's seven-year update.

Metabolic and bariatric surgery (MBS) is gaining traction as a treatment option for adolescents with severe obesity. Since our weight center last published results in 2014, trends have shown increasingly diverse patient populations undergoing MBS and a shift from laparoscopic Roux-en-Y gastric bypass (LRYGB) to sleeve gastrectomy (LSG). We assessed outcomes including follow-up, weight loss, comorbidity resolution, and complications among our recent adolescent and young adult MBS patients. This is a retrospective cohort analysis of patients under 21years of age with severe obesity who underwent MBS at a single institution between 2014 and 2020. Data on demographics, comorbidities, body mass index (BMI), percent of total body weight loss (%TBWL) at various timepoints, and subsequent complications were collected via chart review. Regression examined associations between preoperative factors, follow-up, and %TBWL. There were 79 patients of whom 73% were female; overall, 53% were White, 24% Hispanic, and 15% non-Hispanic Black. The majority (80%) of patients underwent LSG. Three-fourths of patients had follow-up data beyond 1year, and half beyond 3years. The median %TBWL of LSG patients was 23% at a median follow-up of 3.0years, and LRYGB patients 28% at 2.4years. No preoperative factors were associated with follow-up or final %TBWL, but 6-month %TBWL predicted final %TBWL. Preoperatively, 73% of patients had at least one weight-related comorbidity, and 57% had documented improvements in at least one after surgery. There were three 30-day readmissions and no mortalities. This study, which is an update to a previous series from our center, reflects recent national trends with nearly half non-White patients and predominance of LSG over LRYGB. It adds to a growing body of evidence indicating that MBS is a safe and effective method of achieving weight loss and comorbidity resolution in adolescents with severe obesity.

Use of liraglutide after bariatric surgery: a 36-month follow-up in a real-world setting in Chile.

Bariatric surgery has several benefits, including sustainable weight loss and improvement or resolution of metabolic comorbidities. However, despite initially successful weight loss, weight regain occurs during long-term follow-up, and many patients are unable to reach or maintain their target weight goals. Liraglutide is a therapy for obesity aimed at preventing weight regain. This retrospective, observational, single-arm, pre-post study was performed to analyze the relative change in body weight among patients receiving liraglutide after bariatric surgery in a real-world setting in Chile. Treatment with liraglutide at a median dose of 1.2 mg was associated with a mean weight loss from baseline to 3, 6, 12, 24, and 36 months of 5%, 7.7%, 7.6%, 5.8%, and 5.1%, respectively. The mean body mass index reduction was 14.8% at 36 months. Dropout rates were consistent with those of usual obesity treatments. Overall, 70% of the patients were receiving other weight-loss drugs. Liraglutide was well tolerated, but cost barriers led to several patients interrupting its use. Liraglutide is an effective and safe treatment for weight reduction after bariatric surgery in patients receiving routine clinical care in Chile.

Comparable improvement and resolution of obesity-related comorbidities in endoscopic sleeve gastroplasty vs laparoscopic sleeve gastrectomy: single-center study.

Despite excellent surgical outcomes, a minority of qualified patients undergo weight loss surgery. Endoscopic Sleeve Gastroplasty (ESG), an incisionless procedure, has proven to be effective in achieving weight loss and comorbidity improvement. We aim to compare outcomes of ESG to those of Laparoscopic Sleeve Gastrectomy (LSG). A retrospective review of a prospective database of patients who underwent ESG and LSG at NorthShore University HealthSystem from 2016 to 2023 was completed. Demographic and outcome data were analyzed. Pre- and post-surgical data were compared using chi-square and two-sample t tests. Improvement or resolution of obesity-related comorbidities were also assessed. A total of 212 LSG and 68 ESG patients were reviewed. ESG patients were older (47 ± 10 vs. 43 ± 12, p = 0.006) and less obese (BMI 37.0 ± 5.5 vs. 45.8 ± 0.4, p < 0.001) than LSG patients. Median length of stay after ESG was 0days and after LSG 1day (p < 0.001). Severe adverse events were seen less frequent after ESG (1.47%, vs 3.77%). LSG achieved more significant %TBWL at 6 months (25.2 ± 8.9 vs 14.9 ± 7.4), 1 year (27.5 ± 10.8 vs 14.1 ± 9.8), and 2 years (25.7 ± 10.8 vs 10.5 ± 8.8, all p < 0.001) after surgery when compared to ESG. LSG achieved significantly greater %EWL compared to ESG at 6 months (57.0 ± 20.7 vs 50.4 ± 29.2, p = 0.137), 1 year (61.4 ± 24.6 vs 46.5 ± 34.0, p = 0.026), and 2 years postoperatively (59.7 ± 25.5 vs 32.6 ± 28.2, p = 0.001). There were no statistically significant differences in rates of improvement or resolution of diabetes, obstructive sleep apnea, hyperlipidemia, or hypertension. ESG is an effective procedure for weight loss and comorbidity resolution. Obesity-related comorbidities are comparably improved and resolved following ESG vs LSG. Although the weight loss in LSG is significantly higher, patients can expect a shorter hospital length of stay and a lower rate of complications after ESG. ESG continues to show promise for long-term weight loss and improvement in health.

Does the length of bypassed bowel during distal gastric bypass affect weight loss?

Weight recurrence (WR) affects > 20% of patients following Roux-en-Y gastric bypass (RYGB). Shortening of the common channel (CC) after RYGB (distal bypass) has been proposed for additional weight loss in patients with WR, but results vary, and concerns for vitamin deficiencies/malnutrition exist. Our aim was to determine whether the percentage of bowel bypassed after distal bypass is associated with the amount of postoperative weight loss. Patients undergoing distal bypass between 2018 and 2022 were reviewed. Small bowel limb lengths before and after distal bypass were measured, and the percentage of bypassed bowel was calculated (= bypassed biliopancreatic limb/total small bowel length). Patients were dichotomized into two groups based on the percentage bypassed bowel (≤ 50% vs. > 50%). Weight loss (measured as excess BMI loss; EBIL%), comorbidities resolution, complications, and nutritional deficiencies were reviewed. Thirty female patients underwent distal bypass during the study period. After distal bypass, the Roux was lengthened to 150cm (75-175cm) from 75cm (20-200cm), and the CC shortened to 150cm (100-310cm) from 510cm (250-1000cm). These changes resulted in an increase in the size of the bypassed biliopancreatic limb from 40cm (15-90cm) to 330cm (180-765cm) and a total alimentary limb (TALL; Roux + CC) shortening from 590cm (400-1075cm) to 300cm (250-400cm). The group with > 50% bowel bypassed had higher EBIL%. Overall EBIL% was 36.9 ± 14.7%, 53.3 ± 25.6%, and 62.1 ± 36.9% at 0.5, 1, and 2years, respectively. There were minimal vitamin deficiencies. Diabetes resolved in 100% (n = 3/3), HTN in 67% (n = 10/15), and GERD in 73% (n = 11/15). Complication rate was 23%. No reintervention for malnutrition or vitamin deficiencies was required. Distal bypass effectively leads to considerable weight loss and comorbidity improvement in patients with WR after RYGB, but the amount of weight loss depends on the percentage of bypassed bowel. An exact threshold of bypassed bowel that optimizes weight loss outcomes and simultaneously minimizes the nutritional complications needs to be determined. Meanwhile, close monitoring for vitamin deficiencies is recommended.

The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study.

Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) hadRoux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.

Preoperative nonalcoholic steatohepatitis and resolution of metabolic comorbidities after bariatric surgery

BackgroundMost patients undergoing bariatric surgery demonstrate elements of the metabolic syndrome (MetS) and can therefore be diagnosed with metabolically unhealthy obesity (MUO). Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) as hepatic manifestations of the MetS occur in many patients with obesity, but their leverage on postoperative improvement to Metabolic Health (MH), defined as absence of any metabolic comorbidity, remains unclear. ObjectivesThe aim of this study was to assess the influence of liver health status, operative procedure, and sex on postoperative switch from a MUO to an MH phenotype. Secondary objective was weight loss to MH. SettingUniversity Hospital, Germany. MethodsPatients who underwent either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at our obesity surgery center were included in this retrospective study. Liver biopsy was taken and evaluated for presence of NAFLD/NASH. For diagnosis of MH, blood pressure and laboratory values referring to the MetS were assessed preoperatively and at 3, 6, 12, and 24 months’ postoperatively. ResultsOne hundred thirty-three patients (73% female) with a mean body mass index of 52.0 kg/m2 and mean age of 43 years were included in this study. A total of 55.6% underwent RYGB and 44.4% underwent SG. NAFLD was found in 51.1% of patients and NASH in 33.8%. All patients were diagnosed MUO at baseline. Postoperatively, 38.3% patients (n = 51) switched to a MH condition. Mean time to MH was 321 days and mean excess body mass index loss to MH was 63.8%. There were no differences regarding liver health status, operative procedure, or sex. ConclusionsBariatric surgery can resolve MUO independent of liver health status, operative procedure, and sex. However, patients should be closely monitored to ensure sustainable long-term outcomes following the switch to the MH condition.

COMPARATIVE EFFECTIVENESS OF DIFFERENT BARIATRIC PROCEDURES ON WEIGHT LOSS AND COMORBIDITIES

Bariatric surgery has revolutionized the treatment of severe obesity, providing not only significant and sustained weight loss but also improvements in obesity-related comorbidities. Objective: The study's main objective is to compare the effectiveness of different bariatric procedures on weight loss and comorbidities. Methods: This retrospective cohort study was conducted at MTI Lady Reading Hospital Peshawar from 2019 to 2023. Data were collected from 91 patients who wanted weight loss. Participants aged &gt;18 years, with a body mass index (BMI) of 40 or higher or a BMI of 35 or higher accompanied by significant obesity-related comorbidities such as type 2 diabetes, hypertension, or obstructive sleep apnea, were included in the study. All included patients underwent one of the four bariatric procedures. Results: The study included 91 patients who underwent various bariatric procedures at MTI Lady Reading Hospital between 2019 and 2023. The mean age of participants was 42.38 ± 2.35 years. The gender distribution comprised 55 females (60%) and 36 males (40%). The patients' mean preoperative body mass index (BMI) was 45.2 ± 3.01 kg/m². Biliopancreatic diversion with duodenal switch (BPD/DS) demonstrated the highest effectiveness, with an average %EWL of 78% at three years and the highest resolution rates for type 2 diabetes (95%), hypertension (90%), and obstructive sleep apnea (85%). Roux-en-Y gastric bypass (RYGB) also showed substantial weight loss and comorbidity resolution, achieving an average %EWL of 68% at three years. Conclusion: It is concluded that bariatric surgery is a highly effective intervention for achieving significant weight loss and resolving obesity-related comorbidities. Among the procedures studied, biliopancreatic diversion with duodenal switch (BPD/DS) demonstrated the highest effectiveness, with substantial weight loss and resolution rates for type 2 diabetes, hypertension, and obstructive sleep apnea.

Precision medicine for obesity: current evidence and insights for personalization of obesity pharmacotherapy.

Obesity is a chronic and complex disease associated with increased morbidity, mortality, and financial burden. It is expected that by 2030 one of two people in the United States will have obesity. The backbone for obesity management continues to be lifestyle interventions, consisting of calorie deficit diets and increased physical activity levels, however, these interventions are often insufficient to achieve sufficient and maintained weight loss. As a result, multiple patients require additional interventions such as antiobesity medications or bariatric interventions in order to achieve clinically significant weight loss and improvement or resolution of obesity-associated comorbidities. Despite the recent advances in the field of obesity pharmacotherapy that have resulted in never-before-seen weight loss outcomes, comorbidity improvement, and even reduction in cardiovascular mortality, there is still a significant interindividual variability in terms of response to antiobesity medications, with a subset of patients not achieving a clinically significant weight loss. Currently, the trial-and-error paradigm for the selection of antiobesity medications results in increased costs and risks for developing side effects, while also reduces engagement in weight management programs for patients with obesity. The implementation of a precision medicine framework to the selection of antiobesity medications might help reduce heterogeneity and optimize weight loss outcomes by identifying unique subsets of patients, or phenotypes, that have a better response to a specific intervention. The detailed study of energy balance regulation holds promise, as actionable behavioral and physiologic traits could help guide antiobesity medication selection based on previous mechanistic studies. Moreover, the rapid advances in genotyping, multi-omics, and big data analysis might hold the key to discover additional signatures or phenotypes that might respond better to a certain intervention and might permit the widespread adoption of a precision medicine approach for obesity management.

Sacred Sharing Circles: Urban Indigenous Experience with Bariatric Surgery in Manitoba.

Obesity and type 2 diabetes (T2DM) are growing global health concerns. A disproportionate number of Indigenous Peoples live with obesity and its complications. Bariatric surgery offers superior weight loss and comorbidity resolution when compared to medical management. There is a paucity of literature regarding the experiences of Indigenous Peoples undergoing bariatric surgery. The aim of this study was to employ two-eyed seeing and a decolonizing approach to explore the experiences of urban Indigenous bariatric surgery patients. An Indigenous Advisory Committee guided the conception and design of the study. Four urban Indigenous bariatric surgery patients with T2DM participated in two sequential sharing circles and individual interviews facilitated by an Elder. Audio transcripts were analyzed for emerging themes using inductive thematic analysis. Themes generated from shared participant experiences and knowledge included the following: (1) Experiencing hardship or challenges; (2) Reflecting on the importance of supports; (3) Understanding relationships with food; and (4) Healing and recovery. Overall, the participants described a generally positive experience with the bariatric pathway. Participants also described varied connectedness to their Indigenous identity but uniformly expressed interest in more culturally diverse supports such as sharing circles, access to an elder, and Indigenous peer mentorship. Indigenous Peoples have strong motivators for pursuing bariatric surgery and desire access to culturally relevant supports. Suggestions for program improvement included offering sharing circles, providing access to an elder, and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric surgery experiences of Indigenous Peoples in Canada.

Long-Term Effectiveness and Outcomes of Bariatric Surgery: A Comprehensive Review of Current Evidence and Emerging Trends.

Obesity is a global epidemic associated with an increased risk of severe health conditions such as type 2 diabetes, cardiovascular diseases, and certain cancers. Bariatric surgery has become a pivotal treatment for severe obesity, offering significant improvements in weight loss and comorbidity resolution. This comprehensive review aims to assess the long-term effectiveness and outcomes of various bariatric surgical procedures, highlighting current evidence and emerging trends in the field. We extensively reviewed the literature, including randomized controlled trials, cohort studies, and meta-analyses, to evaluate long-term weight loss, resolution of obesity-related comorbidities, quality of life (QoL), and complications associated with different bariatric procedures. Bariatric surgery has demonstrated substantial and sustained weight loss over the long term, with varying degrees of effectiveness among different procedures. Gastric bypass and sleeve gastrectomy are associated with significant improvements in comorbidities such as type 2 diabetes and hypertension. QoL outcomes are generally positive, improving physical health, mental well-being, and social functioning. However, long-term complications, including nutritional deficiencies and the need for reoperations, remain challenges. Emerging trends such as minimally invasive techniques and nonsurgical interventions show promise in enhancing patient outcomes. Bariatric surgery remains a highly effective intervention for managing severe obesity and its related health issues. While long-term outcomes are generally favorable, continued advancements in surgical techniques and postoperative care are crucial for optimizing results and minimizing complications. Future research should focus on personalized approaches to patient management and the development of novel treatment modalities to further improve outcomes in the long term.

Effects of Very Low-Calorie Diet versus Roux-en-Y Gastric Bypass Surgery on Body Composition in Patients with Obesity.

Roux-en-Y gastric bypass (RYGB) is the most effective treatment for severe obesity. A very low-calorie diet (VLCD) is another effective dietary intervention to treat obesity. This study evaluated the effect of a VLCD versus RYGB on weight reduction, changes in body composition and the resolution of comorbidities during a 12-week period. Individuals with obesity at the obesity clinic, Ramathibodi Hospital, Mahidol University, Thailand with a body mass index (BMI) ≥ 37.5 kg/m2 or ≥32.5 kg/m2 with obesity-related complications were recruited. Treatment options, either RYGB or VLCD, were assigned depending on patients' preferences and physicians' judgment. The analysis included 16 participants in the RYGB group and 15 participants in the VLCD group. Baseline characteristics were similar between groups; nevertheless, the participants in the VLCD group were significantly younger than those in the RYGB group. The number of patients with type 2 diabetes (T2D) was slightly higher in the RYGB group (43.8% vs. 33.3%, p = 0.552). Additionally, patients in the RYGB group had a longer duration of T2D and were treated with anti-diabetic agents, while VLCD patients received only lifestyle modifications. At 12 weeks, total and percentage weight loss in the RYGB and VLCD groups, respectively, were as follows: -17.6 ± 6.0 kg vs. -15.6 ± 5.1 kg (p = 0.335) and -16.2% ± 4.3% vs. -14.1% ± 3.6% (p = 0.147). Changes in biochemical data and the resolution of comorbidities were similar between the groups at 12 weeks. A 12-week VLCD resulted in similar weight loss and metabolic improvement compared with RYGB. Large-scale studies with long follow-up periods are needed to elucidate whether VLCD is a viable alternative treatment to bariatric surgery.

Intragastric Balloon as a First Step Before Metabolic Bariatric Surgery in Patients with BMI ≥ 50 kg/m2: are the Results After Balloon Related to Global Outcomes After Surgery?

IntroductionPatients with body mass index (BMI) ≥ 50 kg/m2, classified with obesity class IV/V, require complex treatments. Intragastric balloon (IGB) is a possible treatment before metabolic bariatric surgery (MBS) that may reduce peri-operative complications. This study evaluates IGB outcomes and complications before MBS in patients with Obesity IV/V, and subsequent MBS results, regarding weight loss and comorbidity resolution.MethodsRetrospective cohort study of all patients with BMI above 50 kg/m2 submitted to IGB before MBS between 2009 and 2023 in a high-volume center. Variables analyzed included weight loss after IGB and MBS, IGB complications, and comorbidity resolution. Suboptimal clinical responses were defined as %TWL < 5% for IGB, %TWL < 20% for MBS, and %TWL < 25% or BMI ≥ 35 kg/m2 for IGB + MBS.ResultsSeventy-four patients (mean BMI 58.8 ± 8 kg/m2) were included. After IGB, the mean %TWL was 14.2 ± 8.5%, with a 21.6% complication rate, predominantly nausea and vomiting, and one death. Suboptimal clinical response of IGB affected 13.5% of patients, and 5.4% required early removal. Two years after MBS, the mean %TWL was 38.2 ± 11.6%, mainly due to MBS, yet approximately one-third of %TWL was attributed to IGB. No correlation was found between IGB and MBS outcomes. At 2-year follow-up, 45.1% patients had %TWL ≥ 25 and BMI < 35 kg/m2.ConclusionThe IGB is a treatment option before MBS in patients with Obesity Class IV/V, with acceptable weight loss outcomes but not infrequent complications. A multidisciplinary approach is mandatory, and all treatments must be considered in this difficult subset of patients.Graphical

The Impact of Longer Biliopancreatic Limb Length on Weight Loss and Comorbidity Improvement at 5 Years After Primary Roux-en-Y Gastric Bypass Surgery: A Population-Based Matched Cohort Study

IntroductionDifferent limb lengths are used in Roux-en-Y gastric bypass (RYGB) surgery, as there is no consensus which limb length strategy has the best outcomes. The biliopancreatic limb (BPL) is thought to play an important role in achieving weight loss and associated comorbidity resolution. The objective of this study was to assess the impact of a longer BPL on weight loss and comorbidity improvement at 5 years after primary RYGB.MethodsAll patients aged ≥ 18 years undergoing primary RYGB between 2014–2017 with registered follow-up 5 years after surgery were included. Long BPL was defined as BPL ≥ 100 cm and short BPL as BPL < 100 cm. The primary outcome was achieving at least 25% total weight loss (TWL) at 5 years. Secondary outcomes included absolute %TWL and improvement of comorbidities. A propensity score matched logistic and linear regression was used to estimate the difference in outcomes between patients with long and short BPL.ResultsAt 5 years, long BPL had higher odds to achieve ≥ 25% TWL (odds ratio (OR) 1.19, 95% confidence interval (CI) [1.01 – 1.41]) and was associated with 1.26% higher absolute TWL (β = 1.26, 95% CI [0.53 – 1.99]). Furthermore, long BPL was more likely to result in improved diabetes mellitus (OR = 2.17, 95% CI [1.31 – 3.60]) and hypertension (OR = 1.45, 95% CI [1.06 – 1.99]).ConclusionPatients undergoing RYGB with longer BPL achieved higher weight loss and were more likely to achieve improvement of comorbidities at 5 years.Graphical