Severe Obesity Research Articles

Relations between trajectories of weight loss and changes in psychological health over a period of 2years following bariatric metabolic surgery.

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses. Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression. BMI and HR-QoL improved significantly for all patients from pre-surgery to 24months post-operation, though some patients deteriorated in their outcomes after 12months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories. Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

Sleeve Gastrectomy Versus Semaglutide for Weight Loss in a Severely Obese Minority Cohort: A Propensity-Matched Study.

The rising obesity rates in the USA have led to a surge in various weight loss treatments. Glucagon-like peptide-1 (GLP-1) analogues have shown promise in reducing weight but primarily studied in Caucasian populations. Sleeve gastrectomy (SG) has already proven successful weight loss outcomes. This study aimed to compare the weight loss outcomes between semaglutide and SG in a minority population over a 12-month period. Two separate cohorts of patients were identified through a retrospective review of electronic medical records. The first cohort consisted of patients prescribed semaglutide from January to December 2022, and the second one included patients who underwent SG during the same period. Weight loss was the primary outcome of interest, measured at 3-, 6-, and 12-month post-intervention. Propensity score matching was used to ensure balanced characteristics between the two groups. A total of 206 patients were included; 103 (50%) in the semaglutide group and 103 (50%) in the SG group. The entire cohort consisted mostly in African Americans (67%) and Hispanics (21%). The mean BMI was 55kg/m2 and 56kg/m2 for the SG and semaglutide groups, respectively. The SG group consistently outperformed semaglutide regarding weight loss at all follow-up periods, with the largest difference observed at 12-month post-intervention (total weight loss 32% vs. 2%, p < 0.001). SG led to significantly more weight loss than semaglutide over a 12-month period. Our findings suggesting that GLP-1 agonists might be less effective for weight loss in African American and Hispanic patients with severe obesity warrants further research.

Sleeve Gastrectomy and Gastric Bypass Impact in Patient's Metabolic, Gut Microbiome, and Immuno-inflammatory Profiles-A Comparative Study.

Bariatric surgery is the most long-term effective treatment option for severe obesity. The role of gut microbiome (GM) in either the development of obesity or in response to obesity management strategies has been a matter of debate. This study aims to compare the impact of two of the most popular procedures, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (GB), on metabolic syndrome parameters and gut bacterial microbiome and in systemic immuno-inflammatory response. A prospective observational study enrolled 24 patients with severe obesity, 14 underwent SG and 10GB. Evaluations before (0M) and 6months (6M) after surgical procedures included clinical and biochemical parameters, expression of 17 immuno-inflammatory genes in peripheral blood leukocytes, and assessment of gut microbiome profile using 16s rRNA next-generation sequencing approach. Statistical significance was set to a p value < 0.05 with an FDR < 0.1. A significant and similar decrease in weight-associated parameters and for most metabolic markers was achieved with both surgeries. Considering the gut microbiome in the whole study population, there was an increase in alpha diversity at family-level taxa. Beta diversity between SG and GB at 6M showed near significant differences (p = 0.042) at genus levels. Analysis of the relative abundance of individual taxonomic groups highlighted differences between pre- and post-surgical treatment and between both approaches, namely, a higher representation of family Enterobacteriaceae and genera Veillonella and Enterobacteriaceae_unclassified after GB. Increased expression of immune-inflammatory genes was observed mainly for SG patients. We conclude that SG and GB have similar clinical and metabolic outcomes but different impacts in the gut bacterial microbiome. Results also suggest reactivation of immune response after bariatric surgery.

Associations between circulating amino acids and metabolic dysfunction-associated steatotic liver disease in individuals living with severe obesity.

Metabolic dysfunction-associated steatotic liver disease (MASLD) describes liver diseases caused by the accumulation of triglycerides in hepatocytes (steatosis) as well as the resulting inflammation and fibrosis. Previous studies have demonstrated that accumulation of fat in visceral adipose tissue compartments and the liver is associated with alterations in the circulating levels of some amino acids, notably glutamate. This study aimed to investigate the associations between circulating amino acids, particularly glutamate, and MASLD. In addition, we hypothesized that liver steatosis, concomitant with visceral adiposity, could contribute to the association between circulating glutamate and visceral obesity. We studied a sample of 150 patients living with severe obesity who were non-diabetic and selected to represent a wide range of MASLD severity. Liver histological features were determined by a pathologist from a biopsy sample obtained at the time of bariatric surgery. Bulk RNA sequencing measured the hepatic mRNA expression level of selected genes related to the urea cycle and glutamate metabolism. Fasting plasma amino acid levels were measured by liquid chromatography coupled with tandem mass spectrometry. Patients with more advanced steatosis had larger visceral adipocytes, higher levels of circulating tyrosine, glutamate, and alanine as well as lower levels of serine. MASLD severity was significantly associated with the hepatic mRNA expression of glutamate metabolism genes such as GLS1, GLUL (positively), and NAGS (inversely). In individuals living with obesity, MASLD severity is associated with visceral adipocyte hypertrophy, higher circulating glutamate as well as potential alterations of hepatic amino acid and nitrogen metabolism.

State of precision medicine for heart failure with preserved ejection fraction in a new therapeutic age.

Heart failure with preserved ejection fraction (HFpEF) is defined by heart failure (HF) with a left ventricular ejection fraction (LVEF) of at least 50%. HFpEF has a complex and heterogeneous pathophysiology with multiple co-morbidities contributing to its presentation. Establishing the diagnosis of HFpEF can be challenging. Two algorithms, the 'Heavy, 2 or more Hypertensive drugs, atrial Fibrillation, Pulmonary hypertension, Elderly age >60, elevated Filling pressures' (H2FPEF) and the 'Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology' (HFA-PEFF), can help to determine the likelihood of HFpEF in individuals with symptoms of HF. Phenotype clusters defined largely by the total number and types of co-morbidities may delineate groups of patients with HFpEF with different management needs. It is important to recognize alternative diagnoses or HFpEF mimics such as infiltrative cardiomyopathies, coronary artery disease, lung disease, anxiety, depression, anaemia, severe obesity, and physical deconditioning, among others. Treatment with sodium-glucose co-transporter 2 inhibitors (dapagliflozin and empagliflozin) is recommended for all patients with HFpEF unless contraindicated. Future research should consider alternative approaches to guide the initial diagnosis and treatment of HFpEF, including phenotype clustering models and artificial intelligence, and consider whether LVEF is the most useful distinguishing feature for categorizing HF. Ongoing clinical trials are evaluating novel pharmacological and device-based approaches to address the pathophysiological consequences of HFpEF.

Association Between Cardiometabolic Comorbidity Burden and Outcomes in Heart Failure.

Cardiometabolic comorbidities such as obesity, diabetes, and hypertension are highly prevalent in heart failure (HF). We aimed to examine the association between severity of cardiometabolic comorbidities and hospitalization in patients with HF. In a retrospective electronic health record-based cohort of adults 18 with HF, we categorized individuals based on the number of severe cardiometabolic comorbidities, including hypertension, diabetes, and obesity. Severely uncontrolled comorbidities were defined as systolic blood pressure ≥160 mm Hg, hemoglobin A1c ≥8%, and body mass index ≥35 kg/m2. Cox regression models were used to assess the association between cardiometabolic comorbidity burden and time to all-cause and HF hospitalization at 1 year, adjusting for age, sex, race or ethnicity, and insurance status, smoking, prior hospitalization, and Elixhauser comorbidity index. Stratified analyses were conducted for HF with preserved and reduced ejection fraction. A total of 26 800 individuals with HF (mean age 7513.7, 46% women, 69% White) experienced 4284 (16%) hospitalizations over a 1-year period. Compared with individuals with absent comorbidities, those with 1 or 2 to 3 severely uncontrolled comorbidities had a significantly higher risk of all-cause hospitalization (hazard ratio [HR], 1.23 [95% CI, 1.09-1.39] and HR, 1.57 [95% CI, 1.35-1.83], respectively). We found similar associations for HF hospitalization. These associations were similar among individuals with HF with preserved ejection fraction compared with HF with reduced ejection fraction. Greater cardiometabolic comorbidity burden was associated with increased risk of all-cause hospitalization in HF. This reinforces the role for targeting severely uncontrolled cardiometabolic comorbidities to reduce morbidity in HF.

Peritoneal dialysis in patients with severe obesity: A successful single center experience.

There is growing emphasis on increasing utilization of peritoneal dialysis (PD) in patients with end stage kidney disease (ESKD); however, use in patients with severe obesity has still been fraught for various reasons. We aim to assess the viability of PD in patients with severe obesity (BMI > 40 Kg/m2). We conducted a retrospective chart review of patients admitted at the home dialysis center of an academic center between 2014 and 2020 (n = 99). Patients with a BMI>40 kg/m2 at the time of PD initiation (n = 9) were selected. We extracted and examined the data for these nine patients till March 2023. The mean age at baseline was 47.8 ± 12.6 year, 56% were males, 67% were Hispanic, 33% were white, and mean BMI was 43.3 ± 3.4 kg/m2. By the end of the follow-up of this report, five (56%) patients were still active on PD (mean duration 27.8 ± 4.5 months). PD therapy was terminated in 3 (33%) patients (17.7 ± 6.8 months) due to refractory peritonitis, burnout, transfer to rehabilitation facility, respectively. One patient transferred out to another facility after 10.6 months. Rates of access and mechanical complications as well as peritonitis in these nine patients were similar to center's overall rates. All the patients had elimination of uremic symptoms using incremental prescription and met weekly Kt/V targets of >1.7 using adjusted weight. Overall, patients' weight and glycemic control remained stable. In conclusion, PD can be an effective long-term high-quality dialysis option for patients with ESKD and severe obesity. Further studies in a larger population are required to confirm our findings.

Novel translational mouse models of metabolic dysfunction-associated steatotic liver disease comparable to human MASLD with severe obesity.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease, especially in patients with severe obesity. However, current mouse models for MASLD do not reflect the polygenetic background nor the metabolic changes in this population. Therefore, we investigated two novel mouse models of MASLD with a polygenetic background for the metabolic syndrome. TALLYHO/JngJ mice and NONcNZO10/LtJ mice were fed a high-fat- high-carbohydrate (HF-HC) diet with a surplus of cholesterol diet. A second group of TH mice was additional treated with empagliflozin. After sixteen weeks of feeding, both strains developed metabolic syndrome with severe obesity and histological manifestation of steatohepatitis, which was associated with significantly increased intrahepatic CD8+cells, CD4+cells and Tregs, contributing to a significant increase in pro-inflammatory and pro-fibrotic gene activation as well as ER stress and oxidative stress. In comparison with the human transcriptomic signature, we could demonstrate a good metabolic similarity, especially for the TH mouse model. Furthermore, TH mice also developed signs of kidney injury as an extrahepatic comorbidity of MASLD. Additional treatment with empagliflozin in TH mice attenuates hepatic steatosis and improves histological manifestation of MASH. Overall, we have developed two promising new mouse models that are suitable for preclinical studies of MASLD as they recapitulate most of the key features of MASLD.

Nonlinear Relationship Between Body Mass Index and Liver Transplant Outcomes: A Dose-Response Meta-Analysis.

Weight management was recommended to have more access to transplantation and improve transplant outcomes after liver transplantation (LT). However, the dose-response relationship between body mass index (BMI) and transplant outcomes has not been clearly defined. PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to October 20th, 2019. Dose-response meta-analyses was conducted to establish the dose-response relationship pattern. Twenty-three observational studies were eligible. In the pair-wise analysis, compared with normal BMI, HRs in underweight, overweight, obesity-I, obesity-II, and obesity-III were 2.13, 0.96, 1.06, 1.36, and 1.97 for patient death, and 3.08, 1.02, 1.25, 1.58, and 2.90, for graft loss. In the dose-response analysis, U-shaped relationships were observed between BMI and both patient and graft survival (P < .001, P < .001). Referring to 17.5kg/m2, the patient death risk decreased to 0.72 (95% CI: 0.62-0.84) in 27kg/m2 and then increased to 1.44 (95% CI:1.09-1.90) in 28.7-42kg/m2. Comparing to 17.5kg/m2, individuals in 26.7-28.0kg/m2 had the least risk of graft loss with HR of 0.62 (95% CI:0.48-0.80) and increased to 1.64 (95% CI:1.03-2.61) in 42kg/m2. Subgroup analyses by age, sex, sample size, duration of follow-up, location, publication year, and study type presented similar results. Underweight and severe obesity are associated with a significantly increased risk of graft loss and patient death after liver transplantation. Overweight, especially BMI of 26-28 kg/m2, may have extra survival benefit. Weight management before liver transplantation may be necessary.

Severe obesity, a susceptibility factor for developing inflammatory bowel disease. Results of a population-based study.

Inflammatory bowel disease (IBD) develops in genetically susceptible individuals exposed to certain environmental factors, of which only a few have been established. We aimed to assess whether bariatric surgery (BS) and severe obesity are associated with an increased risk of developing IBD. Adults diagnosed with obesity or severe obesity between 2005 and 2020 were identified from the Catalan Health Surveillance System; those diagnosed with IBD prior to the diagnosis of obesity or severe obesity were excluded. Individuals who had undergone BS and those with a new diagnosis of IBD were identified and their likelihood of developing IBD was analysed. A total of 93,473 individuals with severe obesity, 1,009,256 with obesity and 14,698 who underwent BS were identified. The incidence rates of IBD among individuals who had undergone BS prior to IBD diagnosis was 0.84 cases per 1000 person-years, 0.90 cases per 1000 person-years among individuals with severe obesity without BS and 0.60 cases per 1000 person-years in individuals with obesity. In the multivariable regression analysis, severe obesity (HR 1.46; 95%CI 1.31-1.62), BS (HR 1.57; 95%CI 1.25-1.97) and smoking habit (HR 1.57; 95%CI 1.46-1.69) were risk factors for developing IBD (as well as for Crohn's disease and ulcerative colitis). Conclusions: Severe obesity and BS were independent risk factors for the development of IBD. Non-invasive screening for IBD seems to be warranted in this population.

Proteomic Profiling Reveals Alterations in Metabolic and Cellular Pathways in Severe Obesity and Following Metabolic Bariatric Surgery.

In this study, we investigated the impact of bariatric surgery on the adipose proteome to better understand the metabolic and cellular mechanisms underlying weight loss following the procedure. A total of 46 patients with severe obesity were included, with samples collected both before and after bariatric surgery. Additionally, 15 healthy, non-obese individuals who did not undergo surgery served as controls and were studied once. We utilized quantitative liquid chromatography tandem mass spectrometry analysis to conduct a large-scale proteomic study on abdominal subcutaneous biopsies obtained from the study participants. Our proteomic profiling revealed that among the 2254 compared proteins, 46 were upregulated, and 34 were downregulated 6 months post-surgery compared to baseline (FDR < 0.01). We observed a downregulation of proteins associated with mitochondrial integrity, amino acid catabolism, and lipid metabolism in the patients with severe obesity compared to the controls. Bariatric surgery was associated with an upregulation in pathways related to mitochondrial function, protein synthesis, folding and trafficking, actin cytoskeleton regulation, and DNA binding and repair. These findings emphasize the significant changes in metabolic and cellular pathways following bariatric surgery, highlighting the potential mechanisms underlying the observed health improvements post-bariatric surgery. The data provided alongside this paper will serve as a valuable resource for the development of targeted therapeutic strategies for obesity and related metabolic complications.

Nutritional Status of 8,128,014 Chilean and Immigrant Children and Adolescents Evaluated by the National Board of School Aid and Scholarships (JUNAEB) Between 2013 and 2023.

Nutritional issues, including overweight and obesity, along with the rising number of immigrants facing their own nutritional problems, continue to keep Chile on alert. To evaluate the epidemiological and nutritional status changes among Chilean and immigrant boys, girls, and adolescents (BGA) in schools evaluated by the National Board of School Aid and Scholarships (JUNAEB) from 2013 to 2023. This descriptive study analyzed individual, anonymous, and de-identified data on the nutritional status of BGA in pre-kindergarten, kindergarten, first grade, fifth grade, and the first year of high school using the JUNAEB Nutritional Map. The sample consisted of 8,128,014 BGA, 49.2% women and 50.8% men. In 2013, immigrant BGA represented 0.4% of the total number of children evaluated, and by 2023, this percentage increased to 7.9%. It was observed that Chilean BGA had a lower proportion of thinness, risk of thinness, stunting, and normal weight, but a higher proportion of overnutrition compared to immigrants, similar to observations made during the COVID-19 pandemic. Comparisons by sex showed that Chilean and immigrant women had a lower percentage of thinness, risk of thinness, obesity, severe obesity, and stunting, and a higher proportion of normal weight when compared to men. The rise in immigrant BGA within the Chilean school system, together with the nutritional differences between both groups, highlights the need to consider these particularities when designing nutritional public policies in the health and education sectors.

Genomic deletions on 16p11.2 associated with severe obesity in Brazil

Genomic deletions on 16p11.2 associated with severe obesity in Brazil

Treatment of patients with tumor/treatment-related hypothalamic obesity in the first two years following surgical treatment or radiotherapy

Survivors of sellar/suprasellar tumors involving hypothalamic structures face a risk of impaired quality of life, including tumor- and/or treatment-related hypothalamic obesity (TTR-HO) defined as abnormal weight gain resulting in severe persistent obesity due to physical, tumor- and/or treatment related damage of the hypothalamus. We analyze German claims data to better understand treatment pathways for patients living TTR-HO during the two years following the index surgical treatment. A database algorithm identified patients with TTR-HO in a representative German payer claims database between 2010 and 2021 (n = 5.42 million patients). Claims from 37 patients with TTR-HO were analyzed on a quarterly basis over 2 years. The analysis considered inpatient, outpatient, and prescription data. In the follow-up period, patients with TTR-HO are hospitalized 3.68 times on average; 37% of hospitalizations in year 1 and 31% in year 2 are due to TTR-HO. On average, patients see a general practitioner 12.27 times and various specialists 20.45 times. The need for complex neuroendocrine therapy develops quickly, with most patients having 2–3 neuroendocrine prescriptions in any given quarter. The management of patients with TTR-HO requires frequent inpatient and outpatient visits for tumor follow-up and management of incident comorbidities, and most patients with TTR-HO require intense polytherapy.

Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques, and Surgical Outcomes.

Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique, and outcomes of RYGB reversal remain scarce. We identified 48 cases of RYGB reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010 and 2024 in high-volume referral centers in Europe and USA. Data were collected on body weight, associated diseases, and on surgical outcomes up to 1-year postoperatively. Patients were mainly female (81.3%) with a median age of 50 years (IQR 39-56). RYGB reversal was performed 7 years (median) after primary RYGB in patients with a BMI of 23.9 kg/m2 (IQR 20-27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%), and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3%, and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I-II, 16.7% grade III-IV complications, and one death. At 1 year, the mean BMI of the cohort increased by 18% to 28.25 kg/m2; only 1 patient reached pre-RYGB BMI. Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.

Exploration of motivation to be physically active among overweight adolescents in Switzerland.

Motivation plays an important role in the field of medicine, as it significantly influences behavior change, such as becoming more physically active. This study aimed to investigate the role of motivation in engagement in a physical activity and its impact on quality of life for adolescents suffering from obesity. We assessed the time dedicated to physical activities, the type of motivation, and the relationship between those factors and their quality of life. Seventy-two adolescents aged 12-18 years (51% girls) participated in the study. Fifteen percent of the sample (11/72) were overweight, 56% (n = 40) were affected by obesity and 29% (n = 21) by severe obesity. We found that adolescents were mostly driven to engage in physical activity by self-determined motivation, but those affected by severe obesity were more motivated by external factors. Moreover, there was a disparity in physical activity engagement between genders, with boys being more active than girls. Finally, our data demonstrated that physical exercise contributed to improving quality of life of our population. This study demonstrates that self-determined motivation plays a significant role in promoting physical activity among adolescents with overweight or obesity, with notable differences between genders. Encouraging intrinsic motivation can improve physical functioning and quality of life.

Orthopedia regulates melanocortin 4 receptor transcription and energy homeostasis.

Disruption of hypothalamic melanocortin 4 receptors (MC4Rs) causes obesity in mice and humans. Here, we investigated the transcriptional regulation of MC4R in the hypothalamus. In mice, we show that the homeodomain transcription factor Orthopedia (OTP) is enriched in MC4R neurons in the paraventricular nucleus (PVN) of the hypothalamus and directly regulates Mc4r transcription. Deletion of Otp in PVN neurons during development or adulthood reduced Mc4r expression, causing increased food intake and obesity. In humans, four of the five carriers of rare predicted functional OTP variants in UK Biobank had obesity. To explore a causal role for human OTP variants, we generated mice with a loss-of-function OTP mutation identified in a child with severe obesity. Heterozygous knock-in mice exhibited hyperphagia and obesity, reversed by treatment with an MC4R agonist. Our findings demonstrate that OTP regulates mammalian energy homeostasis and enable the diagnosis and treatment of individuals with obesity due to OTP deficiency.

Role of Endoluminal Functional LumenImaging Probein Bariatric Surgery and Bariatric Endoscopy.

Obesity is associated with significant morbidity, with an estimated prevalence of 42.4% in the USA. Treatment of severe obesity often involves Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. More recently, endoscopic sleeve gastroplasty has emerged as a minimally invasive option for patients with mild to moderate obesity. Endoluminal functional luminal impedance planimetry (EndoFLIP) uses impedance planimetry to assess tissue distensibility and geometric changes across an area but its role in bariatric surgery and bariatric endoscopy has not been fully elucidated. EndoFLIP has some utility in measuring gastric sleeve pouch size during sleeve surgery, assessing gastric sleeve stenosis, predicting the risk of post-sleeve GERD and response to endoscopic dilation, assisting in intraoperative gastric bands adjustment, and evaluating gastrojejunal anastomosis to predict weight regain after gastric bypass.

Immunometabolic Changes Following Gastric Bypass and Sleeve Gastrectomy: A Comparative Study.

Immunometabolism is the interaction between immune system and nutrient metabolism. Severe obesity is considered a state of meta-inflammation associated with obesity that influences the development of chronic-degenerative diseases. We aimed to establish the immunometabolic differences in bariatric patients and to determine whether cellular immunity is associated with metabolic changes. We conducted an observational study in patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). We explored the differences in the immunometabolic profile before and after surgery in the study group, by surgical technique, and we evaluated the changes in immunological variables as a function of metabolic variables with correlation analysis. The follow-up rate was 88.7%. After the intervention, there were changes in cellular immunity, with a decrease in effector T lymphocytes (CD8+CD28-) and an increase in B lymphocytes, memory helper T cells, and cytotoxic T lymphocytes. LSG resulted in a greater decrease in (CD4+CD62-) T lymphocytes compared with LRYGB. Patients who underwent surgery with LRYGB presented greater clinical and metabolic improvements, as well as improvement of obesity-associated medical problems. Women who underwent LRYGB showed a greater reduction in fat-free mass compared with women who underwent LSG. Bariatric surgery, mainly LRYGB, leads to immunometabolic changes and improves associated medical problems.

Early Reinitiation of Obesity Pharmacotherapy Post Laparoscopic Sleeve Gastrectomy in Youth: A Retrospective Cohort Study.

Bariatric surgery is the most effective intervention for severe pediatric obesity, but a subset of youth experience suboptimal weight loss and/or recurrent weight gain. Early re-initiation ofobesity pharmacotherapy postoperatively may improve outcomes, though this has not been evaluated in pediatric populations. A retrospective cohort study at a tertiary care children's hospital evaluated the safety and efficacy of reintroducing obesity pharmacotherapy within six weeks afterlaparoscopic sleeve gastrectomy (LSG). Youth were offered obesity pharmacotherapy reinitiation at their 2-week postoperative visit. The study compared outcomes between 25 youth who chose early obesity pharmacotherapy reinitiation and 21 who received standard care without restarting medication. Primary outcomes included weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions. Between November 2023 and July 2024, 53 youth had surgical consults, and 46 (86% conversion rate; mean age 16.5 ± 1.9years, mean BMI 53 ± 9.7kg/m2; 70% (32/46) female, 80% (37/46) Hispanic, 87% (40/46) publicly insured) underwent LSG, with 93% (43/46) using obesity pharmacotherapy preoperatively. Mixed-effects multivariate regression, adjusting for baseline BMI, age, and sex, revealed that early reinitiation (5.1weeks [IQR 3.7, 8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6months compared to standard care, with no significant differences in complications or readmissions. At 6months, the mean differences were: %BMI: -6.5% (95% CI: -9.13, -3.86), p < 0.001; %TWL: -5.9% (95% CI: -8.52, -3.25), p < 0.001; %EWL: Reinitiators: -45.5% vs. standard care: -39.4%; meandifference: -8.2% (95% CI: -14.69, -1.63), p < 0.001. Early reinitiation also resulted in a significant reduction in emotional overeating at 3 and 6months compared to standard care, with mean differences of -2.5points (95% CI: -3.29, -1.76), p < 0.001, and -3.5points (95% CI: -4.38, -2.69), p < 0.001, respectivelyon self-reported eating behavior questionnaires. Early obesity pharmacotherapy reinitiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates.