Severe Obesity Research Articles

MiniMizer Gastric Ring displacement at 31 weeks of gestation as a life-threatening complication

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic “en caul” cesarean delivery. After a successful “en caul” delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen’s space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.

7866 Efficacy of Zinc and Myoinositol Supplementation on Metabolic Parameters In A Pediatric Population With Obesity: a Randomized Controlled Trial

Abstract Disclosure: V. Antoniotti: None. V. Mancioppi: None. A. Solito: None. C. Partenope: None. A. Petri: None. I. Rabbone: None. L. Scotti: None. F. Prodam: None. Background: In the last decades, pediatric obesity and cardiovascular-associated risks have been relevant challenges. The first treatment against obesity is a lifestyle change, nevertheless, no intervention seems to be effective in the evolution of the condition, especially in the long term. Thus, the interest in non-pharmaceutical as well as pharmaceutical compounds is growing. Inositol compounds have recently been studied in adults with obesity and insulin resistance but have never been investigated in the pediatric age where insulin resistance is a specific trait of puberty. Furthermore, zinc is critical for insulin secretion and growth. Methods. This is a double-blind, randomized, placebo-controlled study aiming to explore the efficacy of 3 months of combined administration of Zinc (5 mg/die) and Myo-inositol (2000 mg/die) in children and adolescents with obesity. 56 patients aged 10- 17.9 years (starting from Tanner 3) with obesity and insulin resistance have been enrolled. The treatment group received 5 mg of Zinc, 2000 mg of Myo-inositol, and 1000 mg of galactooligosaccharides from Pisum sativum, while the placebo group only received 1000 mg of galactooligosaccharides from Pisum sativum. All patients were subjected to an isocaloric diet following the Mediterranean diet style consisting of 55% carbohydrates, 30-35% fat, and 15% protein. Clinical and biochemical evaluations were carried out for the determination of weight, lipid profile, liver function, and glucose-insulin metabolism. Results. At the end of the study, BMI, fasting insulin, and insulin resistance (HOMA-IR) were significantly improved in both groups, while the treatment group also had an increase in HDL cholesterol (p=0.0426). On the other hand, the placebo group significantly improved its eating habits showing greater adherence to the Mediterranean diet than the treatment group. Moreover, subjects were divided according to the degree of obesity. Fasting insulin (p= 0.0137), HOMA-IR (p= 0.0273), and systolic blood pressure (p= 0.0349) showed a significant improvement in treated patients with severe obesity compared to treated patients with low-grade obesity. Thus, subjects with a higher level of obesity respond better to both treatment and lifestyle change than those with a lower grade of obesity. Also, the improvement of the lifestyle and the presence of fiber allow an increase in the metabolic framework in placebo subjects. Conclusions. Supplementation with Zinc and Myo-inositol could be used as a non-pharmacological compound for the control of complications related to obesity also in the pediatric age. Presentation: 6/1/2024

Serum Fatty Acids and Inflammatory Patterns in Severe Obesity: A Preliminary Investigation in Women.

Background: Inflammation plays a central role in many chronic diseases that characterize modern society. Leptin/adiponectin and adiponectin/leptin ratios have been recognized as notable markers of dysfunctional adipose tissue and, consequently, an inflammatory state. Methods: Blood samples were collected from 41 adult volunteers (40.2 ± 8.3 years) diagnosed with severe obesity (BMI 46.99; 42.98-51.91 kg/m2). The adipokines were quantified using an enzyme-linked immunosorbent assay, while the serum fatty acid analysis was conducted using chromatography. Results: The results unveiled a positive correlation between the leptin/adiponectin ratio and the 20:3n6 fatty acid (r = 0.52, p = 0.001), as well as a similar positive correlation between the adiponectin/leptin ratio and the 22:6n3 fatty acid (r = 0.74, p = 0.001). In the regression analysis, the 22:6n3 fatty acid predicted the adiponectin/leptin ratio (β = 0.76, p < 0.001), whereas C20:3 n-6 was a predictor for inflammatory markers (β = 4.84, p < 0.001). Conclusions: In conclusion, the 22:6n3 fatty acid was demonstrated to be a predictive factor for the adiponectin/leptin ratio and C20:3 n-6 was a predictor for inflammatory markers. This discovery, novel within this population, can help develop new intervention strategies aimed at controlling the inflammatory status in individuals classified as having severe obesity.

Bone loss after bariatric surgery is observed mainly in the hip trabecular compartment and after hypoabsorptive techniques

We evaluated the impact of bariatric surgery on bone mineral density (BMD) and microarchitecture over one year using dual-energy X-ray absorptiometry (DXA), the trabecular bone score (TBS), and 3D-DXA to assess changes after different surgical techniques. This prospective, single-center study of 153 patients with severe obesity contrasts the effects on bone health of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch/single anastomosis duodeno-ileostomy with sleeve gastrectomy (DS/SADIS). To our knowledge, this is the first study to evaluate patients undergoing DS/SADIS and to incorporate 3D-DXA analysis in the assessment of bone loss.Patients were 81 % female with a mean age of 50 ± 9 years. Fifty-four per cent underwent SG; 16 %, RYGB; and 30 %, DS/SADIS. Our findings revealed a significant decrease in areal BMD at the LS (−3.49 ± 5.44 %), FN (−5.24 ± 5.86 %), and TH (−8.06 ± 5.14 %) one year after bariatric surgery. Bone microarchitecture at the LS assessed by TBS was degraded in 30 % of patients. Proximal femur 3D-DXA analysis showed that surgery-induced bone loss predominantly affects the trabecular compartment (Trabecular volumetric (v) BMD: −8.00 ± 6.57 %) rather than the cortical compartment (Cortical vBMD: −1.37 ± 2.79 %).These results suggest hypoabsorptive and mixed techniques (DS/SADIS and RYGB) were associated with greater BMD loss and deterioration of microarchitecture than restrictive techniques (SG).The primary determinants of bone density and impairment of microarchitecture were the extent of weight loss and the type of surgical procedure. Despite overall bone loss, Z-score assessments indicated that post-surgical bone status remained within or above the average ranges compared to a healthy population, except for TH following DS/SADIS.In conclusion, our research shows differences in the impact of bariatric surgery techniques on bone density and microarchitecture, emphasizing the need for careful postoperative monitoring of bone health, particularly in patients undergoing hypoabsorptive and mixed procedures.

Metabolic surgery in severely obese adolescents: which technique provides the best benefits?

Obesity is a public health and global health problem due to the disease burden it generates across all age groups, as well as being a pandemic due to its high prevalence worldwide. Bariatric surgery has traditionally been described as an aggressive option in the adolescent population. However, as the evolution of these patients over time and the improvement in health outcomes have been rigorously analyzed, it is positioned as an effective and safe intervention. Recently, novel high-quality evidence has emerged, sparking international scientific discourse on which techniques provide the most benefits and are safer in bariatric surgery for adolescents with severe obesity. Then, the aim of this review was to analyze the most recent clinical evidence, based on study designs, regarding clinical and surgical outcomes obtained by surgical techniques used during bariatric surgery in the management of severe obesity in adolescents. After the literature review, it was identified that surgical resolution for severe obesity in adolescents is effective and safe, with better benefits observed when using Roux-en-Y gastric bypass. There is a similar frequency of adverse events compared to sleeve gastrectomy and gastric banding. Micronutrient deficiency is the primary adverse event, which is potentially preventable and treatable.

Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects.

The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition. Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found. A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.

Hindi Translation, Cultural Adaptation, and Validation of Modified Weight Bias Internalization Scale (WBIS-M): A Cross-Sectional Study from the Metabolic Surgery Clinic in North India

Background: The lack of culturally-sensitive tool masks the epidemiology of weight-bias and internalized-stigma. This study aimed to translate, adapt, and validate the Modified Weight-Bias Internalization Scale (WBIS-M) into Hindi. Methods: The translation and adaptation process followed the World Health Organization guidelines. Three psychiatrists translated the original WBIS-M into Hindi. The bilingual panel comprised four psychiatrists, two laparoscopic bariatric surgeons, a professor of English, and an individual with severe obesity (with an International English Language Testing System (IELTS) score of Band 8.5) who was familiar with Western culture. The panel identified and resolved inadequate expressions of translations or discrepancies. An independent translator, whose mother tongue was English, back-translated it into the English language. Focused group discussions with individuals with severe obesity were conducted. The final H-WBIS-M was administered to undergraduates ( n = 120) after seven days. Test–retest reliability was assessed. The original WBIS-M, Eating Disorder Diagnostic Screen, and Fat Phobia Scale-Short Form were administered to 120 undergraduates and 55 individuals with severe obesity ( n = 175)]. Reliability and validity of H-WBIS-M were analyzed. Results: Kaiser–Meyer–Olkin measure of sampling adequacy was 0.788, and Bartlett’s test of sphericity was χ2 = 1381.892, p = 0.000. The exploratory factor analysis extracted three components. Spearman-Brown coefficient for H-WBIS-M was 0.875. The internal consistency was α = 0.875 ( p = 0.000), intraclass correlation coefficient was 0.857 (95% confidence interval [CI] = 0.812–0.893) ( p = 0.000), and Pearson correlation ranged from 0.869 to 0.989 ( p = 0.000). Cross-language concordance revealed a significant intraclass correlation coefficient (0.877–0.986) ( p = 0.000) and Pearson correlation ranging from 0.781 to 0.972 ( p = 0.000). Conclusions: The H-WBIS-M demonstrated good psychometric properties based on standard testing procedures.

Magnetic single-anastomosis side-to-side duodeno-ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1-year outcomes.

Uncomplicated surgical approaches that minimize anastomotic complications while improving revisional metabolic/bariatric surgical (MBS) outcomes are needed. This prospective single-center study assessed the feasibility, safety, and efficacy of the novel linear magnetic anastomosis system (LMAS [3cm]) in performing a side-to-side duodeno-ileostomy (MagDI) bipartition to revise clinically suboptimal primary sleeve gastrectomy (SG). Patients with severe obesity with/without type 2 diabetes (T2D) with suboptimal weight loss, regain, and/or T2D recurrence post SG underwent revisional MagDI. A distal and proximal magnet were delivered endoscopically to the ileum and duodenum and aligned via laparoscopic assistance. Gradual magnet fusion formed a DI bipartition. technical feasibility, safety (Clavien-Dindo [CD] severe adverse event classification) at 1year. Secondary endpoints: MBS weight and T2D reduction. July 29, 2022-March 28, 2023, 24 patients (95.8% female, mean age 44.9±1.5years, and body mass index [BMI] 39.4±1.3kg/m2) underwent MagDI. Feasibility was attained via correct magnet placement (mean operative time 63.5±3.3min), patent anastomoses created, and magnet passage per anus in 100.0% of patients. There were 4 CD-III mild or moderate severe AEs, 0.0% associated with the LMAS or MagDI: 0.0% anastomotic leakage, obstruction, bleeding, infection, reintervention, or death. Mean BMI reduction was 2.1kg/m2 (p<0.05); total weight loss 5.3%, excess weight loss 16.4%; and the patient with T2D improved. The single-anastomosis MagDI procedure using the novel 3-cm LMAS to revise clinically suboptimal SG was technically straightforward, incurred no major complications, mitigated weight regain, and renewed clinically meaningful weight loss. NCT05322122.

Robotic Surgery for Gynecologic Cancer: Optimism or Controversy in Surgical Oncology?

Robotic Surgery has made possible to remove cancerous organs and tissues in gynecologic cancer patients with less invasive methods. Gynecologist have observed that these minimally invasive surgeries often result in fewer complications and a faster recovery time. As robotic technology continues to develop, the potential advantages of robotic surgery in gynecologic oncology are becoming increasingly evident. Robotic Surgery offers greater precision and control during complex procedures, which can lead to improved patient outcomes and fewer complications. Robotic surgery can often outcome in smaller hospital halts and a rapid return to normal activities. Consequently, more and more GOs are adopting Robotic Surgery to provide their patients with the most advanced and effective treatment options available. Robotic Surgery is now a viable option compared to traditional open surgery. Since its extensive use, negligibly aggressive surgery has become a suitable choice not only for those with severe obesity, but also for women with gynecologic cancers, where traditional open surgery is often associated with significant complications. This review investigates the rationale behind Robotic Surgery, evaluates early results, analyzes its cost-effectiveness and implications for surgical training, and explores innovative applications of robotic-surgical procedure in the treatment of gynecologic cancer.

Protocolo terapéutico y seguimiento del paciente con diabetes mellitus tipo 1 y obesidad

Treatment protocol and follow-up of patients with type 1 diabetes and obesity This protocol focuses on the management of obesity in patients with type 1 diabetes mellitus (DM1), a growing problem due to factors such as lifestyle, insulin treatment, and hypoglycemia. The approach includes four key pillars: nutrition therapy, drug therapy, physical activity, and management of insulin therapy. Nutrition therapy is the first line of treatment and is based on calorie reduction and a diet rich in fiber. In addition, there are pharmacological options for the management of overweight in patients with DM1, although they have specific challenges, such as euglycemic diabetic ketoacidosis. Physical activity and the adjustment of insulin therapy also play an essential role in weight and glycemic control. In severe cases, bariatric surgery is a viable option for patients with severe obesity.

The impact on obesity-related quality of life and eating satisfaction in the early period after laparoscopic sleeve gastrectomy.

Obesity impairs patients' quality of life (QoL). Laparoscopic sleeve gastrectomy (LSG) is a common procedure for patients with severe obesity; however, studies reporting changes in obesity-related QoL are limited. The aim of this study was to assess changes in obesity-related QoL and food tolerance in the early postoperative period. We included 20 consecutive patients who underwent LSG between May 2021 and July 2023. We evaluated changes in obesity-related QoL 6 months after surgery using an obesity and weight loss QoL questionnaire (OWLQOL) and a weight related symptom measure (WRSM). Additionally, we assessed eating satisfaction and food tolerance after surgery. The percentages of total weight loss and excess weight loss were 28.5% and 79.1%, respectively. OWLQOL scores and WRSM changed from 36.5 to 73.0 points and from 44.0 to 15.0 points (p = .007, .007), respectively. The food tolerance score decreased from 25 to 21.2 points (p < .001), while eating satisfaction showed no significant change (p = .25). Obesity-related QoL is enhanced even in the early postoperative period, without sacrificing eating satisfaction. The findings of this study may provide valuable insights for patients when considering LSG.

Determinants of food addiction in patients with severe obesity: focus on the microbiota-gut-brain axis

Determinants of food addiction in patients with severe obesity: focus on the microbiota-gut-brain axis

A high adherence level to nutritional recommendations minimizes protein and minerals loss while maximizes visceral fat loss in bariatric surgery patients

BackgroundMetabolic bariatric surgeries are considered the finest and most appropriate treatment option for patients with severe obesity. Besides the surgical procedure, many factors appear to be associated with improved postoperative outcomes such as compliance to the postoperative diet and supplementation, regular physical activity, medical and nutritional follow-up, and modifications in dietary habits. The objectives of this study were to investigate the effect of adherence to post-operative recommendations on anthropometric measurements and body composition and assess the percentage of total weight loss (%TWL) and excess weight loss (%EWL) 3 months post-operative. Material and MethodsFifty-two participants who underwent a Roux-en-Y gastric bypass or sleeve gastrectomy were included. Participants have filled out a pre-operative questionnaire. Anthropometric measurements were obtained pre-operative and 3 months post-operative using a Body Impedance Analyzer (Inbody 270). The adherence to post-operative recommendations was assessed by the Bariatric Surgery Self-management Questionnaire 3 months post-operative and classified to three adherence levels. ResultsMost anthropometric measurements decreased 3 months post-operative in the three adherence groups (p≤0.05). No significant differences were observed between groups in anthropometric measurements and body composition, except for minerals and visceral fat levels. The mineral loss has decreased in both the high and intermediate adherence groups (-0.09 ± 0.22 kg, and -0.09 ± 0.18 kg, respectively). Also, the high adherence group showed less loss in protein amount post-operatively (p=0.06). Visceral fat level decreased in the high adherence group (p≤ 0.05). ConclusionAdherence to post-operative behavioral and nutritional recommendations was associated with less protein and mineral loss and enhanced visceral fat reduction post-operatively.

Risk of suicide after metabolic bariatric surgery: a meta-analysis of matched cohort studies and population-based studies

BackgroundMetabolic bariatric surgery (MBS) remains the optimal treatment for patients with severe obesity. However, concern is growing about the risk of suicide after MBS. ObjectivesTo compare the risk of suicide in adult patients with obesity, treated with or without MBS. SettingUniversity-affiliated hospital, China. MethodsPubMed and Embase were searched through April 30, 2024. Eligible studies were matched cohort studies and population-based studies (PROSPERO ID: CRD42024561042). Effects were pooled using a random-effects model. Subgroup analysis was performed based on study type. ResultsA total of 3 matched cohort studies (4 matched cohorts) and 2 population-based studies, involving 114,615 adult patients with obesity treated with MBS (272 suicides) and 552,642 non-surgery counterparts (622 suicides), met the selection criteria. Patients treated with MBS had a pooled hazard ratio (HR) of suicide of 2.12 (95% confidence interval [CI] 1.54-2.92, P < .01, I2 = 24%) and a pooled risk radio (RR) of suicide of 2.32 (95% CI 1.55-3.45, P < .01, I2 = 58%) compared with those treated without MBS. In the subgroup analysis, relatively higher pooled HR (2.64 [1.84-3.77] versus 1.67 [1.32-2.12]) and RR (2.98 [2.02-4.41] versus 1.48 [0.80-2.75]) were observed in the subgroup of matched cohort studies compared with the subgroup of population-based studies. ConclusionsAdult patients treated with MBS are at more than double the risk of suicide than those treated without MBS in terms of both HR and RR. However, the absolute risk was low and did not warrant a general discouragement of MBS.

Association of psychiatric history with hypertension among adults who present for metabolic and bariatric surgery

BackgroundPsychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m2) and may be associated with hypertension. ObjectivesTo determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS). SettingAcademic medical center. MethodsOutcomes were identified from electronic medical records. Psychiatric diagnoses were assessed by clinical interview and included any bipolar and related disorder or depressive disorders, anxiety, alcohol use disorder, substance use disorder, post-traumatic stress disorder, and eating disorders. Adjusted odds ratios for the association between psychiatric diagnoses and hypertension and uncontrolled BP, separately, were calculated using logistic regression. Linear regression was used to determine the association of psychiatric diagnoses with SBP. Models were adjusted for age, sex, race, and BMI. ResultsThere were 281 participants with mean age of 40.5 years (standard deviation = 10.9) and BMI of 45.9 kg/m2 (standard deviation = 6.2). Participants were predominantly women (86.5%) and Black (57.2%). Overall, 44.8% had hypertension and 32.5% of these individuals had uncontrolled BP. The adjusted odds ratios for hypertension was higher (2.95; 95% confidence interval 1.48–5.87) and SBP was greater (3.50 mm Hg; P = .048) among participants with a lifetime diagnosis of anxiety compared with those without. Participants with any current psychiatric diagnosis had a higher SBP compared to those who did not have a current psychiatric diagnosis (3.62 mm Hg; P = .029). ConclusionsA diagnosis of anxiety during the lifetime of patients undergoing MBS was associated with almost three times increased odds of hypertension.

Adaptation of a modified Elixhauser comorbidity index to isolate the impact of body mass index on survival outcomes in patients with cancer in a large integrated healthcare system.

124 Background: Variable impacts of body mass index (BMI) on overall survival (OS) and cancer-specific survival (CSS) have been described in patients with cancer, with existing data highlighting both detrimental effects and malignancy-specific benefits. Real-world data derived from integrated healthcare systems are underexplored in this context, and tight control of confounding using validated tools such as the Elixhauser Comorbidity Index (ECI) is rarely employed in pre-existing studies. Herein, we offer a highly refined description of the impact of BMI on cancer-specific outcomes in a large patient cohort using a targeted ECI model. Methods: 153,270 patient records were abstracted from an integrated healthcare system from 2010-2018, including descriptors of age, race/ethnicity, income, disease stage, and treatment regimens. Standardized derivation of BMI within one year prior to diagnosis was performed and categorized by World Health Organization definitions. A custom ECI was designed to exclude ICD codes for obesity to effectively isolate the impact of BMI on downstream analyses. Kaplan-Meier survival estimates of OS and CSS were constructed, and univariate and multivariate Cox proportional hazard (PH) modeling was performed to determine hazard ratios (HR). Results: When normalized to healthy BMI in multivariate modeling, we found a favorable dose-dependent relationship of overweight and obese BMI on OS and CSS independent of age, race/ethnicity, income, modified ECI score, cancer stage, or therapeutic regimen (Table). This advantage to OS and CSS was not as strongly reflected in severely obese patients, though still significant compared to healthy BMI counterparts. Being underweight was a negative prognostic indicator for OS and CSS in all patients compared to a healthy BMI. Conclusions: We demonstrate a beneficial impact of increased BMI on OS and CSS in a large cohort of patients treated in an integrated healthcare model independent of tightly controlled confounding. Specifically, we highlight the utility of isolating obesity using a targeted ECI model for comorbidity adjustment, which may provide a more robust measure of the influence of BMI on survival. Our findings raise questions regarding attention to adequate control of confounding in prior studies, as well as the potential benefit of removing variation in healthcare delivery in understanding these outcomes. Adjusted HR of OS and CSS stratified by BMI category (*95% Confidence Interval). BMI Category Adjusted OS Adjusted CSS Normal Weight(18.5 – 24.9) 1 (reference) 1 (reference) Underweight(&lt; 18.5) 1.35 (1.25 – 1.45*) 1.28 (1.15 – 1.41) Overweight(25 – 29.9) 0.83 (0.81 – 0.85) 0.84 (0.81 – 0.87) Obese(30 – 39.9) 0.81 (0.79 – 0.83) 0.81 (0.78 – 0.84) Severe Obesity(≥ 40) 0.86 (0.82 – 0.90) 0.82 (0.77 – 0.87) Unknown 1.33 (1.24 – 1.43) 1.19 (1.07 – 1.31)

Weight loss and health status 10 years after laparoscopic adjustable gastric band insertion in adolescents: a follow-up report from Teen-LABS

BackgroundMetabolic and bariatric surgery is a safe and effective treatment strategy for severe childhood obesity, affecting 10% of US adolescents. ObjectivesThis prospective observational study addresses knowledge gaps related to changes in weight, cardiometabolic risk, and weight-related quality of life (WRQOL) in adolescents 10 years after laparoscopic adjustable gastric band (LAGB) insertion. SettingFive Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) US centers. MethodsAnthropometric, micronutrient, cardiometabolic risk, and WRQOL data were collected on 274 adolescents undergoing metabolic and bariatric surgery, of which 14 participants underwent LAGB insertion (2008–2011). Descriptive analyses compared outcomes from baseline to 10 years. ResultsParticipants were mostly female (86%), White (71%), with a median age of 18.5 years and preoperative median BMI of 49. Baseline prevalence of type 2 diabetes, hypertension, and dyslipidemia were 1 of 14 (7%), 8 of 14 (57%), and 8 of 13 (62%), respectively, versus 10-year prevalence of 1 of 8 (13%), 4 of 10 (40%), and 3 of 9 (33%), respectively. Two participants underwent LAGB removal (years 2 and 3), whereas two converted from LAGB to Roux-en-Y gastric bypass (years 2 and 6). Following initial BMI reduction (−10%) at year 1, 10-year median BMI in the LAGB retention group was 51, representing a 9.2% increase versus baseline. Micronutrient abnormalities and WRQOL remained similar between baseline and 10 years. One participant (1 of 14) withdrew from the study at year 7. ConclusionsLong-term follow-up of this cohort reveals that LAGB had minimal impact on BMI, cardiometabolic risk factors, and WRQOL among adolescents. These results confirm the limited efficacy of LAGB in the pediatric population.

Evaluating Obesity: The "Why" Behind the American Academy of Pediatrics' Obesity Treatment Clinical Practice Guideline.

The 2023 American Academy of Pediatrics' "Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (Obesity CPG)" is a comprehensive document that addresses the evaluation and treatment of pediatric obesity. Much attention has been focused on the use of medications and surgery to treat severe obesity, but the document also thoroughly reviews the evaluation of obesity and its comorbidities through key action statements and consensus recommendations. The majority of these evaluation guidelines are well within the scope of the general pediatrician and an understanding of and implementation of them can lead to improved obesity care in the primary care setting. The goal of this article is to guide the reader in the evaluation of obesity and its comorbidities in the primary care setting through a chronic disease model lens as a basis for all future care. [Pediatr Ann. 2024;53(10):e378-e385.].

The Impact Of Severe Obesity (Class II/III) In The Middle-age On Cardiac Remodeling And Exercise Capacity

The Impact Of Severe Obesity (Class II/III) In The Middle-age On Cardiac Remodeling And Exercise Capacity

Comparative Safety and Efficacy of Roux-en-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Obesity has become a global epidemic, affecting both developed and developing nations. Despite extensive efforts, historical outcomes of medical interventions for obesity have been unsatisfactory. Bariatric surgeries, including sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB), are now recognized as the primary treatment for severe obesity. However, laparoscopic one-anastomosis gastric bypass (OAGB) has emerged as a promising alternative, offering simplified procedures compared to RYGB. While OAGB's initial outcomes are optimistic, concerns about biliary reflux persist. Our systematic review aims to compare the safety and efficacy outcomes of RYGB and OAGB to inform clinical decision-making in managing obesity. We searched five databases up to February 2024. We included randomized controlled trials (RCTs) comparing RYGB and OAGB in obese patients, focusing on safety and efficacy outcomes. Data extraction covered study details, participant demographics, interventions, and outcomes related to operative details, complications, follow-up results, and weight changes. The risk of bias was assessed using the Cochrane tool. The analysis involved risk ratios for dichotomous data and mean differences for continuous data, using fixed or random effects models based on heterogeneity. Analyses were performed with Review Manager software v5.4. A total of 1057 patients were included in the analysis, sourced from 12 distinct RCTs. The analysis indicated OAGB outperformed RYGB in BMI reduction (MD = -0.69, p = 0.005), whereas RYGB was more effective in excess weight loss (MD = 6.51, p < 0.0001) and excess BMI loss (MD = 3.91, p < 0.0001). OAGB led to shorter operation times (MD = -34.89 minutes, p < 0.0001) and shorter periods of hospital stays (MD = -0.27 days, p = 0.01), along with fewer overall complications (RR = 0.58, p = 0.02) and lower incidence of upper gastrointestinal endoscopy complications (RR = 2.98, p = 0.0001). On the other hand, RYGB showed higher remission rates for dyslipidemia (RR = 0.60, p = 0.0003) and higher remissions of hypertension (RR = 0.83, p = 0.04). The majority of results were homogenous. Both OAGB and RYGB have their respective advantages and limitations. OAGB appears to offer benefits in terms of operation efficiency and early postoperative recovery, making it a potentially preferable option for patients and surgeons focused on these aspects. On the other hand, RYGB might be more suitable for patients prioritizing long-term weight loss and remission of certain comorbidities like hypertension. Ultimately, the choice between OAGB and RYGB should be made on an individual basis, considering the specific needs, conditions, and goals of each patient.