Short-term Weight Loss Research Articles

Potential contribution of the gut microbiota to hypoglycemia after gastric bypass surgery.

Obesity has become a global health problem. Lifestyle modification and medical treatment only appear to yield short-term weight loss. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it sustains weight reduction and results in the remission of obesity-associated comorbidities for obese individuals. However, patients who undergo this surgery may develop hypoglycemia. To date, the diagnosis is challenging and the prevalence of post-RYGB hypoglycemia (PRH) is unclear. RYGB alters the anatomy of the upper gastrointestinal tract and has a combined effect of caloric intake restriction and nutrient malabsorption. Nevertheless, the physiologic changes after RYGB are complex. Although hyperinsulinemia, incretin effects, dysfunction of β-cells and α-cells, and some other factors have been widely investigated and are reported to be possible mediators of PRH, the pathogenesis is still not completely understood. In light of the important role of the gut microbiome in metabolism, we hypothesized that the gut microbiome might also be a critical link between RYGB and hypoglycemia. In this review, we mainly highlight the current possible factors predisposing individuals to PRH, particularly related to the gut microbiota, which may yield significant insights into the intestinal regulation of glucose metabolic homeostasis and provide novel clues to improve the treatment of type 2 diabetes mellitus.

Thyroid Hormone Changes After Sleeve Gastrectomy With and Without Antral Preservation.

The effect of bariatric surgery on thyroid hormone changes yielded inconsistent results. The aim of the present study was to assess the change of thyroid hormone levels following laparoscopic sleeve gastrectomy (LSG), with or without antral preservation (AP). Thyroid hormones (TSH, FT3, FT4) were examined preoperatively, at the end of the first postoperative month, and first postoperative year. Secondly, antral resection (AR) and AP were compared at inducing weight loss and thereby affecting thyroid hormone levels. Euthyroid obese patients (86 female/20 male) underwent LSG. Of these, 58 patients underwent AR and 48 patients AP. The mean FT3 levels significantly decreased both in the first postoperative month and the first year (P < 0.001), whereas mean TSH levels decreased significantly in the first postoperative year (P < 0.001). FT4 levels remained nearly unchanged (P = 0.517). Postoperative first year body mass index (BMI) loss, excess BMI loss percentile (%EBMIL), and total body weight loss percentile (%TWL) were significantly higher in AR group than the AP group (P ≤ 0.01). When the change in thyroid hormone levels was analyzed by pyloric distance according to time periods, no significant difference was found in TSH and FT4 levels (P > 0.05); however, reduction in FT3 levels was significantly greater in patients with AR than in AP patients (P = 0.028). LSG promotes significant reduction in TSH and FT3 levels, whereas FT4 levels remain unchanged. LSG with AR provides more weight loss in short term and appears to be more effective at lowering FT3 levels.

Entamoeba ranarum Infection in a Ball Python (Python regius)

The pathogenic Entamoeba species in snakes is widely regarded to be Entamoeba invadens, which can cause severe amoebiasis with up to 100% mortality. In this case report, we describe a ball python (Python regius) that died after short-term weight loss. Necropsy revealed severe necrotizing colitis with large numbers of intralesional Entamoeba trophozoites. Molecular genetic analysis identified these trophozoites as Entamoeba ranarum, a parasite more usually found in amphibians. Furthermore, the extended history revealed that toads (Rhinella marina) had been housed together with the python. This report illustrates the danger of protozoal cross-infections in exotic animals as well as the importance of molecular genetic tools in Entamoeba diagnosis.

Meta-analysis and Approach of the Real Impact of Anorexigenic Drugs in the Obesity in Humans: The Last Five Years of the Randomized Studies.

Obesity shows a multifactorial disease and presents a serious public health problem, with an alarming epidemic character. According to NHANES (National Health and Nutrition Examination Survey) from 2015 to 2016, 39.6% of American adults and 18.5% of young people were obese and 7.7% of adults and 5.6% of young people had severe obesity. Brazil ranks fifth in the world ranking, with about 18 million people reaching up to 70 million overweight individuals. Despite shortterm weight loss with diet and exercise, weight regain continues to be a concern. Anti-obesity drugs, such as Sibutramine (SIB), Phentermine (PHEN), Fenproporex (FEN), Mazindol (MAZ), Amfepramone (AMFE) and Orlistat (ORL) may play a role in weight reduction in patients whose condition is refractory to non- and maintenance of weight loss. A systematic review followed by meta-analysis of randomized clinical trials over the past five years to explore the efficacy and safety of anorexigenic drugs for weight reduction and consequent treatment of obesity. The search strategy in MEDLINE / Pubmed, Web of Science, ScienceDirect Journals (Elsevier), Scopus (Elsevier), OneFile (Gale) is as follows : - search for mesh terms (Sibutramine, Phentermine, Fenproporex, Mazindol, Amfepramone , Orlistat, Weight loss, Safety), and the use of booleans "and" between mesh terms and "or" among historical findings. It was observed that in the last five years of randomized studies no significant general complications were found, with only 5.7%. The mean overall weight loss was 6.18 (± 2.8) kg in the mean time of 12 months. The overall success rate among these drugs was 80.18%. The p-value values did not present a significant statistical difference, being p <0.05 within each drug group analyzed, for both weight and success rates. The scientific findings of randomized studies on the use of anorexigenic drugs to treat obesity have shown safety and efficiency in the last five years, with a reasonable weight loss and no significant complications.

Prospective study of gut hormone and metabolic changes after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

Laparoscopic sleeve gastrectomy (SG) has surpassed Roux-en-Y gastric bypass (RYGB) as the most prevalent bariatric procedure worldwide. While RYGB and SG demonstrate equivalent short-term weight loss, long-term weight loss tends to be greater after RYGB. Differences in the effect of these procedures on gastrointestinal hormones that regulate energy homeostasis are felt to partially underlie differences in outcomes. The objective of this study was to prospectively quantify blood levels of gut hormones of energy and glucose homeostasis at one year follow up to delineate possible reasons for greater efficacy of RYGB over SG in achieving weight loss. Patients undergoing SG (n = 19) and RYGB (n = 40) were studied before surgery and at 2,12, 26, and 52 weeks postoperatively. Blood samples drawn in the fasted state and after a liquid mixed meal were assayed at baseline, 26, and 52 weeks for peptide YY (PYY), glucagon-like peptide-1 (GLP-1), ghrelin, insulin, glucose, and leptin. Fasting and postprandial appetitive sensations were assessed by visual analog scale. At 1 year there was greater weight loss in RYGB compared with SG patients (30% vs 27%; P = 0.03). Area under the curve (AUC) after the mixed meal for PYY was greater in RYGB patients (P<0.001). RYGB patients had significant increases in GLP-1 AUC compared to baseline (P = 0.002). Ghrelin levels decreased only after SG compared to baseline (P<0.001) but were not significantly different from RYGB. There was a trend toward decreased sweet cravings in RYGB patients (P = 0.056). Differences in gastrointestinal hormones that regulate energy and glucose homeostasis are a possible mechanism for greater efficacy of RYGB compared to SG.

Evaluating the impact of the antrum size following laparoscopic sleeve gastrectomy: a randomized multicenter study.

The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) remains discordant and highly related to the surgical technique. GERD and weight regain are probably understudied by prospective clinical studies depending on different technical factors. The purpose of this article is to evaluate the effect of extent to which the antrum is resected on GERD following LSG but also on early complications and short-term weight loss results. University Hospital, France. Patients were randomly assigned in group A (172 patients), LSG with antral resection, or group B (174 patients), LSG with antral preservation. The baseline characteristics collected were demographic characteristics and anthropometric data (age, sex, body mass index), presence of GERD clinical characteristics, ± pH-metry, postoperative complications, or gastrin level. A total of 279 patients underwent LSG and they were included in the final analysis. The GERD analyzed at 3 months postoperatively by pH-metry was observed for 57.8% in group A and for 52.4% of patients in group B (P = .4819). There was no statistically significant difference (P = .3755) between the 2 groups at 1 year after surgery (group A, 49.5% versus group B, 43.6%). The gastrin serum level was analyzed 1 year after surgery for a total of 107 patients. For group A, the mean gastrin level was 97.4 ± 85.9 pg/mL, which was inferior compared with group B (150.6 ± 152.4 pg/mL) with no statistical difference (P = .067). The recorded excess weight loss for group A was 79.67% (± 28.88) with no statistically significant difference with group B 74.46% (± 36.61) (P = .3678). The mortality rate was nil. We recorded 5 cases of staple line leakage (3 in group A and 2 in group B); 11 patients presented bleeding (3 in group A and 8 group B), and 4 patients presented with gastric stenosis (2 in group A and 2 in group B). The antrum preservation has no significant difference in terms of reflux, weight loss, or complications at 3 or 12 months following LSG. The only significant difference was achieved for nausea and vomiting symptoms, which were more significant for the antrum resection group. Further clinical trials with newer procedures will indicate the factors that can diminish the reflux following LSG. Furthermore, the conservation of a large part of the antrum may be helpful to convert the sleeve to another bariatric procedure (transit bipartition).

Association between Subcutaneous Adipose Tissue Inflammation, Insulin Resistance, and Calorie Restriction in Obese Females.

The worldwide epidemic of overweight and obesity has led to an increase in associated metabolic comorbidities. Obesity induces chronic low-grade inflammation in white adipose tissue (WAT). However, the function and regulation of both innate and adaptive immune cells in human WAT under conditions of obesity and calorie restriction (CR) is not fully understood yet. Using a randomized interventional design, we investigated postmenopausal overweight or obese female subjects who either underwent CR for 3 mo followed by a 4-wk phase of weight maintenance or had to maintain a stable weight over the whole study period. A comprehensive immune phenotyping protocol was conducted using validated multiparameter flow cytometry analysis in blood and s.c. WAT (SAT). The TCR repertoire was analyzed by next-generation sequencing and cytokine levels were determined in SAT. Metabolic parameters were determined by hyperinsulinemic-euglycemic clamp. We found that insulin resistance correlates significantly with a shift toward the memory T cell compartment in SAT. TCR analysis revealed a diverse repertoire in SAT of overweight or obese individuals. Additionally, whereas weight loss improved systemic insulin sensitivity in the intervention group, SAT displayed no significant improvement of inflammatory parameters (cytokine levels and leukocyte subpopulations) compared with the control group. Our data demonstrate the accumulation of effector memory T cells in obese SAT and an association between systemic glucose homeostasis and inflammatory parameters in obese females. The long-standing effect of obesity-induced changes in SAT was demonstrated by preserved immune cell composition after short-term CR-induced weight loss.

The Need And Benefit of Implementing Telemedicine in Clinical Practice

The Need And Benefit of Implementing Telemedicine in Clinical Practice

Effectiveness of a self-regulation intervention for weight loss: A randomized controlled trial.

To evaluate effectiveness and acceptability of a novel intervention, based on self-regulation theory, for weight loss. A two-arm parallel group design was employed. Adult participants with a BMI≥30kg/m2 and the aim to lose weight were recruited and randomized to either a control or intervention group. Both groups were asked to weigh themselves daily for eight weeks. The intervention group was encouraged to use a weight tracking app, and complete daily and weekly questionnaires to prompt action planning, reflection, and evaluation of actions. Participants chose daily actions from a menu of 53 behaviours. The primary outcome was weight change after 8weeks, assessed using linear mixed effects models. At follow-up, 20 intervention group participants were interviewed regarding their experiences in the trial. 100 participants were recruited, and 98% were followed up at 8weeks. Mean weight loss was -4.18kg (SD=3.84) in the intervention compared to -1.01kg (SD=2.67) in the control group; the adjusted difference was -3.20kg (95% CI -4.49, -1.92). Participants rated the intervention's usefulness as 8.25 (SD=2.04) on a scale from 1 to 10. Adherence was a significant independent predictor of weight loss success (-1.54kg per one SD, 95% CI -2.16, -0.93), but not a mediator of the intervention effect. Participants reported that the intervention enabled them to experiment with and identify effective weight loss actions. Guiding participants through the self-regulation process was feasible, acceptable to participants, and led to significantly greater short-term weight loss than unguided self-weighing.

2030-P: The Efficacy of Laparoscopic Sleeve Gastrectomy in Severely Obese Patients with Varying Serum Triglyceride Levels

Purpose: To investigate the metabolic improvements in obese patients with different serum triglyceride (TG) levels after laparoscopic sleeve gastrectomy (LSG). Methods: 118 severely obese patients [body mass index (BMI)&amp;gt;35kg/m2] underwent LSG with complete information of follow-up for 3 and 6 months were analyzed. Patients were divided into two groups based on their different baseline serum levels of TG. Results: The metabolic parameters (BMI, NC, WC, HC, WHR, blood pressure, liver function, blood glucose, blood lipids, insulin resistance, HbA1c, and UA) of the normal and higher TG groups were significantly improved after surgery. Patients with normal TG had better improvement in BMI and WC compared with higher TG patients in both 3 and 6 months. After adjustment for age and gender, ΔWC positively correlated with ΔBMI (r=0.446, P&amp;lt;0.001), creatinine level (ΔCr, r=0.365, P=0.005) in the normal group in 3 months follow-up. In 6 months after LSG, ΔWC positively correlated with ΔBMI (r=0.657, P&amp;lt;0.001) and ΔCr (r=0.442, P=0.009) while ΔWC negatively correlated with the change in eGFR level (ΔeGFR, r=-0.374, P=0.009) in the normal group. In addition, multivariate linear regression analysis showed that decreased ΔWC levels significantly correlated with ΔBMI (β=1.333, R2 =0.259, P&amp;lt;0.001) and ΔCr (β=0.336, R2 =0.160, P=0.005) both in 3 months and 6 months after LSG. Conclusion: LSG can effectively improve metabolic disorders. Moreover, there were differences in weight loss between the normal and high TG groups after LSG, indicating that the baseline TG level can be used to predict short-term weight loss after LSG. Disclosure G. Li: None. Y. Huang: None. J. Zhang: None. X. Wang: None. C. Qian: None. X. Cheng: None. S. Qu: None. Funding National Key Research and Development Program of China (2018YFC1314100); National Natural Science Foundation of China (81970677); Shanghai Pujiang Program (2019PJD040); Shanghai Committee of Science and Technology (18411951803, 17DZ1910603)

Effect of Short Term Weight Loss on Appetite and Satiety Hormones in Overweight Female Adults

Abstract Objectives The objective of this study was to test if short term weight loss has an effect on appetite and satiety hormones in a group of overweight female adults. It was hypothesized that participants who lost weight over a short period show changes in Ghrelin and Leptin. Methods Twelve healthy overweight female adults participating in a weight management program volunteered to wear physical activity monitors (FitBit Blaze), and log food intake over a period of 24 hours on the days when whole blood was drawn to measure plasma hormone concentrations. Energy deficit was determined through subtracting calories expended from the calories consumed. This causal-comparative study identified 7 women (Group 1) who lost at least 1% of their body mass in two weeks and compared their results to 5 women (Group 2) who did not. Hormone Group 1 Group 2 Groups Total Groups Total Week 1 Week 3 Week 1 Week 3 Week 1 Week 3 P-values Ghrelin (pg/ml) 50.12 (49.96) 21. 79 (12.89) 149.07 (82.20) 79.21 (93.23) 91.35 (80.09) 45.72 (64.23) 0.017 Leptin (ng/mL) 10.08 (5.74) 9.12 (5.26) 7.56 (6.37) 7.73 (5.60) 9.03 (5.87) 8.54 (5.19) 0.481 Results Mean (SD) body mass for Group 1 decreased significantly (P &amp;lt; 0.001)) from 85.80 (19.16) to 84.80 (19.21) kg, whereas Group 2 did not show significant change (68.62 + 5.42 vs. 68.70 + 5.46 kg). Mean (SD) energy deficits during the study period did not differ significantly between the groups. However there was a decreasing trend (P = 0.075) in Group 2 which had a 55 calories deficit in week 1 vs. 522 calories in week 3. Means (SD) hormone levels for each group by week (1 vs. 3) are given below. Ghrelin and Leptin levels did not differ between the weeks in each of the groups. However when groups were combined, significant differences in Ghrelin were observed between the weeks (P = 0.017). Similar findings were not observed for Leptin (P 0.481). Correlational analysis showed a significant moderate relationship (r = 0.655) between Ghrelin levels and Energy Deficit at the first week of the study. However this relationship was not significant in the Week 3. Conclusions There were significant associations between plasma Ghrelin levels and Energy Deficits during the beginning of the study, however, these relationships diminished over time. These findings need further research. Funding Sources The study was supported by the UCM Professional Enhancement Grant.

Changes in Whole-Body Amino Acid Metabolism in Response to 2 Weeks of the Very-Low Calorie Diet Are Not Affected by Gender

Abstract Objectives Very Low-Calorie Diet (VLCD) is an approved method to safely achieve substantial short-term weight loss in obese patients. We previously reported that two weeks of the VLCD maintains whole-body protein and amino acid turnover despite a large reduction in lean body mass. Since the observed effects on body weight (BW) and composition differed between men and women, we hypothesized that the changes in amino acid metabolism in a response to the calorie-restricted diet is gender-specific. Methods 34 morbidly obese adults (BMI: 42 ± 0.9 kg/m2, 10 males and 24 females) underwent a VLCD for 2 weeks consisting of 820 kcal/day and 105-grams protein/day. Before the start of the VLCD (baseline), the whole-body production (WBP) rates of multiple amino acids involved in protein metabolism (e.g., glycine (GLY), glutamine (GLN), phenylalanine (PHE), tyrosine (TYR), and arginine (ARG)) were measured after IV pulse administration of their stable isotopes. Weight loss and body composition by dual-energy X-ray absorptiometry were assessed after 2 weeks of the VLCD. Baseline plasma enrichments were measured by LC-MS/MS. Data are presented as mean ± SE. Statistics are performed by Pearson correlation tests. Results The magnitude of the BW loss after 2 weeks of the VLCD differed between males and females (7.0 ± 0.7 kg vs. 4.1 ± 0.2 kg, P &amp;lt; 0.0001, respectively) with a higher reduction in lean body mass observed in men than women (4.3 ± 0.8 kg vs. 2.7 ± 0.4 kg, P &amp;lt; 0.05). Although, females had significantly reduced baseline WBP of ARG (7.3% vs. 2%, P = 0.0027), GLY (22.8% vs. 3.6%, P &amp;lt; 0.001), and PHE (4.8% vs. 3.1%, P = 0.018) in comparison to men, two weeks of the VLCD had a comparable effect on multiple amino acid WBP in both genders. Suppressed contractile myofibrillar protein breakdown rate was observed in both groups (13% vs. baseline, P = 0.02) with no gender difference in net protein breakdown (PHE to TYR conversion rate). Hence, increased catabolism in men cannot be explained by a different response to the 2 weeks of a calorie-restricted diet. Conclusions Despite gender differences in body weight loss and changes in composition in response to a Very Low-Calorie Diet, changes in whole-body amino acid kinetics are not differently affected in men and women. Funding Sources CTRAL Internal Funds.

Laparoscopic Roux-En-Y gastric bypass versus one anastomosis (loop) gastric bypass for obesity: A prospective comparative study of weight loss and complications

IntroductionMost Bariatric units perform Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) and One Anastomosis Gastric Bypass (OAGB) for weight loss and metabolic purposes with satisfactory results and low complication profile. ObjectivesThis study compares LRYGB and OAGB outcomes in a high volume single bariatric unit. MethodsData was collected prospectively and analysed retrospectively for all LRYGB and OAGB performed between Jan 2014 to Dec 2016. The follow up period was for 2 years. Patients who were lost to follow up or had prior bariatric procedure were excluded. Excess weight loss percentage (EWL %), total weight loss percentage (TWL %) and post-operative complications were compared in both groups. Results1268 procedures performed. 113 patients were excluded. At 2 years, for LRYGB and OAGB groups mean TWL % was 31% and 35.4% respectively (P < 0.0001); and mean EWL % was 70.1% and 74.8% respectively (P = 0.0119). Gastroesophageal reflux symptoms were higher in OAGB group 17 (8.5%), with 7 patients needing further surgery, versus 26 (2.7%) in LRYGB (P = 0.0003). There was no difference in incidence of marginal ulcers between LRYGB and OAGB 2.7% vs 5% respectively (P = 0.1115). Internal hernia was seen only in LRYGB patients, 22 (2.2%). There was no significant difference in the re-operation rates following LRYGB 52 (5.4%) and OAGB 16 (8%) (P = 0.1824). ConclusionOAGB had superior short-term weight loss and low complications profile. Both procedures demonstrated no difference in either marginal ulcers or re-operation rates. Reflux symptoms have remained a major side effect of OAGB.

DNA methylation pattern changes following a short-term hypocaloric diet in women with obesity.

We aimed to investigate the effects of short-term hypocaloric diet-induced weight loss on DNA methylation profile in leukocytes from women with severe obesity. Eleven women with morbid obesity (age: 36.9 ± 10.3 years; BMI: 58.5 ± 10.5 kg/m2) were assessed before and after 6 weeks of a hypocaloric dietary intervention. The participants were compared with women of average weight and the same age (age: 36.9 ± 11.8 years; BMI: 22.5 ± 1.6 kg/m2). Genome-wide DNA methylation analysis was performed in DNA extracted from peripheral blood leukocytes using the Infinium Human Methylation 450 BeadChip assay. Changes (Δβ) in the methylation level of each CpGs were calculated. A threshold with a minimum value of 10%, p < 0.001, for the significant CpG sites based on Δβ and a false discovery rate of <0.05 was set. Dietary intervention changed the methylation levels at 16,064 CpG sites. These CpGs sites were related to cancer, cell cycle-related, MAPK, Rap1, and Ras signaling pathways. However, regardless of hypocaloric intervention, a group of 878 CpGs (related to 649 genes) remained significantly altered in obese women when compared with normal-weight women. Pathway enrichment analysis identified genes related to the cadherin and Wnt pathway, angiogenesis signaling, and p53 pathways by glucose deprivation. A short-term hypocaloric intervention in patients with severe obesity partially restored the obesity-related DNA methylation pattern. Thus, the full change of obesity-related DNA methylation patterns could be proportional to the weight-loss rate in these patients after dietary interventions.

Rationale and study design for lifestyle intervention in preparation for pregnancy (LIPP): A randomized controlled trial

IntroductionMaternal obesity increases neonatal risk for obesity and metabolic syndrome later in life. Prior attempts to break this intergenerational obesity cycle by limiting excessive gestational weight gain have failed to reduce neonatal adiposity. Alternatively, pre-conception lifestyle interventions may improve the in utero metabolic milieu during early pregnancy leading to improved fetal outcomes. This randomized controlled trial (RCT) is evaluating whether a lifestyle intervention to reduce weight and improve maternal metabolism in preparation for pregnancy (LIPP) attenuates neonatal adiposity, compared to standard medical advice. Material and methodsOverweight/class 1 obese women after a previous pregnancy, ~12 weeks postpartum, preparing for a subsequent pregnancy, will be block randomized (1:1) to either LIPP or standard of care in a parallel design. Randomization is stratified by lactation status and overweight vs. class 1 obesity. The LIPP program consists of intensive short-term weight loss followed by weight maintenance until conception using supervised exercise and a low glycemic Mediterranean diet. Primary outcomesGroup differences in neonatal adiposity at birth assessed by PEA POD and placental mitochondrial lipid metabolism. Secondary outcomesGroup differences in maternal pregravid and gestational body composition, insulin sensitivity, β-cell function, fasting metabolic and inflammatory biomarkers, and overall quality of life. Exploratory outcomes include umbilical cord blood insulin resistance, lipid profile and inflammation. DiscussionThis RCT will determine the efficacy of maternal weight loss prior to pregnancy on reducing neonatal adiposity. Findings may change standard obstetrical care by providing Level 1 evidence on lifestyle interventions improving neonatal outcomes for women planning for pregnancy. Clinical trial registrationNCT03146156

Predicting Weight Loss and Comorbidity Improvement 7 Years Following Laparoscopic Sleeve Gastrectomy: Does Early Weight Loss Matter?

Predicting the variables that affect the outcomes following laparoscopic sleeve gastrectomy (LSG) would allow focused resource allocation with a view to improving results. Whilst greater early post-operative weight loss following LSG is associated with greater short-term weight loss, the relationship between early results and long-term outcomes has not been described. A retrospective cohort analysis was performed on patients who underwent LSG 7years before a follow-up telephone interview was performed. Multivariate regression analysis was used to explore the relationship between early weight loss at 4weeks following surgery and weight loss at 7years. A non-inferiority analysis assessed whether early weight loss was associated with either improvement or resolution of hypertension or type 2 diabetes mellitus (T2DM) at 7years after surgery. Of the 156 patients identified between April and October 2012, 130 (83.3%) met the inclusion criteria and were included in the analysis. The average preoperative BMI was 42.5kg/m2 (standard deviation 5.2). The change in BMI was 4.6kg/m2 (4.0) at 4weeks and 12.2kg/m2 (5.4) at 7years. There was improvement or resolution in 19/31 (61.3%) patients with T2DM and 14/26 (53.8%) patients with hypertension. Whilst younger age was associated with greater weight loss at 7years follow-up, no such relationship was identified with early post-operative weight loss. Early post-operative weight loss was also not associated with long-term improvement or resolution in hypertension or T2DM. Early weight loss does not appear to be associated with greater weight loss nor comorbidity improvement 7years following LSG. ClinicalTrials.gov (SZMC-95/19).

Systematic Review and Meta-Analysis of Endoscopic Sleeve Gastroplasty with Comparison to Laparoscopic Sleeve Gastrectomy.

Endoscopic sleeve gastroplasty (ESG) has grown in popularity as a potential minimally invasive bariatric procedure with acceptable short- and medium-term outcomes. This review aims to assess the safety and weight loss outcomes of ESG and compare it with laparoscopic sleeve gastrectomy (LSG). A comprehensive search of MEDLINE, EMBASE, Cochrane and World Wide Web was conducted. Five studies were reviewed, three ESG cohort studies and two case-matched cohort studies comparing ESG with LSG. Total unique ESG and LSG patients were 1451 and 203, respectively. All papers demonstrated a modest short-term total body weight loss (TBWL%) at 6months ranging from 13.7 to 15.2% for ESG. Comparably, the two LSG papers demonstrated a superior TBWL% of 23.5 and 23.6% at 6months, with one paper reporting a 12-month TBWL% of 29.3%. Two ESG papers reported medium-term results at 18 and 24months of 14.8% and 18.6%, respectively. Excluding Clavien-Dindo 1 complications, ESG had a complication rate between 2.0 and 2.7%, while comparatively, LSG had a complication rate between 9.2 and 16.9% (current literature reported as 8.7%). In both procedures, there were no grade IV or V complications. ESG when compared with LSG has lower short-term weight loss outcomes with fewer complications. Weight loss results for ESG appear to plateau after the 1-year mark. The future and uptake of ESG as a minimally invasive bariatric procedure will be determined by its long-term data on potential weight loss sustainability.

Sustainable weight loss over three years in children with obesity: a pragmatic family-centered lifestyle intervention.

Childhood obesity has psychological consequences and increases the risk of continuous obesity into adulthood, associated with development of non-communicable disease (e.g. type 2 diabetes). Short-term weight loss intervention studies show good results but long-term studies are limited. One hundred ninety-nine obese children (4-18years of age), with a BMI-SDS (standard deviation score) above + 2 SDS were enrolled into a multifactorial family-centered lifestyle intervention study. The children had yearly visits in the outpatient clinic for anthropometrics, blood samples and DXA-scans, and 6-8 meeting with community health workers between these visits. The children followed the intervention up to 3years. After a follow-up of 26.7 ± 17.5months a reduction in BMI-SDS of -0.25 SDS (p < 0.001) was observed. The 57 children who were adherent to the intervention for ≥ 2years had significantly reduced BMI-SDS compared to the 142 children with shorter intervention (BMI-SDS: -0.38 ± 0.67 vs. -0.20 ± 0.50, p = 0.036). All weight loss was accompanied by decrease in fat mass and increase in muscle mass (p < 0.001). The intervention was found to induce long-term reduction in BMI-SDS in obese children, with beneficial change in body composition. Children who followed the intervention the longest had the greatest reduction in BMI-SDS. Level III, longitudinalcohortstudy.

Weight Loss After Obesity is Associated with Increased Food Motivation and Faster Weight Regainin Mice.

While changes in diet often result in short-term weight loss, weight loss is not typically maintained. It remains unclear why long-term weight loss is so difficult. It was hypothesized that obesity produces persistent changes in behavior that bias animals toward weight regain after weight loss. Mice were induced to gain weight with ahigh-fat diet for 6 weeks and then induced to lose this weight with alow-fat diet for 7 subsequent weeks. A control group was maintained on the low-fat diet for all 13 weeks. Activity was measured continuously with home cage activity monitors for the entire experiment. Motivation for sweetened food pellets was tested following weight loss. A separate group of mice was reexposed to ahigh-fat diet following 2, 4, or 8 weeks of withdrawal to assess the rate of weight regain. Activity levels decreased as animals gained weight and partially recovered following weight loss. Motivation for sucrose pellets was persistently heightened after weight loss. Consistent with these behavioral changes, mice also regained weight at a faster rate when reexposed to a high-fat diet after a period of weight loss. Weight loss after obesity was associated with increased motivation for palatable food and an increased rate of weight regain.

BWHealthy Weight Pilot Study: A randomized controlled trial to improve weight-loss maintenance using deposit contracts in the workplace.

ObjectiveDeposit contracts, where participants “bet” on achieving a goal and get their money back only if successful, have been shown to be effective for short-term weight-loss. This pilot study examined their effect on weight-loss maintenance.MethodsFrom 2016 to 2018, we conducted a pilot, 50-week randomized controlled trial among 42 hospital employees (19 intervention and 23 control), in Boston, Massachusetts, who lost ≥10 lb (4.5 kg) in the two years prior to enrollment. Participants were recruited primarily in-person. Both control and intervention participants were asked to attend a weigh in weekly and received weekly email communication. Intervention participants also entered into a deposit contract to maintain baseline weight within ≤2 lb (0.9 kg). We examined weight change from baseline to 50 weeks (primary outcome) and maintenance of baseline weight at 50 weeks (secondary outcome; binary – yes v. no). Participants completed baseline and follow-up surveys and received incentives for completion.ResultsAt baseline, mean (SD) weight was 83.2 (15.5 kg) among intervention and 80.7 (14.5 kg) among control participants. After 50 weeks, intervention participants had slightly less but non-significant weight gain (adjusted β −1.12 kg; 95% CI −5.28, 3.05) than control participants; 73.7% of intervention v. 39.1% of control participants met their weight-loss maintenance goal by study end (adjusted OR 4.78; 95% CI 1.01, 22.71).ConclusionsA deposit contract was not associated with differences in weight but led to more participants meeting their weight-loss maintenance goals; a deposit contract for weight-loss maintenance should be tested in a full-scale intervention. Most intervention participants viewed the deposit contract as acceptable.