Weight Loss Outcomes In Patients Research Articles

Efficacy of Antiobesity Medications in Patients With Celiac Disease on a Gluten-free Diet: A Retrospective Matched Cohort Study.

We aim to describe the weight loss outcomes of patients with celiac disease (CeD) taking antiobesity medications (AOMs) and compare it with the weight loss outcomes of patients without CeD taking AOMs. Increasing rates of obesity and obesity-associated comorbidities have been previously reported in patients with CeD on a gluten-free diet. The effectiveness of AOMs in this population has not been previously described. In our retrospective cohort study, we matched 39 patients with treated CeD to 78 patients without CeD based on sex and AOM. We assessed the weight loss outcomes at 3, 6, and 12 months after starting the AOM in both cohorts and analyzed if there was a differential response when comparing by type of AOM [injectable glucagon-like peptide 1 (GLP-1) receptor agonists vs. oral non-GLP-1 AOMs]. Both cohorts had similar baseline demographic and anthropometric characteristics. At 12 months, the CeD cohort had a nonsignificantly inferior total body weight loss percentage compared with the cohort without CeD (6.5% vs. 9.5%, P =0.13). The CeD cohort had a similar proportion of patients achieving a total body weight loss percentage of ≥5% than the cohort without CeD (72.7% vs. 72.1%, P =1.00). No significant difference was observed when comparing the weight loss outcomes of injectables (GLP-1 receptor agonists) to oral AOMs. The proportion of patients reporting side effects was similar for both groups, regardless of the type of AOM. Patients with CeD taking AOMs had similar weight loss outcomes to patients without CeD. Hence, AOMs can be a safe and effective therapy for weight management in patients with CeD.

ODP008 Nonalcoholic Fatty Liver Disease (NAFLD) Impacts Weight Loss after Bariatric Surgery

Abstract Background Gastric bypass (GB) and sleeve gastrectomy (SG) remain the most effective intervention for weight loss in obesity. Our previous data showed a significant effect of preexisting diabetes on weight loss over 5 years. Since nonalcoholic fatty liver disease (NAFLD) is implicated as a precursor to clinical diabetes in obesity, we sought to determine if preexisting NAFLD modified weight loss outcomes. Methods 714 patients [79. 0% females, median age: 45 (37-53)] undergoing bariatric surgery were followed for 5 years. Clinically significant NAFLD at baseline was defined with a composite definition, combining the presence diagnosis on the medical record, definitive evidence for fat on imaging studies, presence of biopsy proving NAFLD, and/or elevation of liver function tests without another explanation. To screen for the presence of NAFLD, a natural language-processing tool EMERSE was utilized, and results were verified manually. Presence of diabetes, hypertension, and dyslipidemia were also defined using a combination of diagnostic codes, natural language processing and manual verification. Weight loss was tracked during annual visits and calculated using baseline weight and BMI. Total percent weight loss from baseline (%TWL) was also calculated. Results Of the 714 patients, 380 underwent GB [80.3% females, age 45 (35-53), median BMI 46.4 (41.6-51.9)] and 334 underwent SG [77.5% females, age 46 (39-54), BMI 49.7 (43.7-54.1)]. Overall, 31. 0% patients had clinically significant NAFLD at baseline, while the prevalence of diabetes, hypertension and dyslipidemia were 36. 0%, 54.9%, and 29.4% respectively. %TWL was impacted significantly by NAFLD in the GB group, as individuals without NAFLD lost medians of32.30 (26. 07-37.35), 32.33 (25. 04-39.21),31.12 (21.89-37.64), 26.40 (19.96-36.20), and 25.86 (18.16-34.79)%TWL versus29.63 (24.14-35.28),27.88 (21.44-35.11),24.15 (18.80-34.42),22. 09 (17. 03-30. 07), and21. 06 (14.92-30.25)%TWL compared to those with NAFLD by years1, 2, 3, 4, and 5 (p=0. 014,0. 002,0. 001,0. 002, and 0. 008). Among the SG group, differences in %TWL in NAFLD and non-NAFLD groupswere also significant, but only during year 1 and 2; non-NAFLD group had medians of25.73 (21.36-31.97) and24.55 (18.35-31.24) %TWL vs,22.48 (17.10-27.63) and22.28 (14.75-28.31)%TWL in NAFLD-group (p=<0. 001 and 0. 02). In a multivariable model for %TWL, preexisting NAFLD remained a highly significant covariate when adjusted for baseline BMI, age, gender, surgery type, time (year of follow up), time by surgery type, preexisting diabetes, baseline cholesterol and triglyceride levels (Beta; 95% CI: - 2.288; -3.938, -0.639 p=0. 0067). Of note, the only other significant covariate with regards to comorbidities was presence of baseline diabetes (Beta; 95% CI: -2.811; -4.602, -1. 021, p=0. 0022). Conclusions Preexisting NAFLD impacts weight loss outcomes in patients undergoing bariatric surgery, more so in GB than SG. Mechanisms for the role of clinically significant NAFLD or diabetes in reducing weight loss potential after bariatric surgery require further studies. Presentation: No date and time listed

One anastomosis gastric bypass as a one-stage bariatric surgical procedure in patients with BMI ≥ 50 kg/m2

In patients with BMI ≥ 50 kg/m2, it is difficult to select an appropriate procedure that can lead to optimum results. This study aims to evaluate mid-term weight loss outcomes in patients with BMI ≥ 50 kg/m2 following one anastomosis gastric bypass (OAGB) as a one-stage procedure. A prospective study was conducted on patients with BMI ≥ 50 kg/m2, aged 18 years and above who had undergone primary OAGB from January 2016 to February 2019 with at least two years follow-ups. A total of 197 patients with BMI ≥ 50 kg/m2 had underwent OAGB. The mean age was 38 years and the mean pre-operative BMI was 53.7 kg/m2. Mean EWL% were 63.7%, 67.8% and 66.2% at one, two and five years after OAGB respectively. The highest level of EWL% was 68.4%, which was achieved in the 18th month following OAGB. OAGB can be performed safely in patients with BMI ≥ 50 kg/m2 as a one-stage procedure with acceptable weight loss outcomes and remission of obesity associated medical problems.

Association Between the Parental Weight Status and the Weight Loss Outcome in Patients After Sleeve Gastrectomy.

Obesity is a complex multifactorial disease. Parents with obesity could have an impact on the weight loss outcome of their children following bariatric-metabolic surgery. Therefore, we aimed to investigate the association between the weight status of the parents and the weight loss outcome in patients undergoing sleeve gastrectomy (SG). Patients undergoing SG with ≥ 3years of follow-up between January 2016 and June 2018 were included in this study. The patients were categorized into three groups: (1) both parents did not have obesity (non-obesity parents, NOP); (2) one parent had obesity (single-parent obesity, SPO); (3) both parents had obesity (both parents' obesity, BPO). The main parameters for this study were the patients' preoperative and postoperative weight and the weight of the parents. A total of 218 SG patients were included in this study (NOP, n = 116; SPO, n = 64; BPO, n = 38). There was no statistically significant difference in the preoperative assessments. The main results for the NOP vs. SPO vs. BPO were as follows; parents' body mass index (BMI) 23.6 ± 2.5 vs. 27.9 ± 5.0 vs. 30.2 ± 3.3kg/m2, percentage of total weight loss (%TWL) 30.2 ± 9.0 vs. 30.8 ± 10.4 vs. 23.8 ± 10.9%. The %TWL for the BPO group was significantly lower than the NOP and SPO groups (p < 0.05). The patient's weight loss outcome was significantly lower when both parents had obesity. Further controlled or prospective studies are needed to determine the best means to improve weight loss outcomes in such patients.

Patterns of Weight Loss Medication Utilization and Outcomes Following Bariatric Surgery

BackgroundBariatric surgery is the most effective treatment for obesity; however, some patients experience significant weight regain. Weight loss medications (WLM) are being increasingly used in surgery patients with limited evidence. We examine weight loss outcomes in patients using WLM after bariatric surgery. MethodsIn a retrospective study, 197 bariatric surgery patients who started WLM between 2016 and 2019 at a single center were analyzed. Patients were categorized into 3 groups based on outcomes of the initial surgery: (1) Weight regainers (WR) = achieved goal weight loss after surgery (15% total body weight loss (TBWL) for sleeve gastrectomy (SG) and 25% TBWL for Roux-en-Y gastric bypass (RYGB)) with subsequent regain of > 20% of weight lost; (2) Adequate weight loss (AWL) = achieved goal weight loss without > 20% weight regain; (3) Non-responders (NR) = never achieved goal weight loss. Weight loss and medication use patterns were analyzed. ResultsAmong the three categories, there was no significant difference in duration of medical therapy or %TBWL with medications. RYGB patients lost more weight than SG patients using WLM (p = 0.03). Of the medications used, patients treated with phentermine + topiramate had the highest likelihood of achieving 5%, 10%, and 15% weight loss. Compared to other 2 groups, AWL group initiated WLM earlier and experienced more weight loss when compared to their pre-operative weight or post-operative nadir. ConclusionsRYGB patients respond better to WLM than SG patients. Those who had started WLM before regaining weight (AWL) experienced greater overall weight loss, suggesting that proactive medical therapy at the time of weight plateau can help with greater total weight loss. Phentermine + topiramate is the most effective WLM in post-bariatric surgery patients.

Perceived and Preferred Social Support in Patients Experiencing Weight Regain After Bariatric Surgery\u2014a Qualitative Study

PurposeWhile bariatric surgery generally shows successful weight loss outcomes in patients with obesity, weight regain exists. The aim of this qualitative study was to improve understanding of how patients with substantial weight regain after bariatric surgery experienced the support from family, friends, and healthcare providers, and what kind of support they had preferred.Materials and MethodsQualitative data were collected from semi-structured interviews with 16 participants. Mean weight regain from surgery to interview was 36%. The transcribed interviews were analyzed with thematic analysis.ResultsTwo main themes and seven sub-themes were formulated. The theme, A lonely struggle, illustrates patients’ feelings of abandonment and struggle during weight regain due to lack of support or unfavorable treatment. Participants commonly blamed themselves for re-gaining weight, and shame made them reluctant to engage in social activities or seek medical care. The theme, Others as sources of compassion and control, covers what support they desired, as well as had perceived to be helpful. Exercising or eating healthy with others was appreciated and felt supportive. Pro-active healthcare support and access to dietitians, physiotherapists, and psychological support were desired.ConclusionTo optimize the effect of bariatric surgery, support may need to be individualized and lifelong. Since shame and self-blame in patients with weight regain may hinder seeking professional help, care providers may need to initiate follow-up visits. Empathetic and non-judgmental support, access to multidisciplinary healthcare team, as well as peer-support groups may be beneficial to counteract weight regain post-bariatric surgery.

Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss.

Introduction Class 3 obesity (BMI ≥ 40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. Methods All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. Results Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2 ± 4.9% vs. 3.6 ± 4.7%, p = 0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0.01) and a reduction in the number of medications from baseline to 6 months (1.8 ± 1.0/patient vs. 1.0 ± 1.2/patient, p < 0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7 ± 5.3% vs. 2.4 ± 3.8%, p = 0.015). Conclusions Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.

A274 Is initial psychological clearance status related to weight loss outcomes in patients seeking bariatric surgery?

A274 Is initial psychological clearance status related to weight loss outcomes in patients seeking bariatric surgery?

The Effect of Age, Gender, and Baseline BMI on Weight Loss Outcomes in Obese Patients Undergoing Intragastric Balloon Therapy.

The effect of age, gender, and baseline BMI as predictors of weight loss outcome in patients undergoing bariatric surgery is controversial with conflicting results in the surgical literature. Few studies evaluated the effect of age, gender, and baseline BMI on weight loss in patients undergoing the intragastric balloon (IGB). This study aimed to evaluate age and gender and baseline BMI as predictors of weight loss in a group of obese patients who were treated with the IGB. We prospectively followed 229 patients who underwent the Orbera IGB in the period between June 2014 and December 2017, performed at one institution. Data were collected for age, gender, baseline weight, and baseline BMI. At 6months of IGB insertion, the following parameters were documented: % excess weight loss (%EWL), total body weight loss (TBWL), and % total body weight loss (%TBWL). Patients were categorized according to gender and age groups: age less than 40years and age equal to or more than 50years (45 patients who were 40-49years old were excluded). Baseline BMI was grouped into 2 groups: BMI < 35 and BMI > 40. Patients in the BMI range of 35-40 were excluded. Linear regression analysis was used to evaluate the effect of age, gender, and baseline BMI on weight loss. T test was used to compare the means of TBWL, %EWL, and %TBWL between the groups studied. One hundred eighty-four patients (80% female) were enrolled in the study; 135 (106 females and 29 males) younger than 40years, and 49 (42 females and 7 males) with age equal or more than 50years. There was a significant effect of age on weight loss in females at 6months, with more weight loss (as measured by % excess weight loss) in the younger age group compared with patients aged 50years or more (% excess weight loss was 47.34% and 38%, respectively, p value = 0.04). There was no difference in % excess weight loss in the younger or older male patients (% excess weight loss was 50.21% and 47.05%, respectively, p value = 0.836). Patients of both sexes with lower baseline BMI had a significantly more % excess weight loss compared with the group with the higher baseline BMI (%EWL females/males 53.7%/50.1% and 32.5%/32.2%, respectively, p value <0.01). Female patients younger than 40years lost greater amount of excess weight than older patients at 6months after IGB insertion. On the other hand, age did not alter the outcome in male patients. Lower baseline BMI was significantly correlated with greater excess weight loss in both sexes. Age and baseline BMI can be used as predictors of weight loss outcome in patients treated with IGB.

SAT-110 Long-Term Impact of Gastric Bypass versus Sleeve Gastrectomy on Nonalcoholic Fatty Liver Disease: Retrospective Observations from Michigan Bariatric Surgery Cohort

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in obese patients. Bariatric surgery is highly effective for treatment of NAFLD. We have previously reported 4 and 5-year weight loss outcomes in patients who underwent bariatric surgery at Michigan Medicine from 2008 to 2013. The aim of this study was to assess the impact of weight loss surgery on persistence of NAFLD up to 5 years post-surgery. Retrospective data on weight, blood pressure, lipid panel, A1c, liver enzymes, NAFLD Fibrosis scores (NFS) and imaging were analyzed with respect to the type of surgery [sleeve gastrectomy (SG) or Roux-en Y gastric bypass (GB)] at baseline and yearly for 5 years. Patients were assessed for presence of underlying NAFLD based on liver biopsy, imaging, or clinical diagnosis (ICD-9 or 10 codes) prior to surgery. Persistent NAFLD was assessed based on presence of hepatic steatosis on abdominal imaging (ultrasound, CT or MRI) over follow-up. Follow up data were available on 221 patients with NAFLD at baseline (GB =128, SG=93); median age 47 years (IQR 40-54) with 73% females and a median BMI of 46.2 kg/m2 (IQR 41.2-52.4). Median BMI was higher in the SG group versus GB owing to the criteria for approval in 2008-2012 (48.1 kg/m2 vs. 45.3 kg/m2, p=0.01). Median NFS was higher in SG vs GB (0.04 vs -0.50, p =0.01). Only 38 patients (17.2%) had a liver biopsy, among which 25 (65.8%) showed non-alcoholic steatohepaitis (NASH) and 3 (7.9%) demonstrated cirrhosis. Both groups had a reduction in NFS over follow up with median NFS significantly lower at all-time points in the GB group, p<0.01); improvement in NFS was more pronounced in the GB group at year 1, p=0.03. Overall, 83 patients (37.5%) had follow-up abdominal imaging with 28 (33.7%) having evidence of persistent NAFLD; 28.7% at 1-2 years, 16.3% at 2-4 years, and 55% at >4 years post-surgery. The nadir of BMI occurred at 1 year (median 31.3 and 37.2, in BG versus SG, respectively), with a peak at year 4 for GB (median 35.6) and year 5 for SG (median 40.4). At all-time points, the median weight loss was highest in the GB group. All metabolic parameters remained improved compared to baseline. The following differences were noted in the GB group versus SG group: LDL was significantly lower at year 1, 2 and 5; cholesterol significantly lower at year 1 and 2; significantly larger reduction in hemoglobin A1c at year 2, 4 and 5; and reduction in TG significantly higher at year 1. In a multivariable model integrating type of surgery, baseline diabetes and baseline hyperlipidemia, baseline hyperlipidemia was independently associated with persistent NAFLD (OR: 3.2, 95% CI 1.04-10.10, p=0.04). Change in weight was not predictive of persistent NAFLD. In conclusion, these observations suggest that bariatric surgery may have a weight-independent effect on NAFLD. Further studies are needed to examine the effect of disease severity and co-morbidities on NAFLD resolution after bariatric surgery.

Weight-Centric Management of Type 2 Diabetes Mellitus

Background: Obesity and type 2 diabetes mellitus (T2DM) are inextricably linked. Obesity is the pathophysiologic driver of T2DM, and as such, the treatment of obesity can improve glycemic control. Although there is some data from phase 3 trials of anti-obesity pharmacotherapy in patients with T2DM, there is currently a paucity of data related to the weight-centric management of T2DM in clinical practice. Data from clinical trials of these medications suggests that weight loss outcomes in patients with T2DM are inferior, likely due to the weight gain promoting effects of concomitant antidiabetic therapies. Methods: In a retrospective study, electronic medical records of 359 consecutive new patients seen at the Weill Cornell Comprehensive Weight Control Center from 4/1/14-4/1/15 were reviewed and data related to demographics, medications, weight, and HbA1c was recorded. Results: 48 of 359 patients had T2DM. Baseline age and BMI were 56.2±10.6 years and 39.5±7.6 kg/m2 in patients with T2DM and 48±14.7 years and 35.6±6.8 kg/m2 in patients without T2DM; 54.2% and 70.7% were female, respectively. Management strategies in patients with T2DM included the addition and dose escalation of metformin, GLP-1 agonists, and SGLT2 inhibitors, discontinuation of sulfonylureas and TZDs, and dose reduction of insulin when possible. 56.3% of patients with T2DM were started on anti-obesity pharmacotherapy including lorcaserin, phentermine, topiramate and bupropion. At 12 months, weight loss was 8.9±7.8% in patients with T2DM and 8.6±7.7% in those without T2DM. In patients with T2DM, HbA1c was 7.1±1.1% at initial visit and 6.7±1.3% at 12 months. Conclusions: In this review, weight loss outcomes were similar in patients with and without T2DM. We show that by using a weight-centric approach to diabetes management, patients can achieve glycemic control with concomitant weight loss. Disclosure L. Mandel: None. A. Shukla: None. R. Kumar: Speaker's Bureau; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc.. J. Waitman: None. L. Aronne: Board Member; Self; Myos Corporation, Jamieson Wellness. Consultant; Self; Aspire Bariatrics, Eisai Inc., Novo Nordisk Inc.. Research Support; Self; Pfizer Inc.. Consultant; Self; Takeda Pharmaceuticals U.S.A., Inc.. Research Support; Self; Zafgen. Other Relationship; Self; BMIQ, Gelesis, ERX Pharmaceuticals, Inc.. Research Support; Self; AstraZeneca. Consultant; Self; Sanofi, Janssen Pharmaceuticals, Inc., UnitedHealth Group.

Primary Inadequate Weight Loss After Roux-en-Y Gastric Bypass Is not Associated with Poor Cardiovascular or Metabolic Outcomes: Experience from a Single Institution.

It is well accepted that bariatric surgery has cardiovascular and metabolic effects independent of weight loss. Weight loss outcomes of patients undergoing Roux-en-Y gastric bypass (RYGB) at a high volume referral center were collected at 1year postoperatively. Patients with failed primary weight loss were identified. Primary inadequate weight loss was defined as total body weight loss less than 15%. Changes in hypertension (HTN), dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome profiles were investigated using Student's t test. A total of 2500 patients underwent RYGB from the years 2001-2013 at our institution. One hundred five (4.2%) patients had primary inadequate weight loss. Within this cohort, 81 (77.1%) patients had hypertension, 67 (63.8%) had dyslipidemia, 53 (50.5%) had type 2 diabetes mellitus, and 66 (62.9%) patients had metabolic syndrome. At 1year postoperatively, all metabolic parameters were significantly improved. Measures of metabolic disease included high-density lipoprotein (HDL) (46.3±11.6 versus 54.1±12.7mg/dL, p<0.01), low-density lipoprotein (LDL) (103.6±35.8 versus 89.2±30.0mg/dL, p<0.01), triglycerides (177.3±139.1 versus 117.6±59.3mg/dL, p<0.01), mean plasma glucose (128.9±55.3 versus 102.7±27.3mg/dL, p<0.01), and hemoglobin A1C (7.3±1.9 versus 6.1±1.0%, p<0.01). HTN was noted to improve in 27 (33.3%) patients based on a decrease in the number of anti-hypertensives used (1.7±1.0 versus 1.3±1.3, p<0.01), and 21 (31.8%) patients had resolution of their metabolic syndrome. Improvement in cardiometabolic comorbidities still occurs despite suboptimal weight loss following RYGB.

A5015 - Weight loss outcomes in patients with Stomach Intestinal Pylorus Sparing surgery at 3 years

A5015 - Weight loss outcomes in patients with Stomach Intestinal Pylorus Sparing surgery at 3 years

Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery

BackgroundAs the number of patients who have undergone bariatric surgery increases, it is expected that more patients will present for body contouring procedures after weight loss. It has been reported that abdominoplasty can improve mobility, reduce skin fold complications, and improve psychosocial functioning. No previous studies have evaluated weight loss in patients who pursue plastic surgery after bariatric surgery. ObjectivesThe aim of this study is to evaluate weight loss outcomes in patients who choose to undergo body contouring procedures after bariatric surgery. SettingAcademic center, United States. MethodsPatients who underwent body contouring procedures after bariatric surgery between 2002 and 2014 were included. A comparison was made to a matched cohort based on age, gender, type of bariatric procedure, preoperative body mass index (BMI), and length of follow-up. ResultsIn total, 186 patients had documentation of a body contouring procedure after bariatric surgery. There were 158 (84.9%) female participants in the body countering group. Mean age was 48.5±12.7 years and mean BMI was 49.8±10.4 kg/m2. Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding were performed in 157 (84.4%), 17 (9.1%), and 11 (5.9%) patients, respectively. After a matched follow-up period of 61 months, total weight loss was 43.0±22.6 kg in the body contouring group versus 33.5±21.7 kg in the control group (P<.001), percentage of total weight loss was 30.8±11.4% versus 24.0±13.2% (P<.001), percentage excess weight loss was 66.4±25% versus 52.5±30.5% (P<.001), and BMI dropped by 15.7±7.8 kg/m2 versus 12.1±7.3 kg/m2 (P<.001) in the body contouring group compared with the bariatric surgery–only group, respectively. Multivariate analysis indicated that body contouring after bariatric surgery is significantly associated with increase and durable weight loss (odds ratio 3.59, 95% confidence interval 2.04–5.14, P< .001). ConclusionPatients who underwent body contouring procedures after bariatric surgery had significantly better long-term weight loss than a matched cohort of patients. This finding likely has many contributing factors, and the association between long-term weight loss and body contouring procedures after bariatric surgery requires more detailed study.

Weight loss outcomes in patients with pain.

To determine whether the presence or severity of pain is predictive of suboptimal weight loss outcomes in behavioral weight management programs. This is a secondary data analysis comparing weight loss among participants with overweight/obesity who participated in a 12-month randomized controlled trial. Of the 481 participants randomized, 394 (81.9%) had available pain data and were categorized by Pain Type (back pain, arthritis pain, both, or neither) and Pain Severity (no pain, moderate pain, or severe pain). Dietary and physical activity outcomes were also explored. High rates of moderate and severe (80.2%), and back and arthritis (72.6%), pain were observed. Linear mixed models showed significant differences in % weight loss among Pain Severity, but not Pain Type, groups. Patients with severe pain lost significantly less weight (-0.1 kg, 95% CI = -1.5, -1.2) compared to those with either moderate or no pain (-1.9 kg, 95% CI = -2.5, -1.3; -2.1 kg, 95% CI = -3.3, -1.0, respectively). Patients with arthritis pain lost a significant amount of weight despite only minor improvements in walking distance. Pain severity, but not pain type, is predictive of suboptimal weight loss outcomes.

Weight loss outcomes among patients referred after primary bariatric procedure

BackgroundBariatric patients may not always obtain long-term care by their primary surgeon. Our aim was to evaluate weight loss outcomes in patients who had surgery elsewhere. MethodsWe conducted a retrospective analysis. Postreferral management included nonsurgical, revision, or conversion. Primary outcomes were percent excess weight loss (%EWL) overall, according to original operation, and based on postreferral management. ResultsBetween 2001 and 2013, there were 569 patients. Mean follow-up was 3.1 years. Management was 42% nonsurgical, 41% revision, and 17% conversion. Overall, mean %EWL was 45.3%. Based on original surgery type, %EWL was 41.2% for adjustable gastric banding vs 58.3% for Roux-en-Y gastric bypass (P ≤ .0001). Management affected %EWL (41.2% nonsurgical vs 45.3% revision vs 55.1% conversion, P ≤ .0001). ConclusionsPatients referred after bariatric surgery can achieve satisfactory weight loss. This differs based on surgery type and management strategy.

Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery.

Background. The amount of excess weight loss (%EWL) among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of 51 ± 8 kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG). Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20), “depression” (PHQ-9), “anxiety” (GAD-7), and “mental impairment” (ISR) as well as coping style (Brief COPE) and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%), moderate (40–59%), and high (60–115%). LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients' preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention.

Demographic profile, clinical characteristics, motivations and weight loss outcomes of patients in a nonsurgical weight management programme

Weight management programmes (WMPs) can help overweight individuals lose weight, and thus prevent complications associated with obesity. Herein, we describe the demographic profile, clinical characteristics, motivations and expectations, and outcomes of patients enrolled in a nonsurgical WMP. This was a retrospective study of consecutive patients with a body mass index (BMI) of > 23 kg/m2 enrolled in the four-month WMP at the Health For Life Clinic, Alexandra Hospital, Singapore, between 1 and 31 August 2009. Demographic data, medical history and source of referral were recorded. Details on personal motivations and weight loss goals were obtained from the completed self-administered questionnaires of the WMP participants. Weight, waist circumference, fat percentage and BMI were measured at the start and end of the WMP. A weight loss of ≥ 5% was deemed as a successful outcome. A total of 58 patients (mean age 37.2 years) were included in our study. Of these 58 patients, 58.6% were of Chinese ethnicity and 55.2% were male. Many patients (32.8%) attributed their weight gain to work- or study-related stress, and a minority to poor eating habits (12.1%) or a lack of exercise (10.3%). Patients' motivations included a desire for better health (53.4%) and better fitness (15.5%). However, only 53.4% patients scored their motivation as high (i.e. a score of > 7). The mean expected weight loss was 9.9 kg at 4 months, and 14.1 kg at 12 months. Among the 40 patients (69.0%) who completed the programme, the mean percentage weight loss was 1.8 ± 4.3%. A weight loss of ≥ 5% was achieved by 8 (13.8%) patients. Although the patients in our study cohort were young and educated, only a portion of them appeared to be highly motivated to lose weight, despite joining the WMP. There is a need for patients to be guided on how to set realistic weight loss goals.

Weight loss after bariatric surgery in morbidly obese adolescents with MC4R mutations

ObjectiveTo determine the frequency of Melanocortin4 Receptor (MC4R) mutations in morbidly obese adolescents undergoing bariatric surgery and compare weight loss outcomes in patients with and without mutations.Design and MethodsIn this prospective cohort study, 135 adolescent patients evaluated for bariatric surgery were screened for MC4R mutations; 56 had 12 month postoperative data available for analysis.ResultsMC4R mutations were detected in five of the 135 patients (3.7%); four underwent restrictive bariatric surgery. For the three patients with gastric banding, percent excess weight loss (%EWL) postoperatively was 36.0% at 5 years in one, 47% at 4 years in the second, and 85% at 1 year in the third. For the patient with gastric sleeve resection, %EWL of 96% was attained at 1 year postoperatively. The four MC4R cases had a higher, although non-significant, %EWL compared to 52 non-matched controls at 12 months postoperatively (48.6% vs. 23.4%; p<0.37). When matched by age, sex, and race to 14 controls, there was no significant difference in %EWL (p < 0.31), BMI change (p< 0.27), or absolute weight loss (p <0.20).ConclusionThe frequency of MC4R mutations is similar to prior studies, with affected patients showing beneficial weight loss outcomes.

Bariatric Surgery: 1-Year Weight Loss Outcomes in Patients with Bipolar and Other Psychiatric Disorders

Bariatric surgery is the most effective obesity treatment in terms of weight loss and resolution of comorbidities. Roux-en-Y bypass surgery achieves weight loss of 60% to 70% excess body weight in most morbidly obese individuals. Patients with psychological disorders are reported to have less optimal results and those with bipolar, possibly worse. A retrospective survey of Roux-en-Y bypass bariatric surgery patient clinical records to assess weight loss outcomes for morbidly obese patients, including those with bipolar disorders, other psychiatric conditions, and those without psychiatric diagnoses, was conducted. For all three study subgroups, the baseline mean weight exceeded 300 lbs, and mean BMI was 50. At 6 months, mean values for weight, percent weight loss, BMI, and percent change in BMI for all three groups were not significantly different. At 1 year, overall mean weight was less than 200 lbs, percent weight loss exceeded 35%, and mean BMI was 32. These outcomes were remarkably similar and not significantly different for those with bipolar disorder, other psychological conditions, and those without. The percent reaching follow-up at 12 months also did not differ between the three psychiatric status subgroups. In patients who undergo Roux-en-Y gastric bypass surgery, those with bipolar disorder have successful weight loss outcomes at 12 months that are not significantly different than those who have other psychiatric diagnoses and those with no psychiatric disorder. Despite practices that suggest the contrary, well-managed morbidly obese bipolar patients should be considered as suitable candidates for bariatric surgery using established criteria for risk assessment.