Weight Regain Research Articles

S1515 The Role of Endoscopic Submucosal Dissection, Pursestring Suturing, and Anti-Obesity Medications in Enhancing Weight Loss After Transoral Outlet Reduction in Roux-en-Y Gastric Bypass Patients With Weight Regain

S1515 The Role of Endoscopic Submucosal Dissection, Pursestring Suturing, and Anti-Obesity Medications in Enhancing Weight Loss After Transoral Outlet Reduction in Roux-en-Y Gastric Bypass Patients With Weight Regain

Endoscopic argon plasma coagulation (APC) vs glucagon-like peptide-1 receptor agonists (ARGLP1) liraglutide and semaglutide for the treatment of weight regain (WR) after bariatric surgery (BS).

Endoscopic argon plasma coagulation (APC) vs glucagon-like peptide-1 receptor agonists (ARGLP1) liraglutide and semaglutide for the treatment of weight regain (WR) after bariatric surgery (BS).

S1519 Weight Regain After Endoscopic Sleeve Gastroplasty (ESG): Can Redo ESG (R-ESG) Help? What is the Role of Pharmacotherapy? Analysis of 80 Patients

S1519 Weight Regain After Endoscopic Sleeve Gastroplasty (ESG): Can Redo ESG (R-ESG) Help? What is the Role of Pharmacotherapy? Analysis of 80 Patients

S1513 Revisional Endoscopic Sleeve Gastroplasty/Endoscopic Sleeve-in-Sleeve Versus Surgical Re-Sleeve Gastrectomy in the Management of Weight Regain After Primary Sleeve Gastrectomy

S1513 Revisional Endoscopic Sleeve Gastroplasty/Endoscopic Sleeve-in-Sleeve Versus Surgical Re-Sleeve Gastrectomy in the Management of Weight Regain After Primary Sleeve Gastrectomy

S1598 Efficacy of Transoral Outlet Reduction for Weight Regain Following Roux-en Y Gastric Bypass: A Comparison of Pre and Post COVID-19 Pandemic

S1598 Efficacy of Transoral Outlet Reduction for Weight Regain Following Roux-en Y Gastric Bypass: A Comparison of Pre and Post COVID-19 Pandemic

Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery - a modified Delphi study.

Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. A modified Delphi survey was distributed to patients pre- and post-surgery, and to a variety of healthcare practitioners involved in bariatric care. Across two rounds, participants were asked to rate a variety of physical and psychosocial outcomes of bariatric surgery from 0 (Not Important) to 10 (Extremely Important). Outcomes rated 8-10 by at least 70% of participants were considered highly important (prioritised). The highest-rated outcomes were compared between the three groups as well as between medical and allied health practitioner subgroups. 20 pre-surgical patients, 95 post-surgical patients, and 28 healthcare practitioners completed both rounds of the questionnaire. There were 58 outcomes prioritised, with 21 outcomes (out of 90, 23.3%) prioritised by all three groups, 13 (14.4%) by two groups, and 24 (26.7%) prioritised by a single group or subgroup. Unanimously prioritised outcomes included 'Co-morbidities', 'General Physical Health', 'Overall Quality of Life' and 'Overall Mental Health'. Discordant outcomes included 'Fear of Weight Regain', 'Suicidal Thoughts', 'Addictive Behaviours', and 'Experience of Stigma or Discrimination'. While there was considerable agreement between stakeholder groups on many outcomes, there remain several outcomes with discordant importance valuations that must be considered. In particular, healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups. Future work will consider these priorities to ensure resulting measures encompass all important outcomes and are beneficial and valid for end users.

Weight Regain Following Laparoscopic Sleeve Gastrectomy in Morbid Obesity

Weight Regain Following Laparoscopic Sleeve Gastrectomy in Morbid Obesity

Abstract P352: Transcriptomic Effects of Prolonged Diet-Induced Obesity in Subtypes of Agouti-Related Peptide Neurons of the Hypothalamic Arcuate Nucleus

Obesity is the greatest impediment to improving cardiovascular health. Despite many methods to lose weight, few people can keep it off in the long-term. The adaptation (suppression) of resting metabolic rate (RMR) appears to mediate weight re-gain after weight loss, yet the neurobiology that controls RMR remains unclear. Previously we published that the angiotensin II type 1 receptor (AT 1 R/ Agtr1a ) within Agouti-related peptide (AgRP/ Agrp ) neurons of the arcuate nucleus of the hypothalamus (ARC) is critical for integrative control of RMR. In the ARC, AT 1 R is only expressed by a subset of AgRP neurons (“Type 1”). In lean animals, AT 1 R inhibits this cell via a β-arrestin-1/Gαi-coupled cascade ("Type 1i”). Prolonged diet-induced obesity (DIO) causes RMR adaptation and is associated with a spontaneous G protein cascade switch by AT 1 R in the Type 1 neuron, in which AT 1 R activation begins stimulating the cell via the Gαq-coupled cascade (“Type 1s”). Our ongoing work aims to clarify the molecular mechanisms that govern AT 1 R coupling to Gαi versus Gαq within Type 1 AgRP neurons. First, using a dual-reporter mouse with tdTomato in AT 1 R-expressing cells plus green fluorescent protein in somatostatin (SST/ Sst )-expressing cells, we confirmed that SST expression is a selective marker of the Type 1 subtype of ARC AgRP neurons. Second, we reanalyzed our previously published single-nucleus RNA sequencing dataset describing the mouse ARC following prolonged DIO (PMC7347451) to explore the effects of DIO upon the transcriptomic profiles of AgRP neuron subtypes. Of 26 cell types initially identified, one cluster strongly expressed both Sst and Agrp (Cluster 5). Sub-clustering of Cluster 5 identified four cell types with strong Agrp expression (subclusters 0, 2, 5, and 6). Subcluster 6 may represent the Type 1i subtype due to high Sst expression, as well as enrichment for signatures of Gαi signaling events . Subcluster 6 also had very few DIO-induced differentially expressed genes (up=3, down=2). Interestingly, Subcluster 2 was comprised almost exclusively of nuclei from the DIO group (95%). Subcluster 2 was more closely related to Subcluster 6 than the other Agrp subclusters in the cluster phylogenetic tree, leading us to hypothesize that this cluster represents the DIO-induced Type 1s subtype. These data identify novel markers of AgRP neuron subtypes within the ARC, and a possible transcriptomic signature of subtype switching induced by prolonged DIO.

Pre-Surgery Cortisol Levels as Biomarker of Evolution after Bariatric Surgery: Weight Loss and Weight Regain.

Background: Bariatric surgery (BS) is effective for achieving significant weight loss. However, weight regain (WR) is an emerging problem. Objective: To assess the prognostic value of morning serum cortisol, a 1 mg dexamethasone suppression test (DST), 24 h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC) in a cohort of patients with severe obesity (pwSO) undergoing BS in terms of weight loss and WR. Methods: Patients scheduled for BS underwent the following procedures at baseline, 12 months and 24 months after BS: medical history, anthropometric data, blood analysis and cortisol tests. We evaluated total weight loss (TWL) ≥ 30% at 1 year and WR after 2 years as an increase of ≥10% of the maximum weight lost. Results: In total, 142 subjects were included; 101 (71.1%) were females and the mean age was 45.9 ± 9.2 years. Up to 76.8% of subjects achieved ≥30% TWL, without statistically significant differences in DST results or morning serum cortisol, UFC or LNSC levels. However, a higher pre-surgery morning serum cortisol level was a significant predictor of a WR ≥ 10% (cortisol 17.8 [IQR 13.1-18.5] vs. 12.0 [IQR 8.8-15.8] μg/dL; p < 0.01); OR of 1.216 (95% CI 1.069-1.384); AUC [0.761, CI: (0.616-0.906); p < 0.01]. A cut-off value of cortisol > 13.0 μg/dL was predictive of a WR ≥ 10% (sensitivity 0.71; specificity 0.63). Conclusions: No cortisol test was useful in predicting weight loss; however, the pre-surgery morning serum cortisol level was able to predict a WR ≥ 10% in a cohort of pwSO 2 years after BS. A cut-off value of cortisol > 13 μg/dL might be an easy tool to identify patients at higher risk of WR, enabling healthcare providers to implement tailored, long-term strategies to minimize this outcome.

Weight Regain following Bariatric Surgery and in vitro Fertilization Outcomes

Introduction: The aim of this study was to estimate the time to pregnancy and live birth and evaluate the effect of weight regain in women with a history of bariatric surgery (BS) who underwent in vitro fertilization (IVF) treatments. Methods: This is a retrospective cohort study. All patients with previous BS who underwent IVF treatment in a tertiary university-affiliated hospital between 2013 and 2022 were included. Time to pregnancy and live birth were compared between patients who regained less than or greater than three points of body mass index (BMI) from the nadir weight after BS. Kaplan-Meier curves and log-rank tests were used to compare groups. Results: A total of 78 patients were included in this study. The positive β-hCG, clinical pregnancy, and live birth rates following BS were 89.4%, 78.9%, and 50.8%, respectively. The median time from the beginning of IVF treatments to a positive β-hCG test was 2.97 months (95% CI: 1.04–4.89 months), to a clinical pregnancy was 7.1 months (95% CI: 3.56–10.91), and to a live birth was 20.2 months. Women who maintained their nadir BMI following BS had nearly twice the chance of achieving a clinical pregnancy (HR 1.967, 95% CI: 1.026–3.771, p = 0.042) and were approximately three times more likely to achieve a live birth (2.864, 95% CI: 1.196–6.859, p = 0.018) than those who regained at least three points of BMI. Conclusion: Weight regain after BS is associated with a lower rate of live births and prolonged time to achieve clinical pregnancy and live birth.

Reply to Pantelis, A.G. Comment on "Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143".

We want to express our sincere gratitude for Dr. Pantelis' time and interest in reviewing our article and providing valuable feedback [...].

Liraglutide for the Treatment of Weight Regain After Bariatric Surgery: A Systematic Review and Meta-analysis.

The efficacy of liraglutide for treating type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains unclear. We searched PubMed, Embase, and Cochrane Library databases in January 2024. A random-effects model was employed to compute mean differences (MD) and events per 100 observations with 95% confidence intervals (CI) for continuous and binary endpoints. Statistical analysis was performed using R software. A total of 16 studies were included and 881 individuals. Patients were mostly female (50%), aged 36 to 55years, with a mean body mass index (BMI) of 39.4kg/m2, and had BS surgery 5years prior. Over a mean follow-up time ranging from 3months to 4years, it was observed a statistically significant reduction in BMI (MD - 8.56kg/m2; 95% CI 3.34 to 13.79; p < 0.01) and a mean reduction in total weight (MD - 16.03kg; 95% CI 0.03 to 32.02; p = 0.05) after liraglutide use. Additionally, 65% of patients undertaking liraglutide showed total body weight loss (BWL) above 5% (65.8 events per 100 observations; 95% CI 54.96 to 75.20; p < 0.01), while 26% lost more than 10% of total BWL (26.77 events per 100 observations; 95% CI 19.17 to 36.02; p < 0.01). A limitation is a variability between the studies. Our findings support the use of liraglutide for weight management in patients who experience weight regain after BS. Liraglutide is well tolerated and promotes significant weight loss, providing clinicians with a therapeutic option for this clinical challenge.

Weight-loss maintenance is accompanied by interconnected alterations in circulating FGF21-adiponectin-leptin and bioactive sphingolipids

Weight loss is often followed by weight regain. Characterizing endocrine alterations accompanying weight reduction and regain may disentangle the complex biology of weight-loss maintenance. Here, we profile energy-balance-regulating metabokines and sphingolipids in adults with obesity undergoing an initial low-calorie diet-induced weight loss and a subsequent weight-loss maintenance phase with exercise, glucagon-like peptide-1 (GLP-1) analog therapy, both combined, or placebo. We show that circulating growth differentiation factor 15 (GDF15) and C16:0-C18:0 ceramides transiently increase upon initial diet-induced weight loss. Conversely, circulating fibroblast growth factor 21 (FGF21) is downregulated following weight-loss maintenance with combined exercise and GLP-1 analog therapy, coinciding with increased adiponectin, decreased leptin, and overall decrements in ceramide and sphingosine-1-phosphate levels. Subgroup analyses reveal differential alterations in FGF21-adiponectin-leptin-sphingolipids between weight maintainers and regainers. Clinically, cardiometabolic health outcomes associate with selective metabokine-sphingolipid remodeling signatures. Collectively, our findings indicate distinct FGF21, GDF15, and ceramide responses to diverse phases of weight change and suggest that weight-loss maintenance involves alterations within the metabokine-sphingolipid axis.

Comment on Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143.

I read the article by Salazar J. [...].

Weight Loss Failure Post-Bariatric Surgery

Bariatric surgery (BS) is the most effective intervention for obesity, with proven significant weight loss, complications prevention, comorbidity remission, and improved survival. However, a substantial proportion of patients experience weight loss failure after BS. This review aims to provide an updated insight into weight loss failure after BS, define it, identify its prevalence, explain its health impact, determine risk factors, and summarize prevention and treatment. Future directives and larger-scale prospective studies should be considered to define weight regain (WR) and insufficient weight loss post bariatric surgery and address measures to resolve gaps and controversies.

E4bp4-Cyp3a11 axis in high-fat diet-induced obese mice with weight fluctuation

ObjectiveWeight regain after weight loss is a challenge in obesity management. The metabolic changes and underlying mechanisms in obese people with weight fluctuation remain to be elucidated. In the present study, we aimed to profile the features and clinical significance of liver transcriptome in obese mice with weight regain after weight loss.MethodsThe male C57BL/6J mice were fed with standard chow diet or high-fat diet (HFD). After 9 weeks, the HFD-induced obese mice were randomly divided into weight gain (WG), weight loss (WL) and weight regain (WR) group. After 10 weeks of dietary intervention, body weight, fasting blood glucose (FBG), intraperitoneal glucose tolerance, triglycerides (TG), total cholesterol (T-CHO) and low-density lipoprotein cholesterol (LDL-C) were measured. Morphological structure and lipid droplet accumulation in the liver were observed by H&E staining and oil red O staining, respectively. The liver transcriptome was detected by RNA sequencing. Protein expressions of liver cytochrome P450 3a11 (Cyp3a11) and E4 promoter-binding protein 4 (E4bp4) were determined by Western blot.ResultsAfter 10 weeks of dietary intervention, the body weight, FBG, glucose area under the curve, T-CHO and LDL-C in WL group were significantly lower than those in WG group (P < 0.05). At 4 weeks of HFD re-feeding, the mice in WR group presented body weight and T-CHO significantly lower than those in WG group, whereas higher than those in WL group (P < 0.05). Hepatic vacuolar degeneration and lipid droplet accumulation in the liver were significantly alleviated in WL group and WR group, compared to those in WG group. The liver transcriptome associated with lipid metabolism was significantly altered during weight fluctuation in obese mice. Compared with those in WG group, Cyp3a11 in the liver was significantly upregulated, and E4bp4 was significantly downregulated in WL and WR groups.ConclusionObese mice experience weight regain after weight loss by HFD re-feeding, but their glucose and lipid metabolism disorders are milder than those induced by the persistence of obesity. Downregulated E4bp4 and upregulated Cyp3a11 are detected in obese mice after weight loss, suggesting that the E4bp4-Cyp3a11 axis may involved in metabolic mechanisms underlying weight regulation.Graphical

Weight loss benefits on HDL cholesterol persist even after weight regaining.

Obesity-related comorbidities may relapse in patients with weight regain after bariatric surgery. However, HDL cholesterol (HDLc) levels increase after surgery and seem to remain stable despite a gradual increase in BMI. The aim of this study is to analyze the effects of weight regain after bariatric surgery on HDL cholesterol. This is a retrospective, observational, cohort study in patients who underwent bariatric surgery in the Hospital de la Santa Creu i Sant Pau (Barcelona) between 2007 and 2015. Patients without at least 5 years of follow-up after surgery, under fibrate treatment, and those who required revisional surgery were excluded from the analysis. Data were collected at baseline, 3 and 6 months after surgery, and then annually until 5 years post-surgery. One hundred fifty patients were analyzed. 93.3% of patients reached > 20% of total weight loss after surgery. At 5th year, 37% of patients had regained > 15% of nadir weight, 60% had regained > 10%, and 22% had regained < 5% of nadir weight. No differences were found in HDLc levels between the different groups of weight regain, nor in the % of change in HDLc levels between nadir weight and 5 years, or in the proportion of patients with normal HDLc concentrations either. HDLc remains stable regardless of weight regain after bariatric surgery.

“How I Do It: Endoscopic Management of Weight Regain After Roux-en-Y Gastric Bypass (With Video)”

Transoral outlet reduction (TORe) is an endoscopic intervention for patients who have weight recurrence, dumping syndrome, or post-prandial hypoglycemia following Roux-en-Y gastric bypass (RYGB). TORe offers a minimally invasive alternative to surgical revision, which is often associated with high morbidity rates. This paper will detail the approach to TORe in regard to patient selection, endoscopic technique, and post-TORe outcomes.

Weight Regain after Metabolic Surgery: Beyond the Surgical Failure.

Patients undergoing metabolic surgery have factors ranging from anatomo-surgical, endocrine metabolic, eating patterns and physical activity, mental health and psychological factors. Some of the latter can explain the possible pathophysiological neuroendocrine, metabolic, and adaptive mechanisms that cause the high prevalence of weight regain in postbariatric patients. Even metabolic surgery has proven to be effective in reducing excess weight in patients with obesity; some of them regain weight after this intervention. In this vein, several studies have been conducted to search factors and mechanisms involved in weight regain, to stablish strategies to manage this complication by combining metabolic surgery with either lifestyle changes, behavioral therapies, pharmacotherapy, endoscopic interventions, or finally, surgical revision. The aim of this revision is to describe certain aspects and mechanisms behind weight regain after metabolic surgery, along with preventive and therapeutic strategies for this complication.

Glucagon-like peptide-1 receptor agonists for post-bariatric surgery weight regain and insufficient weight loss: A systematic review

AimThe rising prevalence of obesity has elevated it to a significant public health concern. Bariatric surgery (BS) has emerged as a promising solution for severe obesity and associated complications, surpassing traditional approaches. Nonetheless, the escalating utilization of BS has given rise to novel challenges, namely weight regain (WR) and insufficient weight loss (IWL). Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have surfaced as a promising therapeutic avenue. Recognizing the potential of GLP-1 RAs in addressing relapse among individuals who have undergone BS is imperative for enhancing patient outcomes. Materials and methodsA comprehensive systematic review was undertaken by searching through databases including PUBMED, EBSCO, ProQuest, and manual exploration, following the PRISMA 2020 guideline. Included were studies that examined the application of GLP-1RAs in individuals who had undergone BS and encountered WR and IWL. ResultsThis review encompassed 10 studies, all of which demonstrated consistent findings. Irrespective of the diversity in surgical methods, a range of total weight loss (TWL) outcomes were observed. Both primary and revisional surgeries exhibited reductions in body mass index (BMI); emphasizing the overall efficacy of GLP-1 RAs. The collective evidence consistently highlighted the effectiveness and safety of GLP-1RAs in managing post-bariatric weight concerns. ConclusionsBased on current evidence, GLP-1 RA is a safe and effective treatment for post-BS WR and IWL. However, comparison studies using cohort or randomized controlled trials are needed to confirm its effect.