JAMA – 2024 Feb 27;331(8):654-664 – doi: 10.1001/jama.2024.0318
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Anita P Courcoulas 1, Mary Elizabeth Patti 2, Bo Hu 3, David E Arterburn 4, Donald C Simonson 5, William F Gourash 1, John M Jakicic 6, Ashley H Vernon 7, Gerald J Beck 3, Philip R Schauer 8, Sangeeta R Kashyap9, Ali Aminian 10, David E Cummings 11, John P Kirwan 12
Affiliations Expand
- PMID: 38411644; PMCID: PMC10900968 (available on 2024-08-27); DOI: 10.1001/jama.2024.0318
Abstract
Importance: Randomized clinical trials of bariatric surgery have been limited in size, type of surgical procedure, and follow-up duration.
Objective: To determine long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes.
Design, setting, and participants: ARMMS-T2D (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes) is a pooled analysis from 4 US single-center randomized trials conducted between May 2007 and August 2013, with observational follow-up through July 2022.
Intervention: Participants were originally randomized to undergo either medical/lifestyle management or 1 of the following 3 bariatric surgical procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding.
Main outcome and measures: The primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 7 years for all participants. Data are reported for up to 12 years.
Results: A total of 262 of 305 eligible participants (86%) enrolled in long-term follow-up for this pooled analysis. The mean (SD) age of participants was 49.9 (8.3) years, mean (SD) body mass index was 36.4 (3.5), 68.3% were women, 31% were Black, and 67.2% were White. During follow-up, 25% of participants randomized to undergo medical/lifestyle management underwent bariatric surgery. The median follow-up was 11 years. At 7 years, HbA1c decreased by 0.2% (95% CI, -0.5% to 0.2%), from a baseline of 8.2%, in the medical/lifestyle group and by 1.6% (95% CI, -1.8% to -1.3%), from a baseline of 8.7%, in the bariatric surgery group. The between-group difference was -1.4% (95% CI, -1.8% to -1.0%; P < .001) at 7 years and -1.1% (95% CI, -1.7% to -0.5%; P = .002) at 12 years. Fewer antidiabetes medications were used in the bariatric surgery group. Diabetes remission was greater after bariatric surgery (6.2% in the medical/lifestyle group vs 18.2% in the bariatric surgery group; P = .02) at 7 years and at 12 years (0.0% in the medical/lifestyle group vs 12.7% in the bariatric surgery group; P < .001). There were 4 deaths (2.2%), 2 in each group, and no differences in major cardiovascular adverse events. Anemia, fractures, and gastrointestinal adverse events were more common after bariatric surgery.
Conclusion and relevance: After 7 to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery compared with medical/lifestyle intervention had superior glycemic control with less diabetes medication use and higher rates of diabetes remission.
Trial registration: ClinicalTrials.gov Identifier: NCT02328599.
Observational Study
Diabetes Obes Metab . 2022 Jul;24(7):1206-1215.
doi: 10.1111/dom.14680. Epub 2022 Mar 16.
Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D): Study rationale, design, and methods
Donald C Simonson 1 2, Bo Hu 3, David E Arterburn 4, Philip R Schauer 5, Sangeeta R Kashyap3, Anita P Courcoulas 6, David E Cummings 7, Mary-Elizabeth Patti 2 8, William F Gourash 6, Ashley H Vernon 1 2, John M Jakicic 9, John P Kirwan 5
- PMID: 35233923 PMCID: PMC9177689 DOI: 10.1111/dom.14680
Abstract
Aims: Long-term data from randomized clinical trials comparing metabolic (bariatric) surgery versus a medical/lifestyle intervention for treatment of patients with obesity/overweight and type 2 diabetes (T2D) are lacking. The Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) is a consortium of four randomized trials designed to compare long-term efficacy and safety of surgery versus medical/lifestyle therapy on diabetes control and clinical outcomes.
Materials and methods: Patients with T2D and body mass index (BMI) of 27-45 kg/m2 who were previously randomized to metabolic surgery (Roux-en-Y gastric bypass, adjustable gastric band, or sleeve gastrectomy) versus medical/lifestyle intervention in the STAMPEDE, SLIMM-T2D, TRIABETES, or CROSSROADS trials have been enrolled in ARMMS-T2D for observational follow-up. The primary outcome is change in glycated haemoglobin after a minimum 7 years of follow-up, with additional analyses to determine rates of diabetes remission and relapse, as well as cardiovascular and renal endpoints.
Results: In total, 302 patients (192 surgical, 110 medical/lifestyle) previously randomized in the four parent studies were eligible for participation in the ARMMS-T2D observational study. Participant demographics were 71% white, 27% African-American and 68% female. At baseline: age, 50 ± 8 years; BMI, 36.5 ± 3.5 kg/m2 ; duration of diabetes, 8.8 ± 5.6 years; glycated haemoglobin, 8.6% ± 1.6%; and fasting glucose, 168 ± 64 mg/dl. More than 35% of patients had a BMI <35 kg/m2 .
Conclusions: ARMMS-T2D will provide the largest body of long-term, level 1 evidence to inform clinical decision-making regarding the comparative durability, efficacy and safety of metabolic surgery relative to a medical/lifestyle intervention among patients with T2D, including those with milder class I obesity or mere overweight.
Keywords: Roux-en-Y gastric bypass; adjustable gastric band; bariatric surgery; clinical trial; diabetes remission; lifestyle; metabolic surgery; obesity; sleeve gastrectomy; type 2 diabetes.
© 2022 John Wiley & Sons Ltd.
Figures
Figure 1.
CONSORT Diagram. STAMPEDE – Surgical…
Figure 2.
Study Protocol. Dates for annual…
Review
Am Surg . 2024 May;90(5):925-933.
doi: 10.1177/00031348231220576. Epub 2023 Dec 7.
Updates in Bariatric Surgery
Justin L Hsu 1, Timothy M Farrell 2
- PMID: 38060198 DOI: 10.1177/00031348231220576
Abstract
Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.
Keywords: bariatric surgery; duodenal switch; gastric bypass; morbid obesity; sleeve gastrectomy.
Review
Prim Care . 2024 Sep;51(3):511-522.
doi: 10.1016/j.pop.2024.04.007. Epub 2024 May 7.
Obesity
Tyler Fuller 1, Zakary Newberry1, Munima Nasir1, Justin Tondt 2
- PMID: 39067975 DOI: 10.1016/j.pop.2024.04.007
Abstract
Obesity is a complex, multifactorial disease that is highly prevalent in the United States. Obesity is typically classified by body mass index and the US Preventive Services Task Force recommends screening all patients 6 years or older for obesity. Evaluation includes a thorough history and physical examination as well as laboratory tests including hemoglobin A1c, comprehensive metabolic panel, lipid panel, and thyroid-stimulating hormone. Treatment involves a multidisciplinary approach including nutrition, physical activity, and behavioral therapy as well as pharmacotherapy and bariatric surgery when appropriate.
Keywords: BMI; Bariatric surgery; Diet; Exercise; Obesity.
Copyright © 2024 Elsevier Inc. All rights reserved.
Review
JAMA Surg . 2024 Mar 1;159(3):331-338.
doi: 10.1001/jamasurg.2023.5809.
Bariatric Surgery and Longitudinal Cancer Risk: A Review
Pei-Wen Lim 1, Chee-Chee H Stucky2, Nabil Wasif 2, David A Etzioni 1, Kristi L Harold1, James A Madura 2nd 1, Zhi Ven Fong2
Affiliations Expand
- PMID: 38294801. DOI: 10.1001/jamasurg.2023.5809
Abstract
Importance: Cancer is one of the leading causes of death in the United States, with the obesity epidemic contributing to its steady increase every year. Recent cohort studies find an association between bariatric surgery and reduced longitudinal cancer risk, but with heterogeneous findings.
Observations: This review summarizes how obesity leads to an increased risk of developing cancer and synthesizes current evidence behind the potential for bariatric surgery to reduce longitudinal cancer risk. Overall, bariatric surgery appears to have the strongest and most consistent association with decreased incidence of developing breast, ovarian, and endometrial cancers. The association of bariatric surgery and the development of esophageal, gastric, liver, and pancreas cancer is heterogenous with studies showing either no association or decreased longitudinal incidences. Conversely, there have been preclinical and cohort studies implying an increased risk of developing colon and rectal cancer after bariatric surgery. A review and synthesis of the existing literature reveals epidemiologic shortcomings of cohort studies that potentially explain incongruencies observed between studies.
Conclusions and relevance: Studies examining the association of bariatric surgery and longitudinal cancer risk remain heterogeneous and could be explained by certain epidemiologic considerations. This review provides a framework to better define subgroups of patients at higher risk of developing cancer who would potentially benefit more from bariatric surgery, as well as subgroups where more caution should be exercised.
Review
Medicina (Kaunas) . 2024 May 14;60(5):806.
doi: 10.3390/medicina60050806.
Bariatric Surgery in Asthma: A Narrative Review
Maciej Mawlichanów 1, Paulina Tatara 2, Andrzej Kwiatkowski 1, Anna Różańska-Walędziak 3, Maciej Walędziak 1
- PMID: 38792989 PMCID: PMC11122970 DOI: 10.3390/medicina60050806
Abstract
Nearly 60% of asthmatics in the USA suffer from obesity. Asthma is a comorbid condition alongside obesity, commonly accompanied by conditions such as hypertension and type 2 diabetes. The positive effect of bariatric surgery on patients suffering from hypertension and type 2 diabetes, which leads to either a reduction in the dose of medication taken for the aforementioned diseases or the withdrawal of the disease, is quite well proven in the literature. Currently, the impact of bariatric operations on the control and course of bronchial asthma and pharmacological treatment has not been fully recognized and described, requiring further research; therefore, the following review of the literature was conducted.
Keywords: asthma; asthma after surgery; obesity; surgery in asthma.
Review
Surg Laparosc Endosc Percutan Tech . 2024 Aug 1;34(4):400-406.
doi: 10.1097/SLE.0000000000001296.
Decision-making Considerations in Revisional Bariatric Surgery
Sheena Chen 1, Jessica Chiang 1, Omar Ghanem 2, George Ferzli 1
- PMID: 38963277 DOI: 10.1097/SLE.0000000000001296
Abstract
Objective: With drastic variations in bariatric practices, consensus is lacking on an optimal approach for revisional bariatric surgeries.
Materials and methods: The authors reviewed and consolidated bariatric surgery literature to provide specific revision suggestions based on each index surgery, including adjustable gastric band (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single anastomosis duodenal-ileal bypass with sleeve (SADI-S), one anastomosis gastric bypass (OAGB), and vertical banded gastroplasty (VBG).
Results: AGB has the highest weight recurrence rate and can be converted to RYGB, SG, and BPD-DS. After index SG, common surgical options include a resleeve or RYGB. The RYGB roux limb can be distalized and pouch resized in context of reflux, and the entire anatomy can be revised into BPD-DS. Data analyzing revisional surgery after a single anastomosis duodenal-ileal bypass with sleeve was limited. In patients with one anastomosis gastric bypass and vertical banded gastroplasty anatomy, most revisions were the conversion to RYGB.
Conclusions: As revisional bariatric surgery becomes more common, the best approach depends on the patient’s indication for surgery and preexisting anatomy.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Observational Study
JAMA Netw Open . 2024 Jun 3;7(6):e2415392. doi: 10.1001/jamanetworkopen.2024.15392.
Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality
Dror Dicker 1 2, Yael Wolff Sagy 3, Noga Ramot 3, Erez Battat 3, Philip Greenland 4, Ronen Arbel5 6, Gil Lavie3 7, Orna Reges 8
- PMID: 38848064 . PMCID: PMC11161844 . DOI: 10.1001/jamanetworkopen.2024.15392
Abstract
Importance: Evidence regarding the relative effectiveness of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in reducing mortality and major adverse cardiovascular events (MACEs) is limited.
Objective: To compare all-cause mortality and nonfatal MACEs associated with BMS vs GLP-1RAs for adults with obesity and diabetes and without known cardiovascular disease.
Design, setting, and participants: This observational, retrospective cohort study was based on data obtained from the electronic medical records of Clalit Health Services (Clalit), the largest health care organization in Israel. The study included 6070 members aged 24 years or older, who had diabetes and obesity and no prior history of ischemic heart disease, ischemic stroke, or congestive heart failure. Patients who underwent BMS and patients who received GLP-1RAs from January 1, 2008, through December 31, 2021, were matched 1:1 by age, sex, and clinical characteristics. Follow-up ended December 31, 2022.
Exposures: Initiation of BMS or GLP-1RAs.
Main outcomes and measures: The primary outcome was all-cause mortality, assessed by multivariate Cox proportional hazards regression models. The secondary outcome was nonfatal MACEs, assessed by multivariate competing risk models.
Results: The study included 3035 matched pairs of patients (total, 6070; mean [SD] age, 51.0 [9.5] years; 3938 women [64.9%]), who were followed up for a median of 6.8 years (IQR, 4.1-9.4 years). Among those with a diabetes duration of 10 years or less (2371 pairs), mortality was lower for those who underwent BMS than for those treated with GLP-1RAs (hazard ratio [HR], 0.38; 95% CI, 0.25-0.58). This association became nonsignificant when weight loss during the follow-up period was also included in the model (HR, 0.79; 95% CI, 0.43-1.48). Among patients with a duration of diabetes longer than 10 years (664 pairs), no survival advantage was demonstrated for BMS over GLP-1RA (HR, 0.65; 95% CI, 0.39-1.08). The risk for nonfatal MACEs did not differ between the treatment groups (HR, 0.74; 95% CI, 0.49-1.10 among patients with a diabetes duration of ≤10 years; HR, 1.21; 95% CI, 0.80-1.85 among patients with a diabetes duration of >10 years).
Conclusions and relevance: In this cohort study, BMS was associated with greater reduced mortality compared with first-generation GLP-1RAs among individuals with a diabetes duration of 10 years or less, mediated via greater weight loss. No differences in the risk for mortality were observed between the treatment modalities among individuals with a longer duration of diabetes, nor in the occurrence of nonfatal MACEs among all patients.
Obes Surg . 2024 Jan;34(1):30-42. doi: 10.1007/s11695-023-06913-8. Epub 2023 Nov 24.
IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management-an International Delphi Study
Paulina Salminen 1 2, Lilian Kow 3, Ali Aminian 4, Lee M Kaplan 5, Abdelrahman Nimeri6, Gerhard Prager 7, Estuardo Behrens8, Kevin P White 9, Scott Shikora 6; IFSO Experts Panel
- PMID: 37999891 PMCID: PMC10781804 DOI: 10.1007/s11695-023-06913-8
Abstract
Introduction: This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity.
Methods: A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement.
Results: Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m2, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease.
Conclusions: In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.
Keywords: Anti-obesity medications; Bariatric endoscopy; Bariatric surgery; Consensus; Definitions; Delphi survey; IFSO; Medical treatment; Metabolic bariatric surgery; Obesity, Severe obesity; Outcomes.
© 2023. The Author(s).
Review
Dig Endosc . 2024 Feb;36(2):107-115. doi: 10.1111/den.14633. Epub 2023 Aug 9.
Updates in metabolic bariatric endoscopy
Malorie Simons 1, Reem Z Sharaiha2
- PMID: 37405807 DOI: 10.1111/den.14633
Abstract
Obesity and its associated comorbid conditions have been increasing globally. Endoscopic bariatric and metabolic therapies (EBMTs) were initially designed to replicate bariatric surgery physiology for those who are not or choose not to be surgical candidates. Now, newer procedures target the complicated pathophysiology underlying obesity and its comorbidities. EBMT has been categorized based on its therapeutic target (stomach or small intestine), but innovations have expanded to include extraintestinal organs including the pancreas. Gastric EBMTs, namely space-occupying balloons, gastroplasty with suturing or plication, and aspiration therapy, are primarily used for weight loss. Small bowel EBMTs are designed to cause malabsorption, epithelial endocrine remodeling, and other changes to intestinal physiology to ultimately improve the metabolic comorbidities of obesity rather than induce weight loss alone. These include duodenal mucosal resurfacing, endoluminal bypass sleeves, and incisionless anastomosis systems. Extraluminal or pancreatic EBMT is aimed to restore the production of normal pancreatic proteins that are involved in the progression of type 2 diabetes. This review discusses the current and new technologies of metabolic bariatric endoscopy, their pros and cons, and areas for future research.
Keywords: bariatric endoscopy; endoscopic metabolic therapy; weight loss.
© 2023 Japan Gastroenterological Endoscopy Society.
Review
Medicina (Kaunas) . 2024 Feb 14;60(2):325. doi: 10.3390/medicina60020325.
Association of Obesity and Bariatric Surgery on Hair Health
Katarzyna Smolarczyk 1, Blazej Meczekalski2, Ewa Rudnicka3, Katarzyna Suchta3, Anna Szeliga 2
- PMID: 38399612 PMCID: PMC10890033 DOI: 10.3390/medicina60020325
Abstract
Obesity and obesity-related conditions today constitute a public health problem worldwide. Obesity is an “epidemic” chronic disorder, which is defined by the WHO as normal or excessive fat accumulation that may impair health. It is also defined for adults as a BMI that is greater than or equal to 30. The most common obesity-related diseases are type 2 diabetes mellitus, cardiovascular diseases, metabolic syndrome, chronic kidney disease, hyperlipidemia, hypertension, nonalcoholic fatty liver disease, and certain types of cancer. It has been also proven that obesity can have a negative effect on hair. It can lead to hair thinning. Patients with obesity can undergo bariatric surgery if they meet the inclusion criteria. The four common types of weight loss surgery include a duodenal switch with biliopancreatic diversion, laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Bariatric surgery can affect skin and hair and is associated with telogen effluvium due to weight loss, microelement deficiency, anesthesia, low calorie intake, and low protein intake. Patients who undergo bariatric surgery can experience post-bariatric surgery depression. Hair loss can have a major impact on self-esteem, negatively affecting one’s self-image. The purpose of this narrative review is to critically review how obesity, obesity-related diseases, and bariatric surgery affect hair health in general and the hair development cycle, and how they influence hair loss.
Keywords: bariatric surgery; hair loss; obesity.
Review
Obes Rev . 2024 Aug;25(8):e13757. doi: 10.1111/obr.13757. Epub 2024 Apr 30.
Effects of bariatric surgery on sexual function and fertility: A narrative review
Saikam Law 1 2, Kating Wan2, Wah Yang 1; Global Obesity Collaborative
- PMID: 38689132 DOI: 10.1111/obr.13757
Abstract
Obesity has emerged as a prevalent global health concern, with its detrimental effects on the reproductive system and sexual function garnering increasing attention. Both men and women affected by obesity face a heightened risk of fertility challenges and sexual dysfunction. Although fertility and sexual function are distinct topics, they are intricately linked and mutually influential in both medical and societal contexts. Bariatric surgery (BS) has generated promising results in alleviating sexual dysfunction and enhancing fertility, results which are often gender specific. In men, improvements in sexual function can often be attributed to weight loss and subsequent optimizations in sex hormone levels. However, improving female sexual function may be related to a range of factors beyond weight loss. Bariatric procedures have shown limited benefits for male fertility; in fact, in some situations it can even be detrimental, leading to a decrease in sperm count and quality. Conversely, BS may positively impact female fertility, improving pregnancy and neonatal outcomes. Nevertheless, it is essential to consider the potential risks related to the adverse effects of malnutrition and rapid weight loss following BS, making it advisable to wait for 12-18 months before attempting pregnancy.
Keywords: bariatric surgery; fertility; metabolic surgery; obesity; sexual dysfunction.
© 2024 World Obesity Federation.
Review
Curr Obes Rep . 2024 Mar;13(1):141-153. doi: 10.1007/s13679-023-00548-7. Epub 2024 Jan 3.
Bioavailability of Orally Administered Drugs After Bariatric Surgery
Eliška Dvořáčková 1 2, Alena Pilková 1, Martin Matoulek 3, Ondřej Slanař1, Jan Miroslav Hartinger4
Affiliations Expand
- PMID: 38172482 DOI: 10.1007/s13679-023-00548-7
Abstract
Purpose of review: Oral drug absorption after bariatric surgery is likely to be altered, but the impact of different bariatric surgery procedures on individual drugs is not uniform. The aim of this article is to describe factors influencing the bioavailability of orally administered drugs after bariatric surgery and to provide readers with practical recommendations for drug dosing. We also discuss the medications that may be harmful after bariatric surgery.
Recent findings: The fundamental factors for enteral drug absorption are the production of gastric acid; the preserved length of the intestine, i.e., the size of the absorption surface and/or the preserved enterohepatic circulation; and the length of common loop where food and drugs are mixed with digestive enzymes and bile acids. Bypassing of metabolizing enzymes or efflux pumps and changes in intestinal motility can also play an important role. Significant changes of drug absorption early after the anatomic alteration may also be gradually ameliorated due to gradual intestinal adaptation. The most affected drugs are those with low or variable bioavailability and those undergoing enterohepatic circulation. Attention should also be paid to oral drug formulations, especially in the early postoperative period, when immediate-release and liquid formulations are preferred. The changes in oral bioavailability are especially clinically meaningful in patients treated with drugs possessing narrow therapeutic index (e.g., oral anticoagulants, levothyroxine, and anticonvulsants) or in acute conditions (e.g., anti-infectives); nevertheless, it may also influence the therapeutic value of chronic therapy (e.g., antidepressants. antihypertensives, antiplatelets, statins, PPIs, contraceptives, and analgesics); therapeutic effect of chronic therapy is further influenced by pharmacokinetic alterations resulting from weight loss. Therapeutic drug monitoring, periodical clinical evaluation, and adequate dose adjustments are necessary. Due to safety reasons, patients should avoid oral bisphosphonates, regular use of non-steroidal anti-inflammatory drugs, and, if possible, corticosteroids after bariatric surgery.
Keywords: Drug absorption; Drug dosing; Pharmacokinetics; Roux-en-Y bypass; Sleeve gastrectomy.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Practice Guideline
Hong Kong Med J . 2024 Jun;30(3):233-240. doi: 10.12809/hkmj2210656. Epub 2024 Jun 3.
Recommendations for eligibility criteria concerning bariatric and metabolic surgical and endoscopic procedures for obese Hong Kong adults 2024: Hong Kong Society for Metabolic and Bariatric Surgery Position Statement
S Y W Liu 1, C M S Lai 1, E K W Ng 1, F S Y Chan 2, S K Leung 3, W L M Mui 4, D K H Tong 5, D C T Wong 6, P P C Yam 3, S K H Wong 1
- PMID: 38825732 DOI: 10.12809/hkmj2210656
Free article
Abstract
The surgical management of obesity in Hong Kong has rapidly evolved over the past 20 years. Despite increasing public awareness and demand concerning bariatric and metabolic surgery, service models generally are not standardised across bariatric practitioners. Therefore, a working group was commissioned by the Hong Kong Society for Metabolic and Bariatric Surgery to review relevant literature and provide recommendations concerning eligibility criteria for bariatric and metabolic interventions within the local population in Hong Kong. The current position statement aims to provide updated guidance regarding the indications and contraindications for bariatric surgery, metabolic surgery, and bariatric endoscopic procedures.
Keywords: Bariatric surgery; Metabolic syndrome; Obesity.
Obes Surg . 2024 May;34(5):1415-1424. doi: 10.1007/s11695-024-07181-w. Epub 2024 Mar 21.
Utilization of Anti-obesity Medications After Bariatric Surgery: Analysis of a Large National Database
Stephen A Firkins 1, Vibhu Chittajallu2, Bailey Flora 1, Heesoo Yoo3, Roberto Simons-Linares 4
- PMID: 38512645 DOI: 10.1007/s11695-024-07181-w
Abstract
Purpose: A significant proportion of patients experience insufficient weight loss or weight regain after bariatric surgery. There is a paucity of literature describing anti-obesity medication (AOM) use following bariatric surgery. We sought to identify prevalence and trends of AOM use following bariatric surgery.
Materials and methods: We utilized the IBM Explorys® database to identify all adults with prior bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Those prescribed AOMs (semaglutide, liraglutide, topiramate, phentermine/topiramate, naltrexone/bupropion, orlistat) within 5 years of surgery were further identified. Data was analyzed to characterize AOM utilization among different age, demographic, and comorbid populations.
Results: A total of 59,160 adults with prior bariatric surgery were included. Among AOMs studies, prevalence of use was highest for topiramate (8%), followed by liraglutide (2.9%), phentermine/topiramate (1.03%), naltrexone/bupropion (0.95%) semaglutide (0.52%), and orlistat (0.17%). Age distribution varied, with the highest utilization among those age 35-39 years for topiramate, 40-44 years for phentermine/topiramate and naltrexone/bupropion, 45-49 years for semaglutide, and 65-69 years for liraglutide and orlistat. African American race was associated with higher utilization across all AOMs. Among comorbidities, hypertension, hyperlipidemia, and diabetes mellitus were most associated with AOM use.
Conclusion: Despite a relatively high incidence of weight regain, AOMs are underutilized following bariatric surgery. It is imperative that barriers to their use be addressed and that AOMs be considered earlier and more frequently in patients with insufficient weight loss or weight regain after bariatric surgery.
Keywords: Anti-obesity medication; Bariatric; Roux-en-Y gastric bypass; Sleeve gastrectomy; Weight loss.
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Review
Ann Endocrinol (Paris) . 2024 Jun;85(3):175-178. doi: 10.1016/j.ando.2024.05.008. Epub 2024 Jun 13.
How does bariatric surgery remodel adipose tissue?
Simon Lecoutre 1, Clémentine Rebière2, Geneviève Marcelin 3, Karine Clément 4
- PMID: 38871506 DOI: 10.1016/j.ando.2024.05.008
Abstract
This lecture delves into the pivotal role of adipose tissue in obesity and its response to weight loss, particularly via bariatric surgery. Adipose tissue, responsible for storing excess energy, undergoes significant changes during obesity, marked by inflammation and fibrosis. Bariatric surgery, serving as a model, allow the exploration of adipose tissue remodeling post-weight loss, inducing metabolic and fibro-inflammatory shifts. Despite successful weight loss, inflammation and fibrosis persist, as evidenced by changes in immune cells, altered cytokine profiles and the accumulation of extracellular matrix (ECM). Unfortunately, these lingering effects impair the normal adipose tissue function. In this context, adipose progenitors, an heterogenous resident population of mesenchymal stromal cells, display functions important to fibrosis development, capable of differentiating into myofibroblasts and contributing to ECM deposition. Particularly, a distinct subpopulation of adipose progenitors with high CD9 expression (CD9high) is associated with fibrosis and insulin resistance in human obesity. The persistence of fibrosis post-weight loss poses challenges, correlating with metabolic dysfunction despite improved glucose tolerance. A comprehensive understanding of the mechanisms driving adipose tissue remodeling and fibrosis post-weight loss is imperative for the development of effective treatments for obesity. The intricate interplay between adipose tissue, inflammation, and fibrosis underscores the necessity for further in-depth research to elucidate these mechanisms and formulate targeted therapies for obesity-related complications.
Keywords: Adipose tissue; Bariatric surgery; Fibrosis; Inflammation; Weight loss.
Copyright © 2024 Elsevier Masson SAS. All rights reserved.
Review
Curr Opin Ophthalmol . 2024 May 1;35(3):192-196. doi: 10.1097/ICU.0000000000001038. Epub 2024 Jan 30.
Weight loss, bariatric surgery, and novel antidiabetic drugs effects on diabetic retinopathy: a review
Alejandro M Perez 1 2, Emily Neag 2, Jayanth Sridhar2 3, Basil K Williams Jr 2
- PMID: 38295156 DOI: 10.1097/ICU.0000000000001038
Abstract
Purpose of review: Diabetic retinopathy (DR) is a leading cause of visual impairment, and the increasing prevalence of diabetes and obesity will impact rates of visual impairment moving forward. Our review aims to synthesize the current body of evidence regarding the impact of lifestyle interventions, such as weight loss, bariatric surgery, and novel antidiabetic drugs, on DR.
Recent findings: Literature review revealed insufficient evidence regarding the impact of weight loss on DR. Preoperative DR patients undergoing bariatric surgery were found to have similar short-term chances of improvement or worsening DR. Progression of DR with glucagon-like peptide 1 receptor agonists treatments appears unrelated to specific drugs and was also observed with traditional antidiabetic medications.
Summary: Rapidly correcting HbA1c levels (≥2%) can paradoxically lead to early worsening DR. Patients considering weight loss, bariatric surgery, and novel antidiabetic drugs should be aware of the potential for DR progression, but they should not be discouraged, as achieving glycemic control is essential for reducing long-term morbidity and mortality from other diabetes-related complications. It is advisable to conduct a baseline retinal examination before treatment and continue monitoring during therapy. Further research is needed to understand the long-term effects of these treatments on DR.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Review
Obes Surg . 2024 Jan;34(1):206-217. doi: 10.1007/s11695-023-06955-y. Epub 2023 Nov 22.
Nutrient Deficiency After Bariatric Surgery in Adolescents: A Systematic Review and Meta-Analysis
Faraneh Zolfaghari 1, Yasaman Khorshidi1, Nazanin Moslehi2, Mahdieh Golzarand3, Golaleh Asghari4
- PMID: 37991712 DOI: 10.1007/s11695-023-06955-y
Abstract
Objective: This systematic review and meta-analysis study aimed to estimate changes in blood nutrient concentrations and nutrient deficiencies in adolescents following bariatric surgery.
Methods: We searched PubMed, Scopus, and the Web of Science to find studies published between January 2000 and August 2023. Observational studies reporting the mean blood concentration of nutrients before and after bariatric surgery or the proportion of nutrient deficiencies after the surgery in healthy adolescents were selected.
Results: Fifteen studies were included. Gastric bypass and sleeve gastrostomy were the most common types of surgery. Vitamin D, iron, or ferritin, vitamin B12, calcium, and folic acid were the most studied nutrients, respectively. Other nutrients examined in the studies included zinc, phosphorus, and albumin. The serum ferritin increased by 21 mcg/L (95% CI = 10.0, 32.0 mcg/L) after the surgery, but there were no significant alterations in other nutrients. The postoperative prevalence of low albumin, ferritin, vitamin D, and vitamin B12 levels was 10%, 49%, 41%, and 20%, respectively. Also, 23% had an iron deficiency, and 10% had a calcium deficiency after bariatric surgery.
Conclusions: The serum ferritin level increased following bariatric surgery in adolescents. Vitamin D and ferritin deficiencies were estimated to be present in more than one-third of adolescents after the surgery.
Keywords: Calcium; Folic acid; Gastric bypass; Iron; Sleeve gastrectomy; Vitamin; Zinc.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
IT – Pubblicazione N° 00 del 01/10/2024
The Mediterranean Journal of Surgery, Medicine and Forensic Sciences 1(2024), XX-XX
ISSN: xxxxxx
Ricevuto: 28/09/2024
Accettato: 29/09/2024
Pubblicato online il 01 ottobre 2024
