Journal watch 01/12/2021

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including a clinical trial comparing the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on liver fat content and fibrosis, the latest findings from the Longitudinal Assessment of Bariatric Surgery (LABS-2) Study, the sensitivity of DiaRem Scoring System in predicting T2DM resolution, intragastric balloon (IGB) placement for weight loss, and a study examining obesity bias and stigma in the Irish healthcare system (please note, log-in maybe required to access the full paper).


Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis - A Randomized Controlled Trial

Researchers led by University of Oslo in Norway have found that RYGB and SG were both highly effective in reducing hepatic steatosis.


Writing in the Annals of Surgery, they compared the one-year effects of SG and RYGB on hepatic steatosis and fibrosis. In total, 100 patients (65% female; mean age, 47.5 years; mean body mass index, 42 kg/m2) with type 2 diabetes mellitus (T2DM).


The primary outcome was remission of T2DM and secondary outcomes in the present study were hepatic steatosis and fibrosis assessed by magnetic resonance imaging (liver fat fraction), enhanced liver fibrosis (ELF) test, non-invasive indices and liver enzymes.


A one year, the outcomes showed that liver fat fraction declined similarly after SG and RYGB and almost all patients (SG, 94%; RYGB, 100%) had no or low-grade steatosis. The ELF score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis at one year, with no substantial between-group difference.


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5-year Attrition, Active Enrollment, and Predictors of Level of Participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) Study

Researchers from the US, writing in SOARD, have reported that participant attrition in the LABS-2 Study was low and that the percentage of missed assessments did not increase after year two, maybe due to the implementation of a comprehensive retention plan.


The aims of this paper was to report participant attrition, active enrolment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation after five years.


The LABS-2 Study enrolled 2,458 adults undergoing a first bariatric surgical procedure at one of six US sites from 2006 through 2009. The investigators reported that by year five, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n=121). Controlling for site and calendar year, missed assessments increased from 14.7% to 21.8% between Years 1-2, then stayed relatively stable (20.8%-19.6%, Years 3-5).


Younger age, male sex, white race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations pre-surgery were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up.


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Sensitivity of DiaRem Scoring System in Predicting Type Two Diabetes Mellitus Resolution After Bariatric Surgery in Qassim Region

Investigators from Saudia Arabia have found an increased BMI, shorter duration of diabetes mellitus and lower values of HbA1c post-FBG had a greater chance of diabetes remission postoperatively.

This study sought to test the sensitivity of the DiaRem scoring system for predicting the resolution of T2DM in morbidly obese patients who underwent bariatric surgery at King Fahad Specialist Hospital in Buraydah, Saudi Arabia.


A total of 96 diabetic patients were enrolled (35 males vs 61 females) with a mean age of 46.5 years. Laparoscopic sleeve gastrectomy was the most commonly performed surgery and the most common associated comorbidities were hypertension (50%) and hypothyroidism (14.6%). Results of the DiaRem scoring system showed 0-2 points in 15.6% patients, 3-7 points in 39.6% patients, 8-12 in 26% patients, 13-17 in 9.4% patients and 18-22 in 9.4% patients.


The lowest DiaRem score was associated with a higher value of BMI, shorter DM duration and lower mean values of HbA1c and FBG post-surgery.


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Fluid-filled intragastric balloons are an effective and safe weight loss option across BMI and age ranges

Writing in Surgical Endoscopy, researchers from the University of Puerto Rico, San Juan, Puerto Rico, report on the efficacy and safety of the single-chamber fluid-filled intragastric balloons (IGBs) for weight loss and compared the results across different age groups.


The study included 239 IGB placements in 232 patients (mean age, 44.5 ± 10.3 years; 67% female; baseline BMI 42.0 ± 9.0) from two outpatient GI clinics. Efficacy outcomes included the percentage of the total (%TWL) and excess weight loss (%EWL). Safety outcomes were measured as the number of patients who required early IGB removal (before six months).


%TWL at three months was 10.1% and 14.4% at six months. Overall, 92%, 74% and 47% of patients lost 5%, 10%, and 15% of total weight at six months, respectively. %EWL was 22.1% and 30.7% at three and six months post-IGB placement, respectively. The balloon was safely removed at six months after placement in most patients, whereas in 13.0% of cases early removal was performed at an average of 12.0 weeks after placement.


The researchers noted that the use of a single-chamber fluid-filled IGB is successful in inducing a significant amount of weight loss in almost three-fourths of patients six months after its placement. This beneficial effect is seen across different BMI ranges and age groups at a similar level. Therefore they concluded that “IGBs should be considered an effective and safe alternative for obese patients who fail lifestyle interventions and conservative measures, fulfilling the unmet needs of many who are unwilling or unable to undergo bariatric surgery.”


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A qualitative exploration of obesity bias and stigma in Irish healthcare; the patients’ voice

Reporting their findings in PlosONE, Irish investigators have reported that outside of specialist obesity tertiary care, weight bias and stigmatisation is commonly reported in the Irish healthcare system.


They noted that current data indicates 70% of adults with obesity report experiencing bias and stigmatisation when engaging with healthcare. However, most studies focus on weight bias from a healthcare professional’s perspective, this study explored the lived-in experience of individuals afflicted with obesity, when interacting with the Irish healthcare system. Specifically, it examined whether participants encountered weight bias and stigma, and if so, how it may have impacted them and gathered their suggestions on how it could be best addressed.


Interviews were conducted with 15 individuals who reported regular and consistent engagement with the Irish healthcare system. The participants reported experiencing high levels of weight bias and stigmatisation. Relating to experiences, three themes were identified; interpersonal communication, focus of care and physical environment. In addition, two emergent themes arose; negativity towards future healthcare and escalation of unhealthy behaviours.


The authors recommended that introduction of a timely and clear clinical pathway for obesity management and a focus on HCPs education in relation to obesity causes and complexity, including a concerted effort by HCPs across clinical, research and educational levels is required to alleviate its harmful effects.


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