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 review examining obesity, bariatric surgery, weight loss and breast cancer, a paper examining the evidence surrounding the relationship between obesity treatment, weight stigma and eating disorder, the latest guidelines from the EAES Bariatric Surgery Guidelines Group, the advantages of telemedicine for obesity treatments, and a case study reporting copper deficiency-induced neuropathy after bariatric surgery (please note, log-in maybe required to access the full paper).
Obesity and breast cancer: Preventive and therapeutic possibilities for bariatric surgery
Researchers from the Oregon Health & Science University, Portland, OR, have detailed the potential physiologic mechanisms that may underlie the association between bariatric surgery, weight loss and the reduction in incidence of breast cancer.
Writing in the journal, Obesity, they note that the use of bariatric surgery as an adjunct therapy in endometrial cancer also raises the potential for similar use in select breast cancer patients. Despite the expanding potential applications of bariatric surgery in this field, publications to date have been strictly observational, highlighting a need for future clinical trials.
With rising obesity rates and building evidence for a strong association with obesity, the incidence of breast cancer can be expected to increase. Although weight loss reduces breast cancer risk, the mechanisms are still poorly understood.
The authors argue that as an effective therapy for obesity, bariatric surgery may be a powerful tool in breast cancer prevention and treatment.
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Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk
A commentary by researchers led by the University of Florida College of Medicine, Gainesville, FL, has examined the evidence surrounding the relationship between obesity treatment and weight stigma and eating disorder (ED) risk to combat the false dichotomy that exists between treating obesity, reducing weight stigma and ED risk.
First, an overview of obesity, weight stigma, and ED are introduced, followed by discussion of self-directed dieting vs evidence-based obesity treatments and their relation to factors that influence ED risk.
The commentary ends with a call to action for all clinicians to promote access to evidence-based care, combat weight stigma, and minimise the risk of ED development.
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EAES rapid guideline: systematic review, network meta-analysis, CINeMA and GRADE assessment, and European consensus on bariatric surgery–extension 2022
An international team of researchers - writing on behalf of the EAES Bariatric Surgery Guidelines Group – have provided recommendations on the use of sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, gastric plication, biliopancreatic diversion with duodenal switch, one anastomosis gastric bypass, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy in patients with severe obesity and metabolic diseases. This latest guideline replaces relevant recommendations published in the EAES Bariatric Guidelines 2020.
The Group conducted a systematic review and assessed the certainty of evidence using the CINeMA and GRADE methodologies. They considered the risk/benefit outcomes within a GRADE evidence to decision framework to arrive at recommendations, which were validated through an anonymous Delphi process of the panel.
They identified 43 records reporting on 24 RCTs and suggest sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass over adjustable gastric banding, biliopancreatic diversion with duodenal switch and gastric plication for the management of severe obesity and associated metabolic diseases. One anastomosis gastric bypass and single anastomosis duodeno-ileal bypass with sleeve gastrectomy are suggested as alternatives, although evidence on benefits and harms, and specific selection criteria is limited compared to sleeve gastrectomy and Roux-en-Y gastric bypass.
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The benefit of telemedicine in obesity care
Researchers from the US have published a review that discusses the use of telemedicine to facilitate obesity treatment. They noted that there are many potential barriers to effective use of antiobesity treatments, including limited access to guideline-supported obesity care (often driven by practical challenges, geographic barriers, limited insurance coverage, and high cost of care) and a dearth of specialists and comprehensive treatment teams.
However, driven in part by the COVID-19 pandemic, the recent expansion of telemedicine offers unique opportunities to mitigate these factors. Writing in the journal Obesity, they argued that the continued growth and utility of telemedicine for obesity care require further formative and experimental research to determine best practices, assess challenges for implementation, and evaluate long-term outcomes, as well as proactive policy changes to promote ongoing use of telemedicine beyond the COVID-19 pandemic.
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Copper Deficiency-Induced Neuropathy After Bariatric Surgery Disguised as Demyelinating Disease: A Case Report
Investigators from the New York-Presbyterian Brooklyn Methodist Hospital, US, have reported on the case of a 73-year-old female with a surgical history of Roux-en-Y gastric bypass (RYGB) 20 years prior, who presented with difficulty with ambulation due to sensory ataxia and bilateral, ascending, sensory neuropathy, who was diagnosed with acquired copper deficiency-induced myeloneuropathy.
Writing in Cureus, the researchers noted that there is no gold standard diagnostic test for copper deficiency myelopathy or randomised controlled trials to support guideline-directed dosing for prophylactic copper supplementation status post-bariatric surgery.
They noted that physicians should strive for early diagnosis in asymptomatic patients to prevent potentially irreversible neurological damage. Randomised controlled trials are needed to help determine standardised guidelines for the treatment of copper deficiency myelopathy.
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