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 the latest paper from the Cleveland Clinic comparing severity of illness from COVID-19 between patients with prior bariatric surgery and a non-surgical patients, the latest recommendations from the Professional Practice Committee of the American Diabetes Association for obesity and weight management for the prevention and treatment of type 2 diabetes, the relationship between gastric pouch size post-RYGB and marginal ulceration, the second guidance consensus from the Enhanced Recovery After Surgery Society for optimal perioperative care in bariatric surgery and a study looking at the impact of bariatric surgery on assisted reproductive technology outcomes (please note, log-in maybe required to access the full paper).
Association of Weight Loss Achieved Through Metabolic Surgery With Risk and Severity of COVID-19 Infection
Researchers from the Cleveland Clinic have reported that patients with obesity who previously achieved weight loss with bariatric surgery were associated with a 60% lower risk of developing severe complications from COVID-19 infection. The findings were published in JAMA Surgery.
The aim of this study was to examine whether a successful weight-loss intervention in patients with obesity prior to contracting COVID-19 could reduce the risk of developing a severe form of this disease. A total of 20,212 adult patients with obesity were included in this observational study: a group of 5,053 patients with BMI>35 who had bariatric surgery were carefully matched 1:3 to non-surgical patients, resulting in 15,159 control patients. Compared with those in the non-surgical group, patients who had bariatric surgery lost 19% more body weight prior to March 2020 (the beginning of the COVID-19 outbreak in Cleveland).
Although the rate of contracting SARS-CoV-2 was similar between the groups (9.1% in the surgical group and 8.7% in the non-surgical group), participants in the bariatric surgery group experienced much better outcomes after contracting COVID-19 vs those in the non-surgical group. Researchers found that patients with prior weight loss surgery had a 49% lower risk of hospitalisation (p<0.001), 63% lower risk of need for supplemental oxygen (p<0.001) and 60% lower risk of developing severe COVID-19 (p=0.02).
Although the exact underlying mechanisms are not known, these data suggest that patients who underwent weight-loss surgery were healthier at the time of contracting a SARS-CoV-2 infection, which resulted in better clinical outcomes.
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American Diabetes Association Professional Practice Committee. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Medical Care in Diabetes—2022’
The Professional Practice Committee of the American Diabetes Association (ADA) has published the latest recommendations for obesity and weight management for the prevention and treatment of type 2 diabetes. The recommendations are featured in the paper, ‘American Diabetes Association Professional Practice Committee. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Medical Care in Diabetes—2022’, published in Diabetes Care.
The specific aim of this paper is to provide evidence-based recommendations for obesity management, including behavioural, pharmacologic and surgical (bariatric) interventions, in adult T2DM patients.
The ADA maintains that diet, physical activity and behavioural therapy is recommended to achieve and maintain ≥5% weight loss for most people with type 2 diabetes and overweight or obesity and should include a high frequency of counseling (≥16 sessions in six months), focus on dietary changes, physical activity and behavioural strategies to achieve a 500–750 kcal/day energy deficit.
Regarding pharmacotherapy, the ADA recommends that the medication’s effect on weight should be considered when choosing glucose-lowering medications for T2DM patients. Concerning weight loss medical devices - such as implanted gastric balloons, a vagus nerve stimulator and gastric aspiration therapy - given the current high cost, limited insurance coverage, and paucity of data in people with diabetes, there is limited evidence for medical devices for weight loss.
The ADA recommends:
Metabolic surgery should be performed in high-volume centres with multidisciplinary teams knowledgeable about and experienced in the management of obesity, diabetes and gastrointestinal surgery
Potential patients should be evaluated for comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes
Metabolic surgery patients should receive long-term medical and behavioural support and routine monitoring of micronutrient, nutritional and metabolic status.
Metabolic surgery patients should routinely be evaluated to assess the need for ongoing mental health services to help with the adjustment to medical and psychosocial changes after surgery.
Larger and longer-term studies are needed to determine the role of metabolic surgery in T1DM patients
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Why Size Matters: an Evaluation of Gastric Pouch Size in Roux-en-Y Gastric Bypass Using CT Volumetric Analysis and its Effect on Marginal Ulceration
Researchers from Atrium Health, Charlotte, NC, USA, who evaluated the relationship between gastric pouch size in Roux-en-Y gastric bypass and marginal ulceration using CT volumetrics, have found that a larger gastric pouch size was associated with MU following RYGB.
In total 122 patients were retrospectively identified who underwent esophagogastroduodenoscopy following RYGB at a tertiary care teaching hospital, 57 of which had MU on EGD and 65 who did not. The MU group had more smokers and patients with PPI use than the non-MU group, and the mean time from operation to CT scan was 26.6 months (range: 0–108 months).
The outcomes published in Obesity Surgery reported that MU group had a larger gastric pouch size than the non-MU group (34.1 ± 11.8 versus 20.1 ± 6.8 cm3) and when analysed for matched patient cohorts, this difference remained for the MU group that included smokers and PPI use.
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Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update
Enhanced Recovery After Surgery (ERAS) Society has issued its second guidance consensus for optimal perioperative care in bariatric surgery, providing recommendations for each ERAS item within the ERAS protocol. After conducting a literature search and grading each paper, the international team of authors found that ‘the quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries’. The findings were published in the World Journal of Surgery.
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The impact of bariatric surgery on assisted reproductive technology outcomes: a systematic review protocol
Writing in Systematic Reviews, investigators from the University of Ottawa, Ottawa, Canada, are examining the effects of bariatric surgery on assisted reproductive technologies.
The main outcome will be live birth rate and secondary outcomes will include time to conception, number of rounds of ART, type of bariatric surgery and length of time between bariatric surgery and initiation of ART Risk of bias will be conducted using the National Institutes of Health Study Quality Assessment Tools.
The authors hope their review will provide information on the outcomes of ART following bariatric surgery and may help healthcare professionals make informed decisions about the length of time between bariatric surgery and initiation of ART. The study findings may be of interest to various stakeholders including patients, bariatric surgeons, obstetricians and gynaecologists, and those who specialise in obesity medicine and reproductive endocrinology and infertility.
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