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 effect of the ASMBS weight loss outcome guidelines in the bariatric surgery literature, post-bariatric surgery patients experience with COVID, weight loss indicators according to non-alcoholic steatohepatitis (NASH) presence one and 2 years post-bariatric surgery, a paper calling for a more unified and harmonised definition of metabolic dysfunction to better understand and compare findings across studies and a small patient series demonstrates the resolution of Spinal Epidural Lipomatosis (SEL) in two patients with bariatric surgery with the help of pre- and post-operative MR imaging (please note, log-in maybe required to access the full paper).
Reporting of Weight Loss Outcomes in Bariatric Surgery Following Introduction of 2015 ASMBS Guidelines
Heterogeneity in reporting weight loss (WL) outcomes within the bariatric surgery literature significantly limits synthesis and meta-analysis, as a result, in 2015, the American Society for Metabolic and Bariatric Surgery (ASMBS) published reporting guidelines to achieve consistency in the literature. Investigators from the University of Glasgow, Glasgow, UK, writing in SOARD, have assessed the effect of the ASMBS guidelines in the bariatric surgery literature.
The reported that from 1807 articles, 105 and 158 articles in 2015 and 2021 respectively reported primarily on WL outcomes following bariatric surgery, with overall ASMBS compliance increasing from 5% to 20% (p<0.05). Initial weight and BMI were reported in all studies but specification of this as the immediate preoperative weight reduced from 15% to 6% (p<0.05). In 2021. Two of the nine included journals gave guidance on reporting WL in their instructions to authors, however only 30% (n=42/142) of articles did not comply with the journals’ WL reporting guidance. The number of total unique WL outcomes used increased from 45 to 54.
The authors concluded that there is significant heterogeneity in reporting WL outcomes remains, hindering robust meta-analysis of published articles. Use of referral weight instead of preoperative weight can inflate WL in those with mandated preoperative WL, clarifying initial weight is needed. Use of non-standard measures of WL remains high.
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Impact of COVID-19 on the Post-operative Bariatric Surgery Patient Experience
Researchers led by the University of Wisconsin, Madison, WI, have reported that bariatric surgery patients need ongoing support to access mental health professionals, develop new physical activity routines, and counteract increased food insecurity as a results of increased exacerbated patient vulnerability as the COVID pandemic continues.
To characterise patient and provider perceptions of the impact of coronavirus disease 2019 (COVID-19) on weight loss following bariatric surgery, the authors conducted semi-structured interviews with 34 bariatric surgery patients, six primary care provider and four health psychologists who discussed dietary habits, physical activity and follow-up care.
They found that COVID-19 affected the postoperative bariatric surgery patient experience via three mechanisms: (1) it disrupted dietary and physical activity routines due to facility closures and fear of COVID-19 exposure; (2) it required patients to transition their follow-up care to telemedicine delivery; and (3) it increased stress due to financial and psychosocial challenges.
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NASH Presence is Associated with a Lower Weight Loss One and 2 Years After Bariatric Surgery in Women with Severe Obesity
Researchers in Spain, writing in Obesity Surgery, have reported the weight loss indicators according to non-alcoholic steatohepatitis (NASH) presence one and two-years post-bariatric surgery.
They examined the weight loss pattern of 410 women with severe obesity (SO) after sleeve gastrectomy (SG, n=191) and Roux-en-Y gastric bypass (RYGB, n=219) according to NASH presence at baseline and at 12 and 24 months post-surgery.
Unlike RYGB, after SG, a higher percentage of NASH patients do not reach the excess BMI loss percentage two-years post-surgery. There were no differences in total weight loss percentage and alterable weight loss percentage after RYGB despite the presence of NASH. After SG, there was a worse ponderal evolution of all indicators analysed in the presence of NASH.
The presence of NASH suggests a worse weight loss pattern through all the analysed indicators one and two years after SG in women. The presence of T2DM appears to result in less weight loss after RYGB, but only non-diabetic women presenting NASH lose less weight that non-diabetic women in the absence of NASH after SG, the authors conclude.
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Metabolic dysfunction and obesity-related cancer: Beyond obesity and metabolic syndrome
Investigators from the University of Utah, Salt Lake City, UT, reporting in the journal Obesity, have called for a more unified and harmonised definition of metabolic dysfunction to better understand and compare findings across studies.
Their review summarised 129 studies that evaluated variable definitions of metabolic dysfunction in relation to obesity-related cancer risk and mortality after a cancer diagnosis. They noted that metabolic dysfunction has been associated with risk for, and mortality from, colorectal, pancreatic, postmenopausal breast and bladder cancers, with breast and colorectal cancer risk observed independently of BMI, with increased risk in individuals with metabolically unhealthy normal weight or overweight/obesity, compared with metabolically healthy normal weight.
“An improved definition of metabolic dysfunction will further clarify the magnitude of the relationship across cancer types, enable better comparisons across studies, and further guide criteria for obesity-related cancer risk stratification”, the authors concluded.
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Spinal Epidural Lipomatosis Causing Lumbar Canal Stenosis: A Pictorial Essay on Radiological Grading and the Role of Bariatric Surgery Versus Laminectomy
Researcher at Hartford Hospital, Hartford, US, have reported on a small patient series demonstrates the resolution of Spinal Epidural Lipomatosis (SEL) in two patients with bariatric surgery with the help of pre- and post-operative MR imaging.
Writing in Cureus, the authors explain that SEL is a rare condition characterised by an excessive accumulation of adipose tissue in the spinal canal that can have a compressive effect on intraspinal neuroanatomical structures. Several different conservative and surgical treatment strategies have been proposed but the treatment and outcomes remain controversial, with a lack of severity-based evidence documenting the success of decompressive laminectomy in SEL and there are only anecdotal reports of clinico-radiological success with weight loss from bariatric surgery.
The authors describe the resolution of SEL in two patients with bariatric surgery with the help of pre- and post-operative MR imaging, as well as highlighting the classic “types” of spinal epidural lipomatosis with a surgically relevant grading system and elucidate the existence of concurrent extraspinal lipomatosis (i.e. mediastinal and intra-abdominal lipomatosis), drawing parallels with the natural history of SEL.
The authors propose that bariatric intervention could be better frontline management in patients with multifocal/multisystem lipomatosis (i.e., combined spinal and extraspinal) and spinal decompression would be ideal for those SEL patients with coexisting bony and/or ligamentous spinal canal or foraminal stenosis.
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