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Journal Watch 08/03/2023

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 revisional bariatric surgery, adherence post-op to protein intake and micronutrient supplementation, bariatric surgeons in terms of reproductive health, how newspapers report on adolescent bariatric surgery increases the stigma and the latest analysis from the STEP 1 trial and more (please note, log-in maybe required to access the full paper).

Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients

Researchers from the University of Alberta and the Royal Alexandra Hospital, Edmonton, Canada, reported that revisional procedures have worse perioperative outcomes and are independently associated with serious complications, however, in comparison to primary bariatric surgery, patients undergoing revisional procedures have less metabolic comorbidities.

Writing in Surgical Endoscopy, the authors sought to characterise patient demographics, procedure type and safety outcomes for those undergoing revisional compared to initial bariatric interventions to guide management of these patients. Using data from the 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry, they examined 158,424 patients, including 10,589 (6.7%) revisional procedures.

Revisional patients were more like to be female (85.5% revisional vs. 81.0% initial; p<0.001), had lower body mass index (43.6 ± 7.8 kg/m2 revisional vs. 45.2 ± 7.8 kg/m2 initial; p<0.001) and less metabolic comorbidities than patients undergoing primary bariatric surgery. The most common revisional procedures were Roux-en-Y gastric bypass (48.4%) and sleeve gastrectomy (32.5%). Revisional procedures had longer operative duration compared to primary procedures.

Revision patient were more likely to experience readmission to hospital (4.8% revisional vs. 2.9% initial; p<0.001) and require reoperation (2.4% revisional vs. 1.0% initial; p<0.001) within 30 days of the procedure. Revisional procedures were independently associated with increased serious complications (p<0.001) but were not a significant predictor of 30-day mortality (p=0.409).

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Associations of age, sex, and socioeconomic status with adherence to guideline recommendations on protein intake and micronutrient supplementation in patients with sleeve gastrectomy or Roux-en-Y gastric bypass

German investigators have reported that bariatric patients who are older age and of lower socioeconomic status (SES) might have a greater risk of unfavourable outcome and may require greater attention to micronutrient and protein supplementation.

Reporting in PlosOne, 35 patients (sleeve gastrectomy n=25, Roux-en-Y gastric bypass n=10) reported on supplement usage, recorded their dietary intake for seven days and underwent physical examinations including blood testing. Distributions of age, sex and SES were comparable between the SG and RYGB groups.

They found that non-adherence to recommended protein intake was associated with age ≥50 years (p=0.041) but not sex or SES. Protein intake inversely correlated with markers of obesity. There were no significant associations of age or sex with micronutrient supplementation. Only for vitamins A (p=0.049) and B1 (p=0.047) higher SES was associated with greater compliance.

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Perception and Practice of Bariatric Surgery and Reproductive Health in Women: a Cross-sectional Study of Chinese Bariatric Surgeons

Chinese researchers have reported that there is a large gap in the perception and clinical practice of bariatric surgeons in terms of reproductive health.

Writing in Obesity Surgery, the authors explored the perception and practice of bariatric surgeons on the reproductive health of female patients who underwent bariatric surgery in China to better guide clinical practice and improve clinical outcomes.

An online questionnaire of 31 questions developed by bariatric surgeons was collected by sending to one online communication group (WeChat group) whose members are Chinese bariatric surgeons. A total of 87 bariatric surgeons from mainland China were surveyed. Almost all (97.7%, 85/87) surgeons considered the reproductive health conversation for women who underwent BS to be important or very important. Only 1/4 of surgeons routinely discuss reproductive health–related issues with patients, and only 56% of doctors always ask patients for postoperative contraception.

Less than 20% of bariatric surgeons have full knowledge of postoperative contraception, and nearly 40% of them believe that gynaecologists should be responsible for providing contraception. More than 35% of bariatric surgeons have never been involved in the co-management of pregnancy in patients with a history of BS.

They concluded that it is necessary to further strengthen the education of bariatric surgeons and enhance multidisciplinary cooperation with gynaecology, obstetrics and other disciplines to bring better clinical outcomes.

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‘A radical operation’ – a thematic analysis of newspaper framing of bariatric surgery in adolescents

Investigators from Ghent University, Ghent, Belgium, have concluded that way newspapers report on adolescent bariatric surgery, may increase the stigma surrounding adolescent obesity, and therefore limit the acceptability of specific treatments such as bariatric surgery.

Reporting in BMC Public Health, they analysed how newspaper articles (26 UK and 12 US newspaper articles (2014–2022)) portrayed adolescent bariatric surgery, with attention to the language used and moral arguments made.

The major themes identified related to (1) defining the burden of adolescent obesity, (2) sparking moral outrage, (3) sensation-seeking, and (4) raising ethical issues. The articles employed moral language, specifically non-neutral and negative discourse regarding surgery. Blame was attributed to adolescents or their parents. Sensationalist wording often reinforced the normative content, drawing the attention of the reader and contributing to stigmatization of adolescents with severe obesity as lacking will power and being lazy. Further moral issues that stood out were the challenges in obtaining an informed consent, and the unequal access to surgery for socially disadvantaged groups.

“Despite frequent citing of experts and studies on the efficacy, safety and unmet need for bariatric surgery, obesity and surgery in adolescents are often stigmatized and sensationalized, with (prospective) patients depicted as looking for an easy way out in the form of a solution brought by others (health systems, society, tax payers),” they concluded.

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Impact of BMI and comorbidities on efficacy of once-weekly semaglutide: Post hoc analyses of the STEP 1 randomized trial

Researchers from the UK and Denmark have reported that semaglutide is effective in individuals with baseline BMI<35 and ≥35kg/m2, including in those with comorbidities, according to the latest analysis from the Semaglutide Treatment Effect in People with Obesity (STEP) 1 trial.

Reporting in the journal Obesity, their study assessed the effects of semaglutide on body weight, cardiometabolic risk factors, and glycaemic status in individuals categorized by baseline BMI with or without additional obesity-related comorbidities, including prediabetes and high risk of cardiovascular disease (CVD).

Participants without diabetes and BMI≥30 kg/m2, or BMI≥27 kg/m2 with ≥1 weight-related comorbidity, were randomised to once-weekly subcutaneous semaglutide 2.4mg or placebo for 68 weeks. For this analysis, individuals were categorised into subgroups based on baseline BMI<35 versus ≥35kg/m2 (with no additional criteria, with ≥1 comorbidity, with prediabetes, and with prediabetes and high risk of CVD).

The mean changes in body weight from baseline to week 68 with semaglutide were −16.2% and −14.0% in the subgroups with baseline BMI<35 and ≥35kg/m2, respectively (both p<0.0001 vs. placebo). Similar changes were observed in individuals with comorbidities, with prediabetes, and with prediabetes plus high CVD risk. The beneficial effects of semaglutide on cardiometabolic risk factors were consistent across all subgroups.

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