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Journal Watch 10/7/2024

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 impact of longer BPL length on weight loss, the safety of gastric bypass with same-day discharge, cost-effectiveness of LSG for Chinese patients, EASO proposes framework for the diagnosis, staging and management of obesity in adults, GLP-1RA may reduce the risk of specific obesity-associated cancers and tirzepatide out performs semaglutide, and more (please note, log-in maybe required to access the full paper).

The Impact of Longer Biliopancreatic Limb Length on Weight Loss and Comorbidity Improvement at 5 Years After Primary Roux-en-Y Gastric Bypass Surgery: A Population-Based Matched Cohort Study

Patients undergoing Roux-en-Y gastric bypass (RYGB) with longer biliopancreatic limb (BPL) achieved higher weight loss and were more likely to achieve improvement of comorbidities at five years, according to researchers writing on behalf of the Dutch Audit for Treatment of Obesity Research Group.

Reporting in Obesity Surgery, they noted that different limb lengths are used in RYGB surgery, but there is no consensus as to which limb length strategy has the best outcomes. The objective of this study was to assess the impact of a longer BPL on weight loss and comorbidity improvement at five years after primary RYGB. They defined long BPL as BPL ≥100cm and short BPL as BPL<100cm. The primary outcome was achieving at least 25% total weight loss (TWL) at five years.

The found at five years, long BPL had higher odds to achieve ≥ 25% TWL (odds ratio (OR) 1.19, 95% confidence interval (CI) [1.01 – 1.41]) and was associated with 1.26% higher absolute TWL (β = 1.26, 95% CI [0.53 – 1.99]). In addition, long BPL was more likely to result in improved diabetes mellitus (OR = 2.17, 95% CI [1.31 – 3.60]) and hypertension (OR = 1.45, 95% CI [1.06 – 1.99]).

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Safety of Gastric Bypass with Same-Day Discharge: a Propensity Score-Matched Analysis of the Dutch Audit for Treatment of Obesity

Gastric bypass with same-day discharge (SDD) is safe, with no increased risk of short-term severe complications, reoperations or mortality, researchers from OLVG Hospital, Amsterdam, The Netherlands, have found.

Writing in SOARD, the study investigated the short-term outcomes of gastric bypass with SDD, compared to overnight hospitalisation using data from the Dutch national registry.

A total, 775 SDD patients were matched with 1,550 patients discharged on postoperative days (POD) 1-4. The occurrence of severe complications was 0.9% in both groups (p=1.000), and there were no significant differences in reoperations or mortality. However, there was a significant difference was observed in the readmission rate, with 3.9% in the SDD group vs. 1.6% in the other group (p=0.001). They noted that there was a proportionally small, yet statistically significant difference favoured the control group regarding anastomotic leakages (0.6% vs 0%, p=0.004) and unspecified surgical complications (1.4% vs 0.5%, p=0.028).

However, the authors cautioned that SDD is associated with a higher 30-day readmission rate vs. patients who stay overnight in the hospital after surgery.

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Cost-Effectiveness of Laparoscopic Sleeve Gastrectomy for Chinese Patients

Laparoscopic sleeve gastrectomy (LSG) is a highly cost-effective intervention for managing obesity in Chinese patients, delivering substantial benefits in terms of health-related quality of life (HRQoL) improvement at a low cost, according to researchers from Zhejiang University, Hangzhou, China.

Reporting in Obesity Surgery, the study sought to assess the cost-effectiveness of LSG vs. no surgery in Chinese patients with severe and complex obesity, taking into account both healthcare expenses and the potential improvement in HRQoL.

This retrospective study included 135 Chinese patients who underwent LSG and found at one-year post-LSG, patients achieved an average total weight loss (TWL) of (32.7 ± 7.3)% and an excess weight loss (EWL) of (97.8 ± 23.1)%. The ICER for LSG vs. no surgery over a lifetime was US$4,327/QALY, significantly below the willingness-to-pay (WTP) threshold for Chinese patients with severe and complex obesity. From a lifetime perspective, LSG proved to be cost-effective for all sex and age groups, across all BMI categories, and for both patients with and without diabetes.

They also reported that cost-effectiveness is particularly pronounced among younger individuals, those with higher BMI and patients with diabetes.

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A new framework for the diagnosis, staging and management of obesity in adults

A new framework for the diagnosis, staging and management of obesity in adults, launched by the European Association for the Study of Obesity (EASO) and published in Nature Medicine, proposes modernising obesity diagnosis and treatment to take account of all the latest developments in the field, including the new generation of obesity medications. The framework notes that the current system for diagnosing and managing obesity can no longer be about just body mass index (BMI), which is excluding many people who would benefit from obesity treatment.

Published in Nature Medicine, the EASO Steering Group, comprised of experts including current and former Association Presidents, have put together a series of statements on obesity diagnosis, staging and treatment that will move management of the condition in line with the latest scientific knowledge and developments.

The new framework makes explicit that abdominal (visceral) fat accumulation is an important risk factor for health deterioration, also in people with low BMI and still free of overt clinical manifestations; and the new framework includes people with lower BMI (≥25–30 kg/m2) but increased abdominal fat accumulation and the presence of any medical, functional or psychological impairments of complications in the definition of obesity, hence reducing the risk of undertreatment in this particular group of patients in comparison to the current BMI-based definition of obesity.

Therefore, members of the steering committee proposed that, in particular, the use of obesity medications should be considered in patients with BMI of 25 kg/m2 or higher and a waist-to-height ratio of above 0.5 and the presence of medical, functional or psychological impairments or complications, independently from current BMI cut-off values.

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Ambulatory Discharge of Patients Undergoing Sleeve Gastrectomy Results in Significantly More Adverse Outcomes

Compared to those discharged on postoperative days (POD) 1, same day discharge after sleeve gastrectomy (SDSG) patients are at significantly increased risk for all adverse events analysed, researchers from Geisinger Medical Center, Danville, PA, have found.

Writing in SOARD, the investigators wanted to determine which, if any, patient groups could safely undergo SDSG. Using  Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) data to identify the risk of adverse events within 30 days of SG by postoperative discharge day.

In total, 702,622 SGs were performed during the study period of which 31,308 (4.46%) patients were SDSGs and 409,622 (58.3%) on postoperative day 1 (POD1). Compared to those discharged on POD1, SDSG patients were at increased risk for any complication (OR 1.22 95% CI 1.1-1.36), minor complications (OR 1.17 95% CI 1.03-1.32), major complications (OR 1.36 95% CI 1.15-1.61), readmission (OR 1.09 95% CI 1.00-1.18) and reoperation (OR 1.37 95% CI 1.16-1.62). Other interventions within 30 days were not statistically significant.

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Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes

Glucagon-like peptide 1 receptor agonists (GLP-1RA) may reduce the risk of specific obesity-associated cancers, according to a study by researchers from Case Western Reserve University School of Medicine, Cleveland, OH, that compared the incident risk of each of the 13 OACs in patients with T2D who were prescribed GLP-1RAs vs insulins or metformin.

Writing in JAMA Network Open, this retrospective cohort study included 1,651,452 patients (mean age, 59.8 [15.1] years; 827 873 [50.1%] male and 775 687 [47.0%] female participants) with T2D who had no prior diagnosis of OACs and were prescribed GLP-1RAs, insulins, or metformin during March 2005 to November 2018. They found that GLP-1RAs were associated with lower risks of specific types of OACs compared with insulins or metformin in patients with T2D.

These findings provide preliminary evidence of the potential benefit of GLP-1RAs for cancer prevention in high-risk populations and support further preclinical and clinical studies for the prevention of certain OACs.

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Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity

Adults living with overweight or obesity experienced significantly greater weight loss using tirzepatide compared with semaglutide, researchers from Truveta (a medical research collective) and the Cardiovascular Analytics, Research and Data Science at Providence Heart Institute, Providence Health System, Portland, OR, have reported.

Writing in JAMA Internal Medicine, they compares on-treatment weight loss and rates of gastrointestinal adverse events (AEs) among adults with overweight or obesity receiving tirzepatide or semaglutide labelled for type 2 diabetes (T2D) in a clinical setting.

The study included 41,222 adults meeting the study criteria (semaglutide, 32 029; tirzepatide, 9193). Those receiving tirzepatide were significantly more likely to achieve weight loss and on-treatment changes in weight were also larger for patients receiving tirzepatide at three months and 12 months. Interestingly, the rates of gastrointestinal AEs were similar between groups.

The researchers called for future studies are required to understand differences in other important outcomes.

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