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Journal Watch 13/3/2024

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 a worldwide IFSO survey comparing different national guidelines, what prompts MBS patients to seek bariatric care after being lost to follow-up, prevalence of adolescents meeting criteria for MBS, reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery, GLP-1ra use and residual gastric content before anaesthesia and behavioural factors on weight loss after bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines

More than a third national MBS societies have already shifted to the most updated ASMBS/IFSO 2022 guidelines, however another significant number of countries are still following the NIH 1991 guidelines or do not have any guidelines at all, according to an in international team of researchers.

Writing in Obesity Surgery, the researchers analysed the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries.

Sixty-three out of the 72 IFSO national societies answered the form (87.5%) with 74.6% having some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries.

They concluded that more effort is needed to standardise indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

To access this paper, please click here

Outcomes and Management of Re-Establishing Bariatric Patients

Recurrent weight gain (RWG) is the most common reason for patients after MBS seeking to re-establish care with the MBS team, researchers from Brigham and Women’s Hospital, Boston, MA, have reported.

Reporting in the Journal of the American College of Surgeons, they retrospectively analysed a cohort study of patients after MBS who had discontinued regular MBS follow-up but represented to the MBS clinic between July 2018 and December 2022 to re-establish care.

In total, 400 patients (83.5% female, mean age 50.3 ± 12.2 years at the time of RBC) were included in the study of whom 177 (44.3%) had RYGB, 154 (38.5%) had SG and 69 (17.2%) had AGB. Overall, recurrent weight gain (RWG) was the most common reason for presentation for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB; p<.001). SG patients were more likely to undergo a revision MBS compared to RYGB patients (16.9% vs. 5.8%, p<.001), while RYGB patients were more likely to undergo an endoscopic intervention than SG patients (17.5% vs. 7.8%, p<.001).

Interestingly, the response to AOM agents, specifically GLP-1 drugs, was better in RYGB patients, than SG patients.

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Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery

One in 23 adolescents met the eligibility criteria for MBS suggesting that the healthcare system may face challenges in accommodating the demand for MBS among eligible adolescents, according to US researchers.

Reporting in the journal Pediatrics, the study sought to determine eligibility and characteristics of adolescents who qualify for MBS based on American Academy of Pediatrics guidelines. They analysed data of 603,051 adolescents.

Of the 603,041 adolescents evaluated, 22.2% had obesity (12.9% class 1, 5.4% class 2, and 3.9% class 3). The most frequently diagnosed comorbid conditions were gastroesophageal reflux disease (3.2%), hypertension (0.5%) and nonalcoholic fatty liver disease (0.5%). Among adolescents with class 2 obesity, 9.1% had 1 or more comorbidities qualifying for MBS and 4.4% of all adolescents met the eligibility criteria for MBS.

In multivariable modelling, males, Black and Hispanic adolescents, and those living in more deprived neighbourhoods were more likely to meet MBS eligibility criteria.

To access this paper, please click here

Adolescent bariatric surgery—a survey of referring practitioners

There is a reluctance among general practitioners (GPs) to refer adolescents with severe obesity for consideration of bariatric surgery, according to researchers from Ireland.

Writing in the Irish Journal of Medical Science the aim of this study was to assess the opinions and referral practices of GPs and paediatricians in Ireland, via a survey consisting of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications.

There were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%) and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery, with paediatricians were significantly more likely to refer (72% vs. 28%, p=0.034). A minimum BMI of 40 kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%) and orlistat (22% vs. 0%).

“Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services,” the researchers concluded.

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Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia

Use of a Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) was independently associated with increased Residual Gastric Content (RGC) on preprocedural gastric ultrasonography researchers from The University of Texas Health Science Center at Houston have reported.

Writing in JAMA Surgery, they assessed the association between GLP-1 RA use and prevalence of increased RGC, a major risk factor for aspiration under anaesthesia, using gastric ultrasonography.

From 124 participants (median age, 56 years [IQR, 46-65 years]; 75 [60%] female), the prevalence of increased RGC was 56% (35 of 62) in patients with GLP-1 RA use (exposure group) compared with 19% (12 of 62) in patients who were not taking a GLP-1 RA drug (control group). After adjustment for confounding, GLP-1 RA use was associated with a 30.5% (95% CI, 9.9%-51.2%) higher prevalence of increased RGC (adjusted prevalence ratio, 2.48; 95% CI, 1.23-4.97). There was no association between the duration of GLP-1 RA interruption and the prevalence of increased RGC (adjusted odds ratio, 0.86; 95% CI, 0.65-1.14).

The findings suggest that the preprocedural fasting duration suggested by current guidelines may be inadequate in this group of patients at increased risk of aspiration under anaesthesia.

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To read our summary, please click here

Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis

The presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery, according to researchers from The Netherlands.

Writing in Obesity Reviews, the review and meta-analysis evaluated the influence of several mental and behavioural factors on weight loss. In total, 75 articles were included in the review; 12 meta-analyses were conducted.

Higher postoperative compliance to follow-up was associated with 6.86%–13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms.

However, they reported that preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.

To read our summary, please click here


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