Journal watch 13/8/2025

Welcome to our regular 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 long-term outcomes of single and dual anastomosis duodenal switch, study to reduce morbidity and improve recovery, global variations in practices after bariatric and metabolic surgery, preoperative GLP-1ras in patients undergoing elective surgery and adherence to dietary-related behavioural recommendations after MBS (please note, log-in maybe required to access the full paper).

Long-Term Outcomes of Single and Dual Anastomosis Duodenal Switch

Researchers from Portugal have reported the long-term outcomes of biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in terms of obesity-related comorbidities remission and complication rates do not seem to differ, despite BPD/DS inducing greater weight loss and SADI-S being associated with greater improvements in quality of life.

Writing in Obesity Surgery, they compared long-term outcomes, at least 60 months, of 114 patients undergoing SADI-S and BPD/DS. After ≥ 60 months of follow-up, patients submitted to BPD/DS and SADI-S achieved a total weight loss (TWL) > 20% (96% vs 91%, p=0.67) and similar remission rates of associated medical problems.

Transient vitamin and micronutrient deficiencies during follow-up were observed in 44.8% of BPD/DS patients and 63.5% of SADI-S patients, anaemia in 44.8% and 42.4%, and iron deficiency in 58.6% and 48.2%, respectively. Quality of life (QoL) scores were not significantly different between the groups (BPD/DS: 2.00 ± 0.22 vs. SADI-S: 2.15 ± 0.19, p = 0.08).

After propensity score matching (n=28 per group), differences in weight loss outcomes became more pronounced, favouring BPD/DS, while SADI-S was associated with significantly greater improvement in quality-of-life.

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Refining Bariatric Surgery: A Nationwide 15-Year Study to Reduce Morbidity and Improve Recovery

A team from the Lille University Hospital Chu Lille, Lille, France, has found that although bariatric surgery has become safer over time, with declining mortality and complication rates, the stagnation of improvements in recent years highlights the need for further optimisation strategies.

Reporting in the Annals of Surgery, they evaluated the evolution of postoperative mortality and morbidity associated with bariatric surgery over a 15-year period using a nationwide database.

Using data from France’s national healthcare database Système National des Données de Santé, they reported that from 486,161 first-time bariatric procedures (performed between 2009 and 2023), the overall 90-day mortality rate was 0.1%, varying significantly by procedure (p<0.001), with gastric banding exhibiting the lowest rate. Mortality decreased by 40% over time, but sleeve gastrectomy (SG) and gastric bypass (GBP) showed a plateau effect since 2018. Reoperations declined (4.9% to 4.5%), and ICU admissions for severe complications fell by 58%. Medication analysis revealed reduced analgesic (-29.4%), antidepressant (-15.7%), and anxiolytic (-12.7%) use, while laxative consumption increased (+86.4%).

The researchers added that these findings support the continued integration of surgery within a multimodal obesity treatment paradigm.

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Global Variations in Practices After Bariatric and Metabolic Surgery; the PARTNER study

The PARTNER study, which evaluated global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals, has revealed significant international variation in postoperative management practices following MBS.

PARTNER was an international online survey conducted between October 2024 and January 2025. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes.

There were a total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures.

The international team of researchers said these findings underscore the need for more standardised, evidence-based guidelines to improve long-term outcomes and equity of care worldwide.

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Evaluation of safety of preoperative GLP-1 receptor agonists in patients undergoing elective surgery: a systematic review, meta-analysis and meta-regression

Patients waiting for operations could safely use glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to lose excess weight and reduce their risk of surgical complications linked to their obesity, a study by researchers from the University of Birmingham has revealed.

Published in eClinicalMedicine, the researchers analysed data from 21 studies and 97,059 patients, 31.9% (n=30,981) received preoperative GLP-1 RA therapy. Most studies were single-centre observational cohorts from high-income countries, with no randomised trials identified. Postoperative complications were reported in 12 studies, with no evidence of increased risk in GLP-1 users (pooled odds ratio: 0.78, 95% confidence interval: 0.59–1.05).

The overall GRADE assessment for certainty of evidence was very low. In studies reporting weight loss, preoperative GLP-1 use was associated with weight loss of up to 16.7 kg or 6.0 kg/m2 over six months, though reporting varied across studies.

Overall, GLP-1 therapy led to weight reductions of up to 16.7 kg over six months, suggesting its potential as a scalable preoperative measure.

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Bridging the Gap: Evaluating Tools for Adherence to Dietary-Related Behavioral Recommendations After Metabolic Bariatric Surgery—A Scoping Review

Existing tools for assessing adherence to dietary-related behavioural recommendations after MBS show significant variability, with most lacking standardised psychometric properties and recall periods, limiting their utility, according to an international team of researchers.

Their scoping review aimed to map existing tools for assessing adherence to dietary-related behavioural recommendations after MBS, evaluate their content and psychometric properties, and identify gaps to guide future research and tool development.

From 3,223 publications, they analysed16 reports from ten countries. Tools assessing dietary adherence post-MBS varied widely in content and behavioural targets, with most robust psychometric properties lacking. Reliability was assessed via Cronbach's alpha and test–retest methods and validity via face, content, construct, and criterion measures. In addition, they noted that standardised recall periods and comprehensive scoring systems were notably absent.

They concluded that future research should focus on standardising dietary-related “core principles,” facilitating the development of new instruments in research and clinical settings.

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