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Journal Watch 14/12/2022

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 whether the MBSAQIP Bariatric Risk/Benefit Calculator influences patients’ procedure choice, a comparison of sleeve volume between banded and non-banded LSG, cardiac fat pat change after LSG and RYGB, long-term changes in body image after bariatric surgery and weight loss for obstructive sleep apnoea patients (please note, log-in maybe required to access the full paper).

Patient Perspectives on the Usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: A Randomized Controlled Trial

Researchers from Indiana University School of Medicine, Indianapolis, IN, have reported that most patients who used a risk calculator found it a helpful tool, but it did not influence their procedure choice.

Writing in SOARD, the assessed whether the MBSAQIP Bariatric Risk/Benefit Calculator, which uses procedure-specific prediction models to generate individualised surgical risk/outcome estimates, would influence patient procedure choice.

For this randomised controlled trial at an MBSAQIP-accredited centre, 126 patients were randomised into two groups: the control group received conventional surgeon-led counselling (n=68), while for the calculator group surgeons utilized the Risk/Benefit Calculator to guide decision-making (n=61). Surveys were completed by patients following consultations to evaluate satisfaction and perceived impact of risk calculator on operative selection.

The authors revealed that the percentage of patients whose procedure of choice changed following consultation was similar in the calculator versus non-calculator group (44.3% vs. 41.2%; p=0.723). However, calculator group patients were less likely to perceive surgeon counselling as very important for their decision-making (43.3% vs. 76.5%; p<0.001). 85% of calculator group patients rated the calculator as useful/very useful, and only 1.7% found it not very important. The reasons patients changed procedure choice were similar between the groups (p=0.091); most common cause was to improve their anticipated outcomes (48.7% vs. 54.8%).

They noted that the patient-reported usefulness and importance of the calculator during surgeon counselling suggests that the information provided weighs into patient decision-making.

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Comparison of Sleeve Volume Between Banded and Non-banded Sleeve Gastrectomy: Midterm Effect on Weight and Food Tolerance—a Retrospective Study

Researchers from Alexandria University, Hadara, Alexandria, Egypt, have reported that banded sleeve gastrectomy (BSG) had significantly lower sleeve volume, significantly lower weight regain, and significantly lower food tolerance (FT) scores than laparoscopic sleeve gastrectomy (LSG) after four years from surgery; however, volume changes were not correlated with weight loss.

Reporting in Obesity Surgery, this retrospective study included 1,279 LSG patients and 132 BSG patients who completed four years of follow-up from 2016 to 2021. Body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL) and FT scores were calculated at 1, 2, 3, and 4 years. The sleeve volume was estimated at six months, one year and four years.

Mean %EWL at 1 year was 83.87 ± 17.25% in LSG vs. 85.71 ± 7.92% in BSG and was 83.47 ± 18.87% in LSG and 85.54 ± 7.48% in BSG at four years. Both had significant weight loss over time (p<0.001) with no significant main effect of surgery (p=0.438). Mean sleeve volume at six months was 102.32 ± 9.88 ± 10.28 ml in LSG vs. 101.89 ± 10.019 ml in BSG and at four years was 580.25 ± 112.25 ml in LSG vs. 157.94 ± 12.54 ml in BSG (p<0.001).

Weight regain occurred in 136 (10.6%) and 4 (3.1%) (p.0.002) in LSG and BSG patients, 90 (7%) vs. zero (0%) (p.0.002) and 31 (2.4%) vs. zero (0%) (p.0.07) using the > 10%, > 10kg increase above the nadir and the ≥5kg/m2 BMI increases above the nadir formulas, respectively.

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Cardiac fat pat change after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery: A systematic review and meta-analysis

Researchers from Iran, writing in SOARD, have reported that cardiac fat pad diameter and volume were significantly reduced after sleeve gastrectomy (SG) and Roux-en Y gastric bypass (RYGB), however SG showed greater reduction in fat pad diameter in comparison to RYGB and RYGB had a significant reduction in mean fat pad volume.

Their meta-analysis, which included 19 papers (n=822 patients), sought to investigate the effects of the two procedures on cardiac fat pad reduction. The results of subgroup analysis on the type of surgery showed that bariatric surgeries decreased the mean fat pad diameter but the reduction was greater in SG than RYGB.

Epicardial and pericardial fat type showed a significant decrease of fat pad diameter. The result of subgroup analysis indicated RYGB had a significant reduction in mean fat pad volume. CT scan and cardiac MRI showed a significant reduction of the mean cardiac fat pad volume. Epicardial and paracardial fat type showed a significant decrease in volume.

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Long-term changes in body image after bariatric surgery: An observational cohort study

Investigators from Bordeaux University Hospital, Pessac, France, have concluded that body image improved after bariatric surgery but was not maintained for all five years after surgery.

Reporting in PLOSone, they assessed body image through the Stunkard Figure Rating Scale and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale, which measures appearance evaluation and orientation, overweight preoccupation, and self-classified weight. Surveys were conducted before surgery and at regular intervals until five years after bariatric surgery.

Sixty-one patients were included in the study. At five years, there were 21 patients (34%) lost to follow-up. They detected an overall improvement in body image until 12–18 months post-surgery. Scores declined five years post-surgery but were still higher than preoperative evaluations. Overweight preoccupation did not change throughout the follow-up period. There was a positive correlation between body weight lost and appearance evaluation.

There was also a positive correlation between weight loss and the Body Areas Satisfaction Scale, and a negative correlation between weight loss and overweight preoccupation. Appearance orientation and self-classified weight were not correlated with weight loss.

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Trending Weight Loss Between Usual Care and Bariatric Surgery Among Higher Weight Persons With Obstructive Sleep Apnea

US researchers from the University of Florida College of Medicine-Jacksonville, Jacksonville, FL, have found that despite the direction to lose weight, only 7% of obstructive sleep apnoea (OSA) patients lowered their BMI classification.

This study aimed to investigate the actual weight change documented as a goal of treatment after patients were newly diagnosed with obstructive sleep apnea (OSA). We hypothesized that patients with OSA and classified as overweight and obese based on BMI would fail to achieve significant weight loss over a two- to five-year period.

In this retrospective study, patients received either usual care for weight reduction (n=100) or bariatric surgery (n=24) to assess the overall weight loss and identify barriers. Cox proportional hazards regression, and Kaplan-Meier curves analysed age, gender, ethnicity, and weight differences between usual care and bariatric surgery groups.

At five years, 87% of the usual care patients remained in the same BMI classification, 7% lowered their classification, and 6% raised theirs. For usual care patients, the average net weight per individual of 2.19 kg gained represented a 1.96% weight change. Bariatric patients lost an average net weight of 30.40 kg (22.39%). The significant variables were time-dependent weight change and ethnicity. The Kaplan-Meier curve revealed that weight loss reduced over time in treatment.

Writing in Cureus, the authors noted that patient instruction and provider-driven weight loss strategies seem equally ineffective to achieve sustained weight reduction among high-risk groups. They concluded that more research is needed to investigate optimal strategies that include interprofessional collaborative practices for sustained weight loss.

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