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Journal Watch 15/06/2022

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 an expert Delphi Consensus on Patient Selection in OAGB/MGB, two papers report on the benefits of exercise post-bariatric surgery, the importance of language in medical literature and a paper discussing the current evidence and practice of bariatric surgery (please note, log-in maybe required to access the full paper).

Patient Selection in One Anastomosis/Mini Gastric Bypass—an Expert Modified Delphi Consensus

An international team of researchers writing in Obesity Surgery on behalf of the Expert Delphi Consensus, generate clinical guidelines to aid and support clinicians in performing the right patient selection in OAGB/MGB.

The committee included 57 recognized bariatric surgeons from 24 countries. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus. More than 90% of the experts felt that OAGB/MGB is an acceptable and suitable option “in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m2 as a one-stage procedure,” “as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m2 (instead of BPD/DS),” and “in patients with weight regain after restrictive procedures.

No consensus was reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved “in case of intestinal metaplasia of the stomach” (74.55%), “in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)” (75.44%), “in patients with Barrett’s metaplasia” (89.29%), and “in documented insulinoma” (89.47%).

There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30–35 kg/m2) with associated metabolic problems, and patients with BMIs more than 50 kg/m2 as one-stage procedure. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, they conclude that it should not be offered to patients with grade C or D esophagitis or Barrett’s metaplasia.

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Exercise and bariatric surgery: A systematic review and meta-analysis of the feasibility and acceptability of exercise and controlled trial methods

Investigators from the Université du Québec en Outaouais, Gatineau, Québec, Canada, reporting in Obesity Reviews, have found that exercise and controlled trial methods seem feasible and acceptable for adults awaiting or having undergone bariatric surgery.

Their study sought to assess the feasibility and acceptability of exercise and controlled trial methods in adults awaiting or having undergone bariatric surgery. The systematic review reported that most interventions were supervised, performed after surgery and lasted ≤13 weeks. Pooled data for exercise intervention attendance and dropout rates were 84% and 5% respectively, though possibly misestimated due to poor/selective reporting.

Despite the lack of data available in studies included, exercise and controlled trial methods seem feasible and acceptable for adults awaiting or having undergone surgery however, to better identify methodological or practical challenges, and assess bias, better reporting of feasibility and acceptability indicators is needed in future studies.

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Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests

Researchers from the University of Brasilia, Brasilia, Brazil, writing in PlosOne, have concluded that exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.

The meta-analysis included 15 studies (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41–1.01; I2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84–1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests.

The results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20–1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06–0.87; I2 = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42–0.63; I2 = 73.27%).

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Say what you mean, mean what you say: The importance of language in the treatment of obesity

Writing in the journal Obesity, researchers are recommending a stronger move towards less stigmatising, standardised terminology in scientific journals and with patients, which reflects our understanding of obesity as a disease, according to a study, ‘Say What You Mean, Mean What You Say: The Importance of Language in the Treatment of Obesity’, published in the journal Obesity.

Results revealed that out of 3,020 papers screened, 2.4% included the term "fail" and 16.8% contained "morbid" used in conjunction with obesity. The patients felt that that negative language, particularly the word "failure," implied a personal responsibility for lack of weight loss.

The study's authors write those clinicians involved in research on the treatment of obesity are uniquely positioned to take the lead starting with the adoption of non-stigmatising, clinically-descriptive phrases and the use of first-person language in publications. The researchers add that the adoption of editorial policies discouraging the use of ambiguous, non-scientific phrases such as "fail" or "morbid obesity" would reinforce the need to communicate with clarity and in a way that does not perpetuate the role of the medical professions in stigmatizing obesity.

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To access our summary of the paper, please click here

Bariatric Surgery With Roux-En-Y Gastric Bypass or Sleeve Gastrectomy for Treatment of Obesity and Comorbidities: Current Evidence and Practice

Authors from the US, writing in Cureus, discuss the benefits of bariatric surgery on weight loss as well comorbidities that are present in a majority of patients with obesity.

Their review found that bariatric surgery with either the gastric bypass or laparoscopic sleeve gastrectomy can result in weight loss of up to 80% of excess weight, as well as having a profound effect on multiple comorbidities such as type 2 diabetes mellitus, hypertension and hyperlipidaemia through remission of the disease.

They conclude that the beneficial effects of bariatric surgery in the obese population has been shown to extend beyond significant weight loss and leads to improvement and remission of multiple comorbidities, namely T2DM, hyperlipidemia and hypertension.

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