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 surgery results in T2DM remission improving healthy life expectancy and providing net social benefit despite high procedural costs, a paper from Sweden that found the overall survival following sleeve gastrectomy seems to compare well with gastric bypass, Chinese researchers reported loop duodenojejunal bypass with sleeve gastrectomy (loop DJB-SG) was simpler and outcomes exhibited better weight loss and less medical cost than Roux-en-Y DJB-SG, and a study that has found mean weight gain among UIS adults during the COVID-19 pandemic may be small (please note, log-in maybe required to access the full paper).
The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus
US researchers, writing in the Annals of Surgery, have concluded that bariatric surgery results in diabetes remission improving healthy life expectancy and providing net social benefit despite high procedural costs.
For their study, the authors estimated the individual-level social benefits of diabetes remission through bariatric surgery and compared the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals.
They found that the per capita net social value of bariatric surgery-related diabetes remission was US$264,670 under current and $227,114 under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); then earnings ($51,395 and $46,466) and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). They also reported that doubling surgical utilisation for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilisation ($29.0B).
The authors concluded that per capita benefits appear greater among currently eligible individuals and policies that improve utilisation may produce larger societal value than expanding eligibility criteria alone.
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Long-term Survival After Sleeve Gastrectomy Versus Gastric Bypass in a Binational Cohort Study
Investigators from Sweden, reporting in Diabetes Care, have reported that the overall survival following sleeve gastrectomy seems to compare well with gastric bypass and may even be better during recent years.
Their population-based cohort study of primary laparoscopic sleeve gastrectomy compared gastric bypass for obesity in Sweden and Finland between January 2007 and December 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country and calendar year.
Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared with patients who underwent gastric bypass (n=51,891 [84.4%]), the sleeve gastrectomy group (n=9,612 [15.6%]) had similar all-cause mortality during the entire study period but decreased all-cause mortality in more recent years from 2014 onward. Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than after gastric bypass.
The authors concluded that a tailored surgical approach in relation to patients’ diabetes status may optimize survival in patients selected for bariatric surgery (ie, sleeve gastrectomy for patients without diabetes and gastric bypass for patients with diabetes).
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Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes mellitus: short-term outcomes of a single-center randomized controlled trial
Researchers from the First Affiliated Hospital of Nanjing Medical University, China, have found that despite similar hypoglycaemic effect, loop duodenojejunal bypass with sleeve gastrectomy (loop DJB-SG) was simpler and exhibited better weight loss and less medical cost than Roux-en-Y duodenojejunal bypass with sleeve gastrectomy (Roux-en-Y DJB-SG).
The single-centre randomised controlled study was designed to compare the therapeutic effect and surgical safety of loop DJB-SG to Roux-en-Y duodenojejunal bypass with sleeve gastrectomy (Roux-en-Y DJB-SG) in T2DM patients with obesity. Both loop and Roux-en-Y DJB-SG yielded similar T2DM remission rates (93.02% for loop DJB-SG and 88.89% for Roux-en-Y DJB-SG).
However, loop DJB-SG exhibited higher total weight loss (30.85±7.24% vs 26.11±7.12%), better uric acid reduction, shorter operation time and less hospitalization expense than Roux-en-Y DJB-SG, while there was no statistical difference regarding lipid profiles, major postoperative complications, nutritional status and gastrointestinal disorders between two groups.
Therefore, they concluded in the journal SOARD, that loop DJB-SG was better than Roux-en-Y DJB-SG for treating T2DM.
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Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models
Researchers from Belgium, writing in BMC Public Health, haver concluded that the WHO target to halt obesity by 2025 is unlikely to be achieved.
To estimate the future impact of overweight, the study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning.
They collected the height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018. They reported that the prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women.
A prevalence of 52.3% (21.2%; 83.2%) for overweight, and 27.6% (9.9%; 57.4%) for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% (7,3%; 90,9%) for overweight, and 17,2% (2,5%; 61,8%) for obesity is most likely.
“There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity,” the researchers concluded.
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Weight Gain Among U.S. Adults during the COVID-19 Pandemic through May 2021
Investigators from the Centers for Disease Control and Prevention, Atlanta, GA, reporting in the journal Obesity, who examined the pandemic-related weight increase associated with the pandemic have suggested that the mean weight gain among adults during the COVID-19 pandemic may be small.
We selected 4.25 million adults (18 to 84 y) in an electronic health record database who had at least two weight measurements between January 2019 and February 2020 and one after June 2020. We contrasted weight changes before and after March 2020 using mixed-effects regression models.
Compared with pre-pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with a BMI of 30 or 35 kg/m2, and younger adults.
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