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Journal Watch 15/12/2021

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 the latest paper from the GENEVA study, outcomes of bariatric surgery in elderly patients, the role of food and activity on bariatric outcomes, the SMARTER randomised clinical trial and review of RCT for pharmacotherapy for adults with obesity (please note, log-in maybe required to access the full paper).

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

The latest findings - published on behalf of the GENEVA Collaborators - as part of the Global 30-day outcomes after bariatric surgEry duriNg thE COVID-19 pAndemic (GENEVA) study, has reported that there was no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.

Featured in the International Journal of Obesity, the study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. The paper included data from 185 centres across 42 countries, and from 6,770 patients (SG 3,983; OAGB 702; RYGB 2,085)

Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p=0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications.

The complication rate in the SG group was 7.3% (n=51) as compared to 7.5% (n=53) in the OAGB group (p=0.68). Similarly, 2,085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n=127), compared to 7.9% (n=166) in the RYGB group (p=0.09).

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Outcomes of bariatric surgery in elderly patients: a registry-based cohort study with 3-year follow-up

Researchers led by McMaster University have found that even though patients <65 years had overall better medium-term outcomes, bariatric surgery is safe and yields significant weight loss and comorbidities improvement in patients ≥65 years.

Writing in the International Journal of Obesity. The authors compared the short- and medium-term outcomes between patients <65 and ≥65 years undergoing bariatric surgery, hypothesising similar outcomes between groups.

In total, 22,981 patients <65 and 532 patients ≥65 years were analysed and the overall postoperative complications were similar between patients <65 and ≥65 years (3388/22,981 [14.7%] vs. 73/532 [13.7%], p=0.537). Early (<30 days) postoperative complications, readmissions, reoperations, and mortality rates were also similar between groups.

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The Role of Food and Activity Environment in a Bariatric Surgery Population – Impact on Postoperative Weight Loss

US researchers who examined the impact of environmental food and activity factors on weight loss after bariatric surgery, have reported living in an area with high food insecurity did not significantly impact mean total body weight loss (TBWL).

The study included 1,673 patients; 90% experienced ≥20% TBWL in the short-term and 65% in the long-term. Mean TBWL was significantly different for low vs. high healthy food density (32.5% vs. 33.4%; p=0.024) and low vs. high fitness facility density (32.6% vs. 33.4%; p=0.048) at short-term follow-up. Increased mean TBWL was observed for counties with more vs less exercise opportunities at short and medium-term follow-up (33.4% vs. 32.5%; p=0.025; 31.2% vs. 29.7%; p=0.019).

The authors, writing in SOARD, concluded that these data could be used to support patients to maximise the benefits of bariatric surgery.

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Effect of tailored, daily feedback with lifestyle self-monitoring on weight loss: The SMARTER randomized clinical trial

Researchers from the University of Pittsburgh, PA, have reported that there was no significant between patients who self-monitored and feedback (SM+FB) versus SM without FB (SM) in a behavioural weight-loss intervention at six months. The findings were published in the journal, Obesity.

All participants received a 90-minute 1:1 counselling session, a Fitbit Charge 2 and a digital scale for SM. SM+FB participants were provided access to a customised smartphone application that provided three daily FB messages. The primary outcome was percentage of weight change from 0 to 6 months.

At 6 months, there was a significant percentage of weight change in both groups (SM+FB: −3.16%, 95% CI: −3.85% to −2.47%, p < 0.0001; SM: −3.20%, 95% CI: −3.86% to −2.54%, p<0.0001) but no significant between-group mean difference (−0.04%, 95% CI: −0.99% to 0.91%, p=0.940). A ≥5% weight loss was achieved by 31.9% of the SM+FB group and 28.3% of the SM group.

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Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials

Researchers from the West China Hospital, Sichuan University, China, who performed a systematic review of randomised controlled trials of weight-lowering drugs in adults with overweight and obesity, report that phentermine–topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

Published in The Lancet, the paper included 143 eligible trials and 49,810 participants. Except for levocarnitine, all drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification.

Naltrexone–bupropion, phentermine–topiramate, GLP-1 receptor agonists and orlistat were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more and percentage bodyweight change.

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