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Journal Watch 17/04/2024

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 semaglutide vs ESG, 3D vs 2D video systems in bariatric surgery, psychological and psychosocial differences when undergoing surgery, surgery and serum uric acid levels, and internalised weight stigma, and more (please note, log-in maybe required to access the full paper).

Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss

Endoscopic sleeve gastroplasty (ESG) is cost saving compared with semaglutide in the treatment of class II obesity and a price threshold analyses revealed a three-fold decrease in the price of semaglutide is needed to achieve nondominance, US researchers have reported in JAMA Network Open.

The study authors assessed the cost-effectiveness of both treatments over five years and examined the costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100,000/QALY.

The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of –$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33,583 relative to semaglutide. Endoscopic sleeve gastroplasty sustained greater weight loss over five years vs semaglutide (BMI of 31.7 vs 33.0).

To achieve non-dominance, the annual price of semaglutide, currently $13,618 would need to be $3,591.

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Three-dimensional Versus Two-dimensional Laparoscopic Bariatric Surgery: A Systematic Review and Meta-analysis

The use of 3D video systems in bariatric surgery appears to significantly decrease operative time during GB and recovery in all surgical procedures, according to researchers from Federico II University Hospital, Naples, Italy.

Writing in Obesity Surgery, this systematic review included six studies (629 patients) who underwent 2D (386) and 3D (243) laparoscopic bariatric surgeries were selected. They found that operative time was significantly shorter in patients undergoing 3D laparoscopic gastric bypass, a shorter hospital stay was also detected for both during sleeve gastrectomy and gastric bypass with 3D laparoscopy. Additionally, the study showed the potential benefit of 3D imaging in preventing intra- and postoperative complications.

They concluded that the adoption of 3D vision may be advantageous in this context however, firm conclusions cannot be drawn and additional high-quality studies are warranted.

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When Insurance Is Not a Barrier: Psychological Factors Predicting Whether Bariatric Candidates Undergo Surgery

Psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery, according to researchers form Madigan Army Medical Center, Tacoma, WA.

Writing in SOARD, they used the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) in 279 archived patients to examine scale associations with undergoing surgery.

A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complains, cynicism, and helplessness/hopelessness.

They concluded that MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs.

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Bariatric Surgery and Its Metabolic Echo Effect on Serum Uric Acid Levels

Bariatric surgery for weight loss leads to a significant reduction in serum uric acid (SUA) levels in the long run for patients with obesity and severe obesity, researchers from Tongji University School of Medicine, Shanghai, China, have reported.

Writing in Cureus, their review elaborated on factors contributing to decreased serum uric acid levels after bariatric surgery, such as alterations in renal function, insulin sensitivity and inflammatory markers.

The findings suggested that the decrease in the level of SUA is caused by a combination of many processes such as improvements in renal function, increased insulin sensitivity and changes in inflammatory markers Post-surgery, there may be a temporary rise in SUA levels due to rapid weight loss and metabolic changes due to surgical trauma. However, long-term follow-ups typically reveal a notable and consistent reduction in SUA levels.

They concluded that bariatric surgery has a significant role in managing pre-surgery uncontrolled hyperuricemia and repeated attacks of gout, along with the primary target of weight loss.

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Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study

Internalised weight stigma (IWS) differs substantially between demographic groups and this is not explained by differences in BMI, according to UK researchers.

Writing in The Lancet Regional Health Europe they re-assessed previously reported associations of IWS with demographic, socioeconomic, and wider social factors such as sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression.

They reported IWS was higher for females, sexual minorities and less socioeconomically advantaged. The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family and the media or had experienced bullying.

In addition, pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS.

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