Journal Watch 2/7/2025

Welcome to our regular 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 expert consensus paper on surgery for T2DM, the association of weight loss with gallstone formation following sleeve gastrectomy, mortality related to bariatric surgery (MORSE Study), Caprini Venous Thromboembolism risk stratification in bariatric patients and GLP-1 receptor agonists for the treatment of obesity in children and adolescents, and more (please note, log-in maybe required to access the full paper).

International expert consensus on surgery for type 2 diabetes mellitus

An international panel of experts has published 43 statements on the nature, terminology and mechanisms of action of metabolic and bariatric surgery (MBS), which the panel believes will guide clinicians on various aspects of MBS for T2DM, also grades the quality of the available evidence for each of the proposed statements.

The panel embarked on a Delphi consensus-building exercise to propose an evidence-based expert consensus covering various aspects of MBS in patients with T2DM. They defined the scope of the exercise and proposed statements and surveyed the literature through electronic databases. The literature summary and voting process were conducted by 52 experts, who evaluated 44 statements. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

They found that the currently available scores for predicting remission of T2DM after surgery are not robust enough for routine clinical use, and there is a need for further research to enable more personalized treatment. Additionally, they agreed that metabolic surgery for T2DM is cost-effective, and MBS procedures for treating T2DM vary in their safety and efficacy.

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Association of Weight Loss with Gallstone Formation Following Sleeve Gastrectomy: A Retrospective Cohort Study

Markers of absolute weight loss, percentage of excess weight loss, absolute BMI loss, and percentage of excess BMI loss were not associated with post-sleeve gastrectomy (SG) gallstone formation, according to researchers from Peru.

Published in Obesity Surgery, the team assessed the association between weight loss and de novo gallstone formation in adults undergoing SG. They retrospectively analysed 386 adults who underwent SG at a private clinic in Lima, Peru, and were followed for 12 months.

The mean age of the patients was 36.4 years, and 68.1% were female. The means for AWL, PEWL, ABMIL, and PEBMIL were 29.1 kg, 28.1%, 10.7 kg/m2, and 27.8%, respectively. In the multivariable model, neither AWL (aRR 0.99; 95% CI 0.97–1.02; p = 0.712), PEWL (aRR 0.98; 95% CI 0.93–1.01; p = 0.075), ABMIL (aRR 0.97; 95% CI 0.91–1.04; p = 0.465) nor PEBMIL (aRR 0.97; 95% CI 0.94–1.01; p = 0.079) were associated with the occurrence of de novo gallstones.

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Mortality Related to Bariatric Surgery (MORSE Study): A Retrospective, International Collaborative Audit

UK researchers have carried out a study that characterised patients where death was attributed to a bariatric procedure and identifies common causes of death in these patients. They believe the findings could aid development of strategies for preventing and managing these complications in the future.

Published in Clinical Obesity, they carried out a retrospective collaborative audit of patients who had undergone bariatric surgery and developed complications that ultimately led to death. About 30 centres from 21 countries submitted data on 82 patients where patient death was deemed to be related to bariatric surgery.

Mortality within 90 days post-surgery was observed in 58 individuals (70.7%), while 24 patients (29.3%) died after this period. Causes of mortality after SG include GI leak, PE, respiratory infection, and malnutrition. Causes of mortality after RYGB include GI leak, coronary heart disease, and bleeding. Reported common causes of early mortality in this study were gastrointestinal leaks, bleeding, coronary heart disease, and pulmonary embolism. Reported common causes of delayed mortality were gastrointestinal leaks and malnutrition.

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Preoperative Biomarkers and Thromboelastometry According to Caprini Venous Thromboembolism Risk Stratification in Bariatric Patients: Are Clinical Risk Assessments Enough?

Preoperative D-dimer and CRP are significantly increased in bariatric patients and correlate with prothrombotic features on thromboelastometry, according to US researchers.

Writing in the Journal of the American College of Surgeons, they evaluate preoperative prothrombotic biomarkers and thromboelastometry in relationship to clinical venothromboembolism stratification in bariatric patients.

One hundred bariatric patients were assessed and risk stratified to Caprini Risk Score (CRS) 3 to 4 (23), CRS 5 to 8 (67), and CRS greater than 8 (10). D-dimer, plasminogen activator inhibitor-1, and CRP were increased compared with NC, all p < 0.001, and P-selectin and von Willebrand factor demonstrated no differences compared with NC. D-dimer demonstrated significant differences between moderate, high, and very high-risk groups (all p < 0.05), and positive correlation with CRS (r = 0.44, p < 0.001).

For thromboelastometry, clot formation time (CFT) was faster than normal in 18% of patients, with maximum clot firmness higher than normal in 54% of patients. No difference was found comparing thromboelastometry between CRS groups. Significant correlations were found between CRP and CFT (r = −0.44), α-angle (r = 0.40), and maximum clot firmness (r = 0.44), all p < 0.05, respectively. D-dimer negatively correlated with CFT (r = −0.34, p < 0.05), and clotting time (r = −0.78, p < 0.05) in very high-risk patients.

However, no significant differences were found comparing viscoelastic tests among CRS groups, which suggests patients with marked prothrombotic findings are not being differentiated into higher-risk categories by clinical assessment alone.

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GLP-1 receptor agonists for the treatment of obesity in children and adolescents: a meta-analysis of randomized controlled trials

The use of glucagon-like peptide-1 (GLP-1) receptor agonists in children and adolescents with obesity significantly reduced BMI z-score, waist circumference and body weight, according to Brazilian researchers.

Published in Pediatric Research, this meta-analysis included 11 RCTs with 1,024 patients with obesity, aged from 6 to 19 years old, comparing GLP-1 receptor agonists versus placebo in children and adolescents.

Compared with placebo, GLP-1 agonists significantly decreased body weight (MD −4.32 kg; 95% CI −7.02 to −1.63 kg; p < 0.01), BMI z-score (MD −0.28; 95% CI −0.45 to −0.1; p < 0.01) and waist circumference (MD −3.84 cm; 95% CI −6.97 to −0.70 cm; p = 0.02) in this population. An analysis of patients <12 years old showed that GLP-1 receptor agonists significantly decreased BMI z-score (MD −0.33; 95% CI −0.47 to −0.20; p < 0.01). Gastrointestinal symptoms were the most frequent adverse event (RR 1.52; 95% CI 1.09 to 2.12; p < 0.01).

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