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Journal Watch 21/06/2023

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 surgical outcomes for patients with bipolar/schizoaffective disorder, outcomes from LSG and OAGB in adolescents, significant variability in ESG practice, educating patients on weight recurrence after surgery, single anastomosis sleeve ileal bypass outcomes and patients with binge-eating disorder exhibit greater emotional dysregulation, and more (please note, log-in maybe required to access the full paper).

Bariatric Surgery Outcomes in Patients with Bipolar or Schizoaffective Disorders

When compared to the general bariatric population, patients with bipolar/schizoaffective disorder (BSD) had similar to slightly improved weight loss, with a comparable risk and complication profile, according to researchers from the Mayo Clinic, Rochester, MN.

Writing in SOARD, they conducted a retrospective chart review analysis of bariatric surgical procedures in patients with BSD between 2008-2021 at Mayo Clinic. They matched 71 patients with BSD with 142 controls in a 1:2 ratio. After adjusting for baseline preoperative weight, patients with BSD had a 3.4% greater total weight loss compared to controls over 24 months (p=0.02). Remission in obesity-related diseases, was similar in both groups. In addition, perioperative complication rates were similar other than deep venous thrombosis, which showed a higher rate in BSD patients (p=0.04).

However, patients with BSD have increased alcohol use after bariatric surgery highlighting the need for psychological care before and after surgery in this population.

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Laparoscopic Sleeve Gastrectomy Versus One Anastomosis Gastric Bypass in Adolescents With Obesity

A comparison of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) has reported both surgeries are effective and safe for weight loss in the adolescent population, although OAGB was associated with significantly fewer GI symptoms compared to LSG.

Researchers from Tel Aviv University, Tel Aviv, Israel, writing in the Journal of Pediatric Gastroenterology and Nutrition, compared perioperative, early postoperative and one-year postoperative outcomes of adolescents with obesity who underwent LSG or OAGB surgery.

The study included 75 adolescents (22 underwent OAGB and 53 underwent LSG) and there were no significant preoperative group differences in age, sex, and BMI score. They reported that there was a low rate of perioperative (5.7% vs 0) and postoperative complication (15.1% vs 10%) with no statistical differences between LSG and OAGB group.

At 12 months, the percent excessive weight loss + IQR was 42.40% and 38.00% in the LSG and OAGB group, respectively (p=NS). The results of the Pediatric Quality of Life Inventory Gastrointestinal Symptoms scale revealed significantly less food limitation and heartburn after OAGB compared to LSG (food limitation 71.63 vs 53.85 and heartburn 83.654 vs 61.6, P = 0.03 and P = 0.029, respectively).

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Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey

Researchers from the University of Texas Health Science Center, Dallas, TX, have found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation and medication use, for pre- and post-endoscopic sleeve gastroplasty (ESG) care.

Reporting in Obesity Surgery, the investigators sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development.

They conducted an anonymous cross-sectional survey to examine practice patterns related to ESG, surveying five sections: endoscopic practice, training, and resources; pre-ESG evaluation and payment model; perioperative/operative period; post-operative period; and endobariatric practice other than ESG.

They found that most respondents (n=21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n=13/32) would not perform ESG on patients with BMI over 50, with a majority of respondents (74.2%, n=23/31) highlighting that ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n=21/31).

“Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costsm” they concluded. “Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs.”

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How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery

Researchers from the Netherlands have stated that patients should be adequately counselled on weight recurrence after bariatric-metabolic surgery (BMS).

Reporting in Obesity Pillars, the study authors examined the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get ‘Back on Track’ (BoT). For their study, they conducted in-depth interviews and focus groups with 19 stakeholders, including patients and HCPs involved in BoT. They noted that patients and HCPs reported a wide array of causes of weight recurrence. Importantly, patients found it difficult to decide when weight recurrence is problematic and when they should ask for help, and patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help.

They concluded that E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact.

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Unpredictable Malnutrition and Short-Term Outcomes after Single Anastomosis Sleeve Ileal (SASI) Bypass in Obese Patients

Single Anastomosis Sleeve Ileal (SASI) bypass may be an effective bariatric and metabolic surgery that can achieve satisfactory weight loss and improvement in medical comorbidities, according to researchers from Helwan University, Helwan, Egypt.

Reporting in the Journal of Obesity, the study included 30 patients and found that postoperatively, 48% of the patients (n=13) developed gallstones (GS) and the formation of GS was significantly higher in patients with longer durations of obesity and rapid weight loss. In addition, 63% of the patients (n=19) had malnutrition and 15 cases required revision due to the fear of further weight loss. Interestingly, revision and malnutrition were significantly higher among male patients than female patients and among patients with longer durations of obesity (p≤0.001).

Although SASI bypass may be an effective bariatric and metabolic surgery this study highlights the potential risks of severe malnutrition and unpredictable weight loss, and the researchers concluded that patient selection and duration of obesity may play a role in mitigating these risks.

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Food addiction and binge eating disorder are linked to shared and unique deficits in emotion regulation among female seeking bariatric surgery

Iran University of Medical Sciences, Tehran, Iran, have reported that individuals with obesity and comorbid binge-eating disorder (BED) exhibit greater emotional dysregulation compared to those with obesity only (OB) or food addiction (FA), indicating a need to assess BED in individuals with obesity.

Writing in the Journal of Eating Disorders, the study authors sought to identify overlapping and distinctive features in emotion dysregulation as an underlying mechanism and emotional eating as a clinical feature among four groups of females with obesity seeking bariatric surgery.

The study included 128 patients who were divided into four groups: those with FA (n=35), BED (n=35), BED + FA (n=31) and a control group of individuals with OB (n=27). They found BED + FA group showed the highest levels of emotional dysregulation and emotional, while the OB group acquired the lowest scores.

“Emotion dysregulation may be linked to increased BED and FA, but those with BED seem more affected by limited access to emotion regulation strategies,” they concluded. “These findings support the notion that PEBs are associated with emotion dysregulation and underscore the need for tailored interventions that target emotion regulation skills before and after bariatric surgery.”

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