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Journal Watch 22/03/2023

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 improvement in the ability to work after surgery, endoscopic sleeve gastroplasty outcomes, post-surgical macronutrient composition and food tolerance after bariatric surgery (please note, log-in maybe required to access the full paper).

Improvement of Work Ability After Weight Loss Surgery: Results of a Longitudinal Study of Patients Suffering from Extreme Obesity Before and 4 Years After Bariatric Surgery

The ability to work four years after bariatric surgery remained significantly improved compared to the ability prior and one year after surgery researchers from Germany have reported.

Writing in Obesity Surgery, 197 patients were included in the study that examined the change over time in the work ability index (WAI) and BMI using a repeated-measures analysis of variance (ANOVA). A hierarchical multiple regression analysis was calculated to predict socio-demographic and psychosocial characteristics pre-surgery on WAI at four years.

Interestingly, an increase in WAI was seen between prior to surgery and six months after surgery, as well at 12 months and at four years. BMI reduction was significant between at all time points. There was no significant interaction effect of BMI reduction four years after surgery on decreased work ability from six months to four years. The hierarchical multiple regression analysis revealed an association of WAI scores at t1 on WAI scores at t4 only.

The authors write that the findings might indicate the use of psycho-social measures post-bariatric surgery to increase work ability, although there was no association between work ability and other socio-demographic or psycho-social factors.

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Endoscopic sleeve gastroplasty: early results of a minimally invasive procedure in patients with obesity

Portuguese investigators have reported that endoscopic sleeve gastroplasty (ESG) is safe and effective to manage obesity with significant weight loss at three months observed in patients with obesity class I and class II.

Writing in Surgical Endoscopy, the study included 73 patients with obesity classes I, II and III (BMI 31.1–46.6 kg/m2) underwent ESG between September 2021 and April 2022 at a tertiary care hospital using Overstitch (Apollo Endosurgery). ESG’s efficacy and safety was evaluated at one and three months post-procedure with regard to excess weight loss (EWL) and total weight loss (TWL).

Initial weight was 105.7 ± 15.7 kg and mean BMI 38.6 ± 3.5 kg/m2. At one and three months, mean %EWL was 25.4 ± 7.1 and 36.3 ± 11.4, and %TBWL was 11.2 ± 2.6 and 15.8 ± 4.2, respectively.

Significant excess weight loss at three months was only observed in patients with BMI<40 kg/m2 (p=0.001).

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Relationship between dietary macronutrient composition with weight loss after bariatric surgery: A systematic review

Researchers from the Universidade Federal de Viçosa, Viçosa, Brazil, have reported that high-protein intake >60g a 90g/day may favour weight loss and maintenance after bariatric surgery, but it is relevant to balance the other macronutrients.

Writing in Obesity Reviews, their systematic review included eight articles with 2,378 subjects. The studies indicated a positive relationship between weight loss and protein intake after BS.

They highlighted that prioritisation of protein followed by carbohydrates with a lower percentage of lipids favours weight loss and increases weight stability after surgery. A one percent increase in protein intake raised the probability of obesity remission by 6%, and high-protein diet increase 50% weight loss success.

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Is Food Tolerance Different After Bariatric Surgery Depending on the Surgical Procedure?

Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after bariatric surgery, Spanish researchers report.

Published in Obesity Surgery, the study sought to compare biliopancreactic diversion (BPD), gastric bypass (GB) and sleeve gastrectomy (SG) and their effect on food tolerance. Food tolerance test (FTT) showed a better self-perception of the intake after surgery in BPD at six months (p=0.013), and at 12 months (p=0.006).

BPD also had a better tolerance of 8 food groups at 6 months (red meat p=0.017, white meat p=0.026, salad p=0.017, bread p<0.001, rice p=0.047, pasta p=0.014, fish p=0.027) and at 12 months, but only red meat (p=0.002), bread (p < 0.001), rice (p=0.025) and pasta (p=0.025) remained statistically different. Two years after surgery, only the red meat food group (p=0.007) showed differences.

BPD had the lowest incidence of vomiting at six months (p<0.001), 12 months (p=0.008), and 24 months (p = 0.002). The total score of FTT was better in BPD at six months (p<0.001), 12 months (p<0.001), and 24 months (p=0.001]. BPD showed the best intake in energy and proteins at six months and 12 months, but % FML was higher in GB both at six and 12 months (p<0.050).

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Endoscopic Gastric Sleeve: A Review of Literature

Endoscopic sleeve gastrectomy (ESG) is an effective procedure for treating obesity, however there is a need to focus more on randomized controlled trials to ascertain the long-term efficacy and safety of the procedure, as well as uncover the associations between the procedure’s cost-effectiveness, procedure time and impact on the length of hospital stay, according to a literature review by US researchers.

Writing in Cureus, their literature review established that ESG is effective when used as an alternative intervention for obesity. The beneficial effects are felt particularly in terms of the procedure’s capacity to ensure that the total body weight loss mean percentage is significant. ESG was also found to impair gastric emptying, pose metabolic effects that are key to controlling obesity-associated metabolic dysregulation, and the ability to increase satiety.

However, the procedure was documented to yield a few adverse events in some studies including pulmonary embolism, potential pneumoperitoneum and possible post-procedure leak in the posterior aspect of the gastric fundus as sutures exert tension and also cause thin walls.

They concluded that for obese individuals not undergoing bariatric surgery, ESG can be an ideal treatment option, including individuals in need of a bridge to surgery and also those diagnosed with moderate obesity.

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