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 factors influencing primary care provider referral for bariatric surgery, a systematic review and meta-analysis of bariatric surgery and cardiovascular disease, the relationship between percentage weight loss and WHO-Five Wellbeing Index in bariatric surgery patients, barriers to bariatric surgery in adolescents and first-pass metabolism of alcohol occurs in the stomachs of women who have LSG (please note, log-in maybe required to access the full paper).
Factors influencing primary care provider referral for bariatric surgery - Systematic review
A systematic review by Canadian investigators, which sought to identify barriers to and facilitators of primary care provider (PCP) referral for bariatric surgery in patients with obesity, has reported that most of the identified barriers can be addressed through education of current PCPs and through curriculum change for undergraduate medical students and postgraduate trainees. The findings were featured in the paper, ‘Factors influencing primary care provider referral for bariatric surgery', published in the journal Canadian Family Physician.
Barriers included fear of surgery complications and side effects, cost, lack of availability, perception that surgery is a quick fix or a last resort, and prior negative experiences. Facilitators included direct requests from patients, patient motivation, previously failed weight-loss interventions, and obesity-related comorbidities. Those PCPs who were knowledgeable about the risks and benefits of bariatric surgery were more likely to refer their patients.
They concluded that education and continuing professional development programnes regarding bariatric surgery are needed to improve PCP knowledge and capacity to manage patients with obesity.
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Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis
A systematic review and meta-analysis by investigators from the Netherlands has found that bariatric surgery is associated with reduced all-cause and cardiovascular (CV) mortality, and lowered incidence of several CV diseases in patients with obesity.
Reporting their findings from 39 studies, in the European Heart Journal, they found that bariatric surgery was associated with a beneficial effect on all-cause mortality (p<0.001 vs. controls) and CV mortality (p<0.001). In addition, bariatric surgery was also associated with a reduced incidence of heart failure (p<0.001), myocardial infarction (p<0.001) and stroke (p<0.001), while its association with atrial fibrillation was not statistically significant (p=0.12).
They concluded that bariatric surgery should therefore be considered in these patients.
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The Relationship Between Percentage Weight Loss and World Health Organization-Five Wellbeing Index (WHO-5) in Patients Having Bariatric Surgery
Researchers from the University College Dublin, Ireland, have report that there is no correlation between the baseline WHO-5 Wellbeing Index and % total weight loss (TWL) one-year post-bariatric surgery.
The study sought to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery.
Writing in Obesity Surgery, they noted that the %TWL between pre- and one-year post-surgery was 30.0±8.3% and the WHO-5 Wellbeing Index mean score was 56.5±16.8.
They added that patients with low mood or depression need to be assessed and offered appropriate treatment but should not be excluded from bariatric surgery only based on their mood.
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Barriers to Metabolic Bariatric Surgery in Adolescents: Results of a Qualitative Study
US researchers have reported the primary barriers to bariatric surgery for adolescents with severe obesity are related to a general lack of information about surgery, social stigma and access issues related to costs which decrease or limit access.
Writing in SOARD, they conducted 14 qualitative interviews with individuals who received bariatric surgery between the ages of 19-25 in the last five years regarding the barriers to surgery they experienced as an adolescent.
They identified three principal groups of barriers related to 1) a lack of information that surgery was an option and the absence of discussions about surgery with medical providers while an adolescent, 2) a lack of access to surgery primarily related to insurance coverage, costs and family related issues 3) a general stigma around surgery as a treatment for obesity.
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Site of Alcohol First-Pass Metabolism Among Women
A study of alcohol metabolism in women who underwent sleeve gastrectomy and peers who had not had weight loss surgery, indicates first-pass metabolism (FPM) process occurs in the stomach, not the liver.
The study, ‘‘Site of Alcohol First-Pass Metabolism Among Women’, published online in the journal JAMA Network Open, led by investigators from University of Illinois at Urbana Champaign, compared 12 women who had LSG surgery to nine women who did not undergo surgery and had equivalent age, body max index, and alcohol drinking patterns.
They reported that LSG patients had a shorter Tmax, higher peak BAC and greater area under the curve but a similar AER. In the subset of participants who were matched for Tmax to control for gastric emptying rate, the AUC was increased by 34% in the LSG group.
The findings also explain why some patients' sensitivity to alcohol increases dramatically after bariatric surgery, significantly heightening their risks of alcohol-related disorders.
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