Journal watch 24/9/2025

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 laparoscopic reversal of gastric bypass, surgery vs GLP-1ras, GLP-1s in a plastic surgery setting, magnetic sphincter augmentation and GERD-related symptoms and obesity severity and cancer screening, and more (please note, log-in maybe required to access the full paper).

Laparoscopic Reversal of Gastric Bypass: A Retrospective Review

Laparoscopic reversal of gastric bypass is a complex surgery requiring a specialised surgical center, and it should be a last resort for intractable chronic symptoms, according to researchers from Cairo University, Giza, Egypt.

Reporting in Obesity Surgery, the retrospective analysis included ten patients who underwent reversal of either Roux-en-Y gastric bypass (RYGB) or one-anastomosis gastric bypass (OAGB) and investigated their indications, complications and outcomes.

Ten patients underwent gastric bypass reversal; 60% of them had a reversal of OAGB, while 40% had a reversal of RYGB. The main indications for bypass reversal were malnutrition (hypoalbuminemia) (33%), excessive loss of weight (29%), followed by chronic abdominal pain, chronic anaemia, diarrhoea, non-healing Marginal ulcer, and persistent reflux, representing 10% each. Follow-up was achieved in 90% of patients at 180 days (6 months), and the overall postoperative morbidity was 10%.

In six months, there was a single mortality event (10%) attributed to preexisting liver cell failure. The mean BMI preoperatively and postoperatively were 26.2 kg/m2 and 27.9 kg/m2, respectively (p=0.013) at six months, while the mean serum albumin levels preoperatively and postoperatively were 2.8 g/dl and 3.4 g/dl, respectively (p=0.019).

The study authors added that patient education about relatively high morbidity and the possibility of dissatisfaction is crucial.

To access this paper, please click here

Obesity Treatment With Bariatric Surgery vs GLP-1 Receptor Agonists

Metabolic bariatric surgery (MBS) achieves greater weight loss and lower ongoing cost compared to the glucagon-like peptide-1 receptor agonists (GLP-1 RAs), according to a study authored by Highmark Health researchers.

Writing in JAMA Surgery, the study specifically looked at the costs and clinical side effects of surgery vs. GLP-1s for managing class II and class III obesity, as well as weight loss outcomes for those with class III obesity.

In total, 14,101 patients received MBS (mean [SD] follow-up, 34 [16] months) and 16,357 patients received GLP-1 RAs (mean [SD] follow-up, 32 [17] months). After propensity score weighting, baseline characteristics were comparable. The mean (SE) total costs over two years were $63,483 ($1563) for GLP-1 RAs and $51,794 ($1724) for MBS (p<0.001). The main driver of this difference was higher sustained pharmacy costs in the GLP-1 RA group throughout year two of follow-up.

Over two years, bariatric surgery resulted in approximately 18 percent lower costs compared to medications, mostly because of sustained high pharmacy costs associated with medication use. This translates to an average cost savings of nearly $12,000 per patient.  

To access this paper, please click here

To access our summary of this paper,  please click here

Considerations for the Use of Glucagon-like Peptide-1 Medications for Obesity in a Plastic Surgery Setting

Researchers from the College of Public Health, Temple University, Philadelphia, PA, have warned how some plastic surgeons are promoting GLP-1s and using them to treat patients.

Writing in Plastic and Reconstructive Surgery - Global Open, the researchers worry that some plastic surgeons continue to perpetuate the outdated view that obesity is a cosmetic issue, both in how they talk about GLP-1s and how they are using them with patients.

Conditions like hypertension or Type 2 diabetes can improve or even go into remission as someone loses weight, which may require a patient to change their medication. Studies have also shown that some patients lose significant muscle mass as they lose weight, and so they may require additional strength training. Nutritional and behavioural counselling also can help patients make changes to help them lose weight and maintain it over time.

The researchers are also concerned that plastic surgeons are offering only GLP-1s as an intervention for weight loss, and ignoring other effective options like lifestyle changes focused on diet and exercise, or metabolic and bariatric surgery.

They made a series of recommendations to plastic surgeons prescribing GLP-1s including treating obesity as a chronic disease rather than a cosmetic issue, pursuing additional training on evidence-based approaches to obesity management and providing more comprehensive support to patients on the medications.

To access this paper, please click here

To read our summary of this paper, please click here

Magnetic sphincter augmentation for gastroesophageal reflux after sleeve gastrectomy: a prospective study

Magnetic sphincter augmentation (MSA) seems to improve GERD-related symptoms and patient quality of life in patients with pathological gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG), according to research from the University of Milan, Milan, Italy.

The prospective, single-arm, multi-centre study included 12 subjects (75% females) underwent MSA for pathologic GERD after LSG. The primary outcome was post-MSA patient-reported quality of life assessed with the GERD-HRQL questionnaire. Esophageal acid exposure, endoscopic, high-resolution manometric findings, and PPI use were secondary outcomes.

Overall, 11 patients completed the 12-month follow-up with clinical and instrumental assessment. GERD-HRQL scores (38.6 vs. 10.1; p=0.003) and daily PPI use (100% vs. 27.3%; p=0.003) significantly improved compared to baseline. Notably, %Acid Exposure Time (AET) (14.1 vs. 7.1; p=0.06), DeMeester score (60.7 vs. 20.5; p=0.017), total number of reflux episodes (110 vs. 40; p=0.012), number of re-reflux (142 vs. 63; p=0.016), distal contractile integral (DCI) (mmHg-s-cm) (728 vs. 2040; p=0.043), and LES basal pressure (mmHg) (7.3 vs. 26.1; p=0.028) were improved compared to baseline. No device adverse events nor explants occurred during follow-up.

To access this paper, please click here

Obesity Severity and Cancer Screening in US Adults

In a cross-sectional study, researchers from Pennington Biomedical Research Center found that severe obesity is associated with a lower rate of cancer screenings, which the researchers said could possibly be due to greater health care engagement and fewer barriers.

In their study, published in JAMA Network Open, the researchers analysed de-identified data from the Behavioral Risk Factor Surveillance System to reach these findings. While rates of cancer screenings varied among the various BMI groups and the various types of cancer screenings, screening rates for Papanicolaou testing, mammography, sigmoidoscopy and colonoscopy among those in the 50 or greater BMI group saw a significant reduction compared to the base groups.

Excluding profiles that did not include body mass index information, the researchers evaluated more than 2 million profiles in the surveillance data, categorizing them into five BMI groups: 30 to 34.9, 35 to 39.9, 40 to 49.0, more than 50, and the range of 18.5 to 29.9 used as a reference. The cancer screenings the researchers examined included colon and rectal, cervical, breast, and prostate cancer – all of which are routinely recommended by the US Prevent Services Task Force.

In contrast to the 50 and greater BMI category, other BMI categories associated with higher rates of obesity, such as BMI in the 30 to 39.9 range, show comparable or slightly higher screening rates than the reference, possibly due to greater health care engagement and fewer barriers.

To access this paper, please click here