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Journal Watch 25/10/2023

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 a meta-analysis on the mineral status after bariatric surgery, coping with weight loss after bariatric surgery, body contouring for bariatric vs non-bariatric patients, Health Action Process Approach (HAPA) in bariatric patients and future multi-modal therapeutic concepts in obesity treatment, and more (please note, log-in maybe required to access the full paper).

Change in Mineral Status After Bariatric Surgery: a Meta-analysis

Researchers from First Affiliated Hospital of Jinan University, Guangzhou, have reported a high deficiency rate of serum iron, zinc, copper, chlorine, phosphorus, and calcium after bariatric surgery.

The meta-analysis, published in Obesity Surgery, sought to report on the change in mineral levels after bariatric surgery and the prevalence of postoperative mineral deficiency, with subgroup analyses of different surgical procedures, study regions, and follow-up time.

The analysis included 107 articles (47,432 patients) and the most severe mineral deficiency after bariatric surgery was iron (20.1%), followed by zinc (18.3%), copper (14.4%), chlorine (12.2%), phosphorus (7.5%) and calcium (7.4%). A subgroup analyses revealed that SG had fewer deficiencies in serum iron, calcium, zinc, magnesium, phosphorus, copper, and selenium than RYGB. However, OAGB showed a higher incidence of serum iron and zinc deficiencies than RYGB. Studies with follow-up ≥ 5 years had a lower prevalence of zinc, copper, and selenium deficiencies than follow-up < 5 years.

“The difference in surgical procedures, study regions, and follow-up time may affect postoperative mineral status; more targeted mineral supplement programs are needed considering these influencing factors,” the researchers concluded.

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The role of anxiety and depression in understanding the relationship between coping and weight loss 24 months after bariatric surgery

Researchers from West Virginia University School of Medicine, has concluded that clinicians should take patient levels of anxiety and depression into account when making recommendations to promote weight loss among patients pursuing bariatric surgery.

Writing in SOARD, they examined the relationship between coping, including interpersonal, intrapersonal, and maladaptive coping, and the moderating role of anxiety and depression on the association between coping and weight loss in patients 24 months after bariatric surgery.

In total, 396 patients who underwent bariatric surgery and who had 24-month weight loss data were included in the study. The researchers then caried out three moderation models to test whether the relationship between various coping styles and post-surgical weight loss was moderated by anxiety and depression symptoms.

They found that there was a statistically significant interaction between anxiety and depression on the association between interpersonal coping and percent excess weight loss (%EWL). In addition, anxiety and depression also moderated the relationship between maladaptive coping and %EWL. Anxiety and depression, however, did not moderate the association between intrapersonal coping and %EWL, but intrapersonal coping positively predicted %EWL at 24-months post-bariatric surgery.

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Weight Control following Body Contouring Surgery: Long-Term Assessment of Postbariatric and Nonbariatric Patients

Patients with previous bariatric surgery who undergo body contouring (BC) regain more weight at long-term follow-up, compared to body contouring patients who did not have bariatric surgery, according to a study led by researchers from West Virginia University.

Writing in Plastic and Reconstructive Surgery, the authors performed a retrospective cohort study of 60 post-bariatric patients and 61 non-bariatric patients who underwent trunk-based BC (abdominoplasty, panniculectomy, and circumferential lipectomy).

From before BC to endpoint follow-up, post-bariatric and non-bariatric patients experienced a 4.39% ± 10.93% and 0.25% ± 9.43% increase in weight from baseline, respectively (p=0.0273). Once nadir weight loss was attained, weight regain occurred through endpoint follow-up in both groups (11.81% in the post-bariatric cohort and 7.56% in the non-bariatric BC cohort; p=0.0106).

“All patients tend to regain weight after achieving their nadir following trunk-based BC operations, eventually surpassing their preoperative weight. This is not clinically surprising, nor does it conflict with the psychological benefits of removing tissue in this area. It primarily increases the confidence with which these patients can receive counsel of their expected postoperative course,” the authors concluded.

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Covariates of a healthy diet and physical activity self-management one year after Bariatric surgery: A cross-sectional study

Using the Health Action Process Approach (HAPA) model is applicable for promoting healthy diet and physical activity self-management in patients who have undergone bariatric surgery, according to investigators from Tehran University of Medical Sciences, Tehran, Iran.

Reporting in PlosOne, they evaluating covariates of healthy diet and physical activity self-management among 272 patients undergone bariatric surgery. Data were collected using bariatric surgery self-management standard questionnaire (BSSQ) and items based on HAPA model for healthy diet and physical activity self-management.

Coping planning construct and risk perception in dietary self-management and action and risk perception in physical activity self-management had the highest and lowest effect powers, respectively. Coping planning and action planning in diet, and action planning in physical activity were significantly related to self-management.

“Using HAPA with special attention to the contribution of the constructs is suggested. Moreover, it is suggested to design interventions with the lens of HAPA constructs to improve healthy diet and physical activity self-management in patients after bariatric surgery,” the authors concluded.

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Obesity and its comorbidities, current treatment options and future perspectives: Challenging bariatric surgery?

An increasing knowledge about the gut-brain axis and especially the identification and physiology of incretins has resulted a high number of potential drug candidates with impressive weight-reducing potential that could challenge bariatric surgery, according to researchers from the University of Würzburg, Würzburg, Germany.

Writing in Pharmacology & Therapeutics, the paper provides a comprehensive overview of obesity and its comorbidities, with a special focus on organ-specific pathomechanisms, discusses prevention and treatment strategies for primary obesity and highlights FGF21, GDF15 and mitochondria as therapeutic targets in obesity

“Assuming that the promising evolution in anti-obesity drug development will continue, pharmacological therapies might soon push the indication for bariatric surgery away to only the drug-resistant or very severe cases,” the authors concluded.

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