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Journal watch 27/07/2022

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 impact bariatric surgery can have on patient’s marital status, Roux-en-Y gastric bypass as a promising therapy for MAFLD, a clear benefit of adjunct treatment with semaglutide in post-bariatric patients, medical students lack adequate knowledge to manage patients living with obesity, and lifestyle interventions for older people with sarcopenic obesity (please note, log-in maybe required to access the full paper).

Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study

People who have bariatric surgery are more than twice as likely to get married or divorced within five years, compared to the general US population, according to researchers from the University of Pittsburgh School of Public Health.

Published in the Annals of Surgery Open, the study included 1,441 US adults who underwent RYGB or SG and self-reported marital status preoperatively and annually postoperatively for ≤5 years.

Preoperative, 57% of participants (79% female, median age 47 years, median body mass index [BMI] 47 kg/m2) were married, 5% cohabitating, 4% separated, 15% divorced, 2% widowed, and 17% always single.

The 5-year cumulative incidence of marriage among unmarried participants (n=614) was 18%. The 5-year cumulative incidence of separation/divorce among married participants (n= 827) was 13%. Female sex, younger age, household income <$25,000 versus ≥$100,000, smoking, and sexual desire ≥once/week versus never preoperative independently predicted (p≤0.05) separation/divorce.

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Gastric Bypass Resolves Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD) in low-BMI Patients: A Prospective Cohort Study

Researchers from the University of Heidelberg, Heidelberg, Germany, have reported that Roux-en-Y gastric bypass (RYGB) is a promising therapy for MAFLD even in low-BMI patients with insulin-treated T2D with complete histologic resolution.

Reporting in the Annals of Surgery, the study recruited 20 patients and assessed the impact of RYGB on MAFLD in a prototypical cohort outside the guidelines for obesity surgery. They reported that MAFLD completely resolved in all patients three years after RYGB while fibrosis improved as well. Fifty-five percent were off insulin therapy with a significant reduction in HbA1c (8.45±0.27% to 7.09±0.26%, p=0.0014).

The researchers concluded that RYGB restores the oxidative balance, adipose tissue function, and gastrointestinal hormones.

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The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery—a Retrospective Analysis

Investigators from the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, have reported that there is a clear benefit of adjunct treatment with semaglutide in post-bariatric patients.

Writing in Obesity Surgery, the study sought to retrospectively assess the effectiveness of adjunct treatment with the GLP-1 receptor agonist semaglutide in non-diabetic patients with WR or IWL after BS.

Forty-four post-bariatric patients without type 2 diabetes (T2D) with weight regain (WR) or insufficient weight loss (IWL) were included in the analysis. The primary endpoint was weight loss three and six months after initiation of adjunct treatment. The results showed that total weight loss during semaglutide treatment was −6.0±4.3% (p<0.001) after three months (3.2 months, n = 38) and −10.3±5.5% (p<0.001) after six months (5.8 months, n=20). At 3 months, categorical weight loss was >5% in 61% of patients, >10% in 16% of patients and >15% in 2% of patients.

The authors said that these results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients, however the results need to be confirmed in a prospective randomised controlled trial.

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A Canadian survey of medical students and undergraduate deans on the management of patients living with obesity

According to researchers from Queen’s University, Kingston, Canada, and writing in BMC Medical Education, Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity.

The study examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity and explored how this topic is taught within undergraduate medical education (UGME) curricula in Canada.

One hundred thirty-three (6.9%) and 180 (9.3%) out of 1,936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Students had greatest knowledge about aetiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviours and calculating body mass index. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities.

The paper concluded that changes to UGME curricula may help address this gap in education.

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Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity—An evidence map

Investigators from the Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany, have mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity.

Fifty-four RCTs (seven in sarcopenic obesity) reporting 464 outcomes in the outcome domains: physical function (n=42), body composition/anthropometry (n=120), biomarkers (n=190), physiological (n=30), psychological (n=47), quality of life (n=14), pain (n=4), sleep (n=2), medications (n=3) and risk of adverse health events (n=5) were included.

The authors stated that their evidence map is the first step of a harmonisation process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions.

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