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 BMS lowers long-term liver complications, SG vs GLP-1s in African American and Hispanic patients, postoperative care pathway guidelines for RYGB, health expenditure for RYGB vs LSG, racial disparities in post-op outcomes following primary and revisional MBS, and GLP-1ra use and thyroid cancer risk, and more (please note, log-in maybe required to access the full paper).

Long-term liver outcomes after metabolic surgery in compensated cirrhosis due to metabolic dysfunction-associated steatohepatitis
Researchers from the Cleveland Clinic have reported BMS represents a safe and effective therapeutic option to influence the trajectory of cirrhosis.
Writing in Nature Medicine, the Surgical Procedures Eliminate Compensated Cirrhosis In Advancing Long-term (SPECCIAL) observational study compared the effects of BMS and nonsurgical treatment in patients (62 patients (68% female) who underwent metabolic surgery and 106 nonsurgical controls (71% female)) with obesity and compensated histologically proven MASH-related cirrhosis.
The 15 year cumulative incidence of major adverse liver outcomes (MALO) was 20.9% (95% confidence interval (CI), 2.5–35.9%) in the surgical group vs 46.4% (95% CI, 25.6–61.3%) in the nonsurgical group, with an adjusted hazard ratio of 0.28 (95% CI, 0.12–0.64, p=0.003). The 15 year cumulative incidence of decompensated cirrhosis was 15.6% (95% CI, 0–31.3%) in the surgical group compared with 30.7% (95% CI, 12.9–44.8%) in the nonsurgical group, with an adjusted hazard ratio of 0.20 (95% CI, 0.06–0.68, p=0.01.
They concluded that among patients with compensated MASH-related cirrhosis and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MALO.
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Sleeve Gastrectomy Versus Semaglutide for Weight Loss in a Severely Obese Minority Cohort: A Propensity-Matched Study
Sleeve gastrectomy led to significantly more weight loss than semaglutide over a 12-month period, but GLP-1 agonists might be less effective for weight loss in African American and Hispanic patients with severe obesity, according to investigators from University of Illinois at Chicago, Chicago, IL.
Reporting in Obesity Surgery, they compared the weight loss outcomes between semaglutide and SG in 206 patients in African Americans (67%) and Hispanics (21%) over a 12-month period.
There were 103 patients (50%) in the semaglutide group and 103 patients (50%) in the SG group. The mean BMI was 55 kg/m2 and 56 kg/m2 for the SG and semaglutide groups, respectively. The SG group consistently outperformed semaglutide regarding weight loss at all follow-up periods, with the largest difference observed at 12-month post-intervention (total weight loss 32% vs. 2%, p<0.001).
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American Society for Metabolic and Bariatric Surgery: Postoperative Care Pathway Guidelines for Roux-en-Y Gastric Bypass
The Quality Improvement and Patient Safety (QIPS) Committee of the American Society for Metabolic and Bariatric Surgery (ASMBS) has published post-operative care pathway guidelines for Roux-en-Y gastric bypass to provide a structure to providers based on current evidence for the post-operative care of patients with overweight or obesity undergoing RYGB.
The QIPS Committee of the ASMBS previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG), pre-operative care of patients undergoing Roux-en-Y gastric bypass (RYGB) and most recently intra-operative care of patients undergoing RYGB.
The guidance covers postoperative monitoring, urinary catheter use, managing postoperative nausea and vomiting, postoperative venous thromboembolism prophylaxis, diabetes medications and glycaemic control, diet initiation and progression, postoperative radiology and laboratory studies, and postoperative medication management.
“This document can serve as a pathway to assist providers in the early and long-term postoperative care of patients undergoing RYGB, with the goal of improving healthcare quality and surgical safety,” the authors noted. “There are multiple areas without level 1 evidence and further research is needed. This pathway should be updated as more robust evidence emerges.”
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Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy
In a health expenditure analysis between RYGB and SG, overall expenditures decreased substantially in the postsurgical period primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.
The study by researchers from Duke University, published in the Annals of Internal Medicine, compared health expenditures three years before and 5.5 years after RYGB (n=3,147) or SG (n=3,510).
Expenditures per six-month period decreased by about 30% for both groups, from US$4039.06 (US$3770.88 to US$4326.31) three years before to US$2441.13 (US$2151.07 to US$2770.30) 5.5 years after RYGB and from US$3918.37 (US$3658.75 to US$4196.40) three years before to US$2658.15 (US$2279.17 to US$3100.16) 5.5 years after SG.
Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, −US$217.02 [CI, −US$671.29 to US$201.96]) except for the first six months, when expenditures were transiently higher in the RYGB group (difference, US$564.32 [CI, US$232.60 to US$895.20]), driven by a higher inpatient admission rate.
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Black-vs-white racial disparities in 30-day outcomes following primary and revisional metabolic and bariatric surgery: a MBSAQIP database analysis
US and Canadian researchers have found a measurable contrast between racial disparities in postoperative outcomes following primary and revisional MBS.
Writing in Surgical Endoscopy, this observational study identified 112,495 Black and 434,266 White primary MBS and 10,838 Black and 37,075 White revisional MBS patients. A total of 219,114 primary and 21,314 revisional patients were matched.
Following primary MBS, Black patients had higher rates of death (0.1% vs. 0.06%, p<0.001), all occurrences morbidity (5.6% vs. 4.7%, p<0.001), serious events (2.2% vs. 1.9%, p<0.001), and all cause and related reoperations (1.2% vs. 1.1%, p=0.006; 0.2% vs. 0.1%, p=0.01), readmissions (4.6% vs. 3.4%, p<0.001; 2.8% vs. 1.9%, p<0.001), and interventions (1.4% vs. 1.1%, p<0.001; 0.8% vs. 0.6%, p<0.001) vs White patients.
But there were no significant Black-vs-White disparities in death, morbidity, serious events, reoperations, interventions, and bleeding following revisional MBS. However, Black patients had higher rates of all cause and related readmissions (7.4% vs. 6.2%, p=0.005; 4.4% vs. 3.6%, p=0.01), but lower surgical site infection rates (1.6% vs. 2.1%, p=0.04).
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GLP-1RA Use and Thyroid Cancer Risk
Despite the low absolute risk of thyroid cancer among patients receiving GLP-1ra therapy, there was an increased risk of new thyroid cancer diagnoses within the first year of GLP-1ra initiation compared to 3 other diabetes drugs, US researchers have reported in JAMA Otolaryngol Head Neck Surgery.
The study included adults with type 2 diabetes at moderate risk for cardiovascular disease and without history of thyroid cancer who had newly filled prescriptions for GLP-1RA, sodium-glucose cotransporter 2 inhibitor (SGLT2i), dipeptidyl peptidase-4 inhibitor (DPP4i) or sulfonylurea.
From 351, 913 patients – 41,112 started treatment with GLP-1RA; 76,093 with DPP4i; 43,499 with SGLT2i and 191,209 with sulfonylurea therapy. The numbers of patients diagnosed with thyroid cancer were 69 (0.17%) in the GLP-1RA group, 172 (0.23%) in the DPP4i group, 72 (0.17%) in the SGLT2i group and 381 (0.20%) in the sulfonylurea group.
In the modified intention-to-treat analysis, GLP-1RA initiation was not significantly associated with increased overall risk for thyroid cancer compared to the other 3 diabetes drugs. However, the risk for thyroid cancer was significantly higher within the first year after GLP-1RA initiation and was amplified in the overall as-treated analysis that censored patients when therapy was discontinued or another medication was added.
“This finding may have been due to enhanced early detection; therefore, further research is necessary to understand the underlying causes of this association” they write.
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