Journal Watch 6/8/2025

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 MBS and cancer risk, superabsorbent hydrogel capsule for weight loss, MBS and racial disparities, ESG for MASH and post-MBS cognitive-behavioural therapy (please note, log-in maybe required to access the full paper).

Risk for cancer after bariatric surgery compared with the general population: a nationwide matched cohort study

All-cancer incidence risk is similar between patients who underwent metabolic and bariatric surgery (MBS) and the general population, according to a study led by researchers from Örebro University, Örebro, Sweden.

Writing in the journal Obesity, they evaluated how the incidence of cancer after MBS compared with the general population. In total 68,424 surgical patients were compared with the 640,944 controls. They found there was no difference in the risk for new onset of cancer. Compared with controls, MBS was associated with a lower risk for breast cancer in women and melanoma skin cancer in men and women, but an increased risk remained for colon cancer, liver cancer, pancreatic cancer, corpus uteri cancer, renal cancer, malignant meningioma, and non-Hodgkin's lymphoma.

They recommended that patients who have undergone MBS should continue recommended cancer screening and clinically approved work-up for cancer symptoms as recommended for the general population.

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Association of the Early Response to an Oral Shape-Shifting Superabsorbent Hydrogel Capsule With Weight Loss

US researchers have reported that the superabsorbent hydrogel capsule (Epitomee) is associated with greater weight loss at 24 weeks, compared to placebo.

Reporting in Clinical Obesity, 124 participants received the Epitomee capsule and 126 in the placebo group. Weight loss at week 24 was greater in Epitomee group compared to placebo (9.3% ± 6.0% vs. 6.9% ± 4.3%; p<0.0001). The odds ratio for ER to achieve > 5% weight loss at week 24 was 4.10 (95% CI: 1.02, 16.46) for Epitomee and 2.38 (95% CI: 0.62, 9.21) for placebo.

A greater proportion of ER to Epitomee, compared to placebo, achieved > 5% (76% vs. 62%; p=0.0472), ≥ 7% (61% vs. 38%; p<0.0045) and ≥ 10% (39% vs. 17%; p<0.0025) weight loss at week 24.

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Comparative analysis of racial disparities between adolescents and adults undergoing bariatric surgery: analysis from the MBSAQIP database

Investigators at the Medical University of South Carolina, Charleston, SC, have found that disparities exist for black adolescents and adults undergoing MBS.

Writing in SOARD, their study analysed patient characteristics and perioperative outcomes to determine if racial disparities differ across age groups in black and white bariatric patients. Adolescents (≤19 years) and adults (>19 years) who underwent primary MBS from 2020-2022 were identified in the MBSAQIP datafile. In total, 2,829 adolescents (n=793, 28% black) and 434,775 adults (n=102,973, 23.7% black) were included. Preoperative median BMI was higher in black vs. white adolescents (48.6 vs 45.4, p<0.001) and black vs. white adults (45.3 vs. 43.3, p<0.001).

Comorbidity burden was similar between black and white adolescents. Compared to white adults, black adults had higher rates of diabetes, hypertension and renal insufficiency, p<0.001. Black adolescents (7.1% vs. 3.5%) and adults (4.1% vs. 3.1%) were less likely to receive perioperative VTE prophylaxis versus white patients, p<0.001. Incidence of postoperative PE was higher in black adolescents (0.3% vs. 0%, p=0.02) and adults (0.2% vs. 0.09%, p<0.001).

While most outcomes were not clinically significantly worse in black patients, the authors noted that ensuring appropriate VTE prophylaxis is an important modifiable target for improving outcomes.

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Endoscopic Sleeve Gastroplasty Plus Lifestyle Intervention in Patients With Metabolic Dysfunction-associated Steatohepatitis: A Multicenter, Sham-controlled, Randomized Trial

Spanish researchers have reported that endoscopic sleeve gastroplasty (ESG) is an effective and safe method to promote weight reduction associated with significant improvement in patients with metabolic dysfunction-associated steatohepatitis (MASH) and obesity.

Reporting in the journal Clinical Gastroenterology and Hepatology, they reported the results of a multi-centre, randomised, controlled, and double-blind study to evaluate the effectiveness and safety of ESG in patients with MASH.

Forty patients were randomized 1:1 to ESG plus lifestyle modification vs sham endoscopy (SE) plus lifestyle intervention. Total body weight loss (TBWL) was 9.47% (±9.38%) in the ESG group vs 3.91% (±5.43%) in the ESI group (p<0.05). Liver stiffness decreased 5.63 (±7.17) KPa in the ESG group vs 0.2 (±5.38) KPa in the ESI group (p<0.05). Steatosis was significantly reduced in the ESG group (−0.94 ± 0.87) vs the ESI group (−0.26 ± 0.99) (p=0.033).

No differences on NAS (−1.89 ± 2.11 vs −1.47 ± 2.01) score or fibrosis (−0.1 ± 0.91 vs −0.84 ± 1.21) was seen. In patients achieving weight loss >10%, they found a significant improvement on NAS score (−4 ± 0.94 vs −0.81 ± 1.62; p<0.01), but not in fibrosis stage (−0.3 ± 1.06 vs −0.59 ± 1.25).

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Feasibility of Online Cognitive-behavioral Group Therapy Following Metabolic Bariatric Surgery: A Randomized Pilot Study

Researchers from the University of São Paulo, Brazil, have reported that both group cognitive-behavioural therapy (CBT) and psychoeducational lectures delivered as online interventions were feasible and beneficial for bariatric patients who experienced recurrent weight gain.

Writing in Obesity Surgery, they sought to investigate the applicability of group CBT delivered through an online intervention on mental health symptoms and weight change in patients who experienced recurrent weight gain four years after MBS.

Of the 142 postoperative patients assessed, 33 had regained 15% of the total weight lost from their lowest postoperative weight. After excluding 13 patients who declined to participate, 20 were randomly allocated into two groups: the intervention group, which received eight sessions of online group CBT, and the control group, which attended three psychoeducational lectures.

A marginal reduction in depressive symptoms was observed across both groups (mean difference = –3.35, 95% CI: –6.80 to 0.09; p=0.06), along with a statistically significant decrease in binge eating behaviours (mean difference = –3.36, 95% CI: –5.43 to –1.29; p=0.004). However, no significant changes in body mass or anxiety symptoms were observed. In the group CBT condition, the mean attendance was 6.6 sessions; in the control group, it was 2.4 lectures.

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