Journal Watch 9/7/2025

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 long BPL vs. short BPL, trauma- and violence-informed care in bariatric patients, bariatric surgery and the impact of health literacy and two papers reporting on the predictors and associations of post-LSG gallstone formation, and more (please note, log-in maybe required to access the full paper).

Long Biliopancreatic Limb (BPL) RYGB Versus Short BPL RYGB Post-Suboptimal Initial Clinical Response of SG or Recurrent Weight Gain: A Randomized Controlled Study

Extending the long biliopancreatic limb (BPL) length in conversional Roux-en-Y gastric bypass (RYGB) may enhance the procedure’s effectiveness in certain aspects of weight reduction and metabolic profile, according to researchers from the Kasralainy School of Medicine, Cairo University, Giza, Egypt.

Reporting in Obesity Surgery, this randomised controlled trial investigated the effect of BPL RYGB versus short BPL RYGB post- suboptimal initial clinical response (SoCR) or recurrent weight gain (RWG) of sleeve gastrectomy (SG) on weight loss and metabolic profile.

The patients were followed for one year, and weight loss, metabolic profile, and postoperative complications were analysed. The RYGB-LBPL group showed statistically significant improvements in EBMIL%, HbA1c reduction and HDL levels, while other outcomes showed no significant differences.

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How Do Trauma- and Violence-Informed Care Approaches Underpin Bariatric Surgery Interventions for Type 2 Diabetes Mellitus Remission? A Scoping Review

The absence of reporting a trauma- and violence-informed care (TVIC) principles in bariatric surgery, raise concerns about emotional safety, risks for retraumatisation and long-term outcomes, according to researchers from McMaster University, Hamilton, ON, Canada.

Reporting in Obesity Reviews, the study authors state that there is an established relationships between trauma and obesity, and obesity and T2DM. Therefore, there is a need to examine bariatric surgical practices from a TVIC perspective. Their review explored and described the extent to which the four TVIC principles—(1) understand trauma, violence, and its impact; (2) create emotionally and physically safe environments; (3) foster opportunities for choice, collaboration, and connection; and (4) use a strengths-based and capacity-building approach - have been integrated into bariatric surgery processes for T2DM remission.

Nineteen studies were included, described in 30 publications. Despite established associations between trauma, obesity, and chronic illness, none of the included studies collected demographic data on participants' history of trauma or violence. Among included studies, mental health exclusions were common, potentially limiting access for individuals with trauma-related mental health challenges.

“Integrating the principles of TVIC throughout bariatric surgical care is essential to promote emotionally safe and inclusive care to enhance postoperative success and sustained health outcomes,” they concluded.

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Patients’ perceptions of bariatric surgery in the Deep South: the impact of health literacy

Low health literacy (HL) patients in the Deep South of the US have reported less familiarity with healthcare treatment options, trust in their doctors and likelihood to consider bariatric surgery when indicated, researcher from the University of Alabama at Birmingham, Birmingham, AL, have reported in Surgical Endoscopy.

Bariatric surgery utilisation is low in the Deep South despite the high prevalence of obesity in the region, they authors noted. However, the impact of HL on access to bariatric surgery is unclear, so they assessed the relationship between HL and patients’ perspectives on healthcare, including bariatric surgical care in the Deep South.

A multi-institutional study was conducted in surgery clinics at three institutions in Alabama. A total of 127 participants were recruited, with 26.8% (n=34) having low HL. Low HL patients reported lower household incomes and lower rates of post-secondary education (11.7% vs. 45.2%, p<0.01). Participants with low HL also reported less understanding of prescribed medications (90.6% vs. 98.8%), awareness of available treatment options (71.9% vs. 90.0%), and trust in their doctors (91.2% vs. 98.9%; all p<0.01).

In addition, low HL patients were more likely to have challenges in making an appointment (23.5% vs. 8.6%) and miss appointments due to transportation issues (44.1% vs. 17.2%, both p<0.01). Although there were no differences in obesity rates, low HL patients were less likely to consider bariatric surgery if indicated (61.8% vs. 81.7%) and recommend bariatric surgery to others (52.9% vs. 72.0%; both p<0.01).

“Community outreach and education programmes addressing the unique needs of low HL patients are necessary to increase their awareness and improve their access to bariatric surgery,” the authors recommended.

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Incidence of Symptomatic Gallstone Disease in Bariatric Patients Undergoing Sleeve Gastrectomy, and the Dilemma of Prophylactic Cholecystectomy: A Single-Center Retrospective Study

Research at the Hamad Medical Corporation, Doha, Qatar, have found that the weight loss rate, rather than total weight, is a critical and statistically significant predictor of gallstone formation, especially for early onset, post-LSG.

Reporting in Cureus, they sought to identify the prevalence of symptomatic gallstone disease after LSG, determine the incidence of cholecystectomy and evaluate the advantages of prophylactic cholecystectomy in a Qatari population. A total of 105 patients underwent LSG during this period. After excluding those with prior cholecystectomy and asymptomatic cases, 98 patients remained in the cohort.

Among the patients in the cohort, 16 patients (16.3%) developed symptomatic gallstone disease. The cohort consisted of 64 female patients (61.0%) and 41 male patients (39.1%), with a mean age of 29.1±12.7 years. Female patients accounted for 81.2% of gallstone cases, while males accounted for 18.8%.

The most compelling finding was the relationship between weight loss rate and the timing of gallstone diagnosis. A significant negative correlation was observed (r=-0.553, p=0.0262), indicating that faster weight loss was associated with earlier gallstone development. A Post-Hoc test confirmed that the early diagnosis (≤6 months) group had a significantly faster rate of weight loss, compared to both the intermediate and late diagnosis groups.

“Our data suggest that a selective approach, based on individual risk factors for each patient, is warranted, with close follow-up of such patients,” they concluded.

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Association of Weight Loss with Gallstone Formation Following Sleeve Gastrectomy: A Retrospective Cohort Study

Researchers from Peru have reported markers of absolute weight loss (AWL), percentage of excess weight loss (PEWL), absolute BMI loss (ABMIL) and percentage of excess BMI (PEBMIL) loss were not associated with post-LSG gallstone formation.

Writing in Obesity Surgery, they assessed the association between weight loss and de novo gallstone formation in adults undergoing LSG.

They retrospectively analysed 386 adults who underwent SG at a private clinic in Lima, Peru, and were followed for 12 months. The mean age of the patients was 36.4 years, and 68.1% were female. The means for AWL, PEWL, ABMIL, and PEBMIL were 29.1 kg, 28.1%, 10.7 kg/m2, and 27.8%, respectively. In the multivariable model, neither AWL (p=0.712), PEWL (p=0.075), ABMIL (p=0.465) nor PEBMIL (p=0.079) were associated with the occurrence of de novo gallstones.

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