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Journal watch - review of the latest clinical papers 22/09/2021

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 new American Heart Association scientific statement on the long-term treatments for hypertension for people living with obesity, a comparison of four-year healthcare expenditures RYGB vs. SG, a study assessing the amount of post-op weight loss associated with initial T2DM remission, the impact of bariatric surgery on diastolic heart failure, and researchers from China have highlighted the rise of obesity rates in the county and outlined the reasons for the increase (please note, log-in maybe required to access the full paper).

Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association

Bariatric and metabolic surgical procedures and weight-loss medications show promise for reducing the long-term effects of hypertension in people who are overweight or living with obesity, according to a new American Heart Association scientific statement published in the Association’s journal Hypertension.

Metabolic and bariatric surgery can aid weight loss in people with severe obesity, defined as people who have a BMI of 40 or higher, or if they have a BMI of 35 or higher along with an obesity-related health condition including hypertension. The statement includes a research review on metabolic surgery. High blood pressure was resolved in 63% of people who had metabolic surgery, and several studies showed less use of blood pressure-lowering medicines after surgery.

The statement also highlights questions and gaps in research data on the use of medications and surgery to prevent and treat obesity-related hypertension. These issues include whether these strategies will have the intended outcome of preventing organ damage, how effective they are for individuals who already have kidney disease or heart failure, and comparing the effectiveness of medications, surgery or a combination of both to determine the best approach for long-term blood pressure reduction.

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Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Writing in JAMA Network, researchers from Canada report that four-year health care expenditures, all-cause mortality and number of hospital admissions associated with Roux-en-Y gastric bypass (RYGB) did not significantly differ from those for sleeve gastrectomy (SG).

The study included over 9,000 patients (RYGB, n=6,301 and SG, n=926) and found that the four-year cumulative costs were not statistically significantly different between RYGB and sleeve gastrectomy ($33,682 vs. $33,948; p=0.86). Having a history of coronary artery disease was associated with a 35% increase in overall health care expenditures; chronic kidney disease, a 54% increase; and mental health admissions, a 67% increase. There were no statistically significant differences in all-cause mortality between RYGB and sleeve gastrectomy (1.5% vs 2.2%; p=0.26) or the total number of hospitalisations (754 vs 669; p=0.11)

The study authors stated that important patient-level drivers of health care expenditures need to be further investigated.

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Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission

Researchers from the US have reported that weight loss after bariatric surgery is strongly associated with initial T2DM remission however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. They published their findings in Diabetes Care.

The study authors sought to assess the amount of weight loss (percent total weight loss, %TWL) necessary to achieve initial remission of T2DM following surgery in SG patients.

Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of T2DM. Patients were more likely to remit with each 5% increase in TWL until 20% TWL. When categories >25% TWL were examined, all patients had a likelihood of initial remission similar to that of 20–25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0–5% TWL, even if they were using insulin at the time of surgery.

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Bariatric surgery decreases the number of future hospital admissions for diastolic heart failure in subjects with severe obesity. Retrospective analysis of the US national inpatient sample (NIS) database

Reporting in SOARD, investigators from the Cleveland Clinic found that bariatric surgery was associated with significantly reduced hospitalisations for diastolic heart failure (DHF) when adjusted for baseline CVD risk factors.

The researchers compared 296,041 bariatric patients with 2,004,804 patients with severe obesity (controls). Univariate and multivariable analysis were performed to assess the impact bariatric surgery on the rate of hospital-admissions for DHF, adjusting for demographics, comorbidities and other risk factors associated with cardiovascular disease (CVD).

After adjusting for all CVD risk factors, controls exhibited marked increases in the odds of DHF overall and controls with hypertension and coronary artery disease demonstrated an almost threefold increase in odds of DHF admissions.

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Epidemiology and determinants of obesity in China

Reporting in The Lancet Diabetes & Endocrinology, researchers from China have examined the rise of obesity rates in the county and outlined the reasons for the increase. They estimated that 34.3% of adults are overweight and 16.4% are living with obesity. Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations.

They hypothesised that the growing burden of overweight and obesity could be driven by economic developments, sociocultural norms and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments.

Specifically, the claim that increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours, have contributed to the rise in obesity.

They recommend that multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.

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