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Murphy E, Finucane FM. Addressing uncertainty about the role of structured lifestyle modification for metabolic surgery patients. Metabolism 2024; 151:155739. [PMID: 37984732 DOI: 10.1016/j.metabol.2023.155739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
There is good evidence that structured lifestyle modification programmes improve health in patients with metabolic and cardiovascular disorders, but there is no specific evidence that they improve outcomes in patients undergoing metabolic or obesity surgery. Despite expert consensus guidelines stating this fact, some healthcare systems still compel patients to participate in a structured lifestyle modification programme prior to metabolic or obesity surgery. There is a well-established need for individualised multidisciplinary dietetic and physical activity care for metabolic and obesity surgery patients, and the benefits of intentional weight loss prior to surgery are well proven, but these are distinct from potentially harmful requirements for patients to undertake compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery and reinforce obesity stigma. A critical step in rejuvenating metabolic surgery is to reframe patient participation in structured lifestyle modification programmes as an opportunity for education and empowerment, not as an indicator of motivation or suitability for metabolic surgery. Large, well-designed and adequately powered clinical trials are needed to address uncertainties in the evidence base for these programmes. Given genuine equipoise, they will need to determine whether "surgery plus lifestyle" is superior to "surgery plus placebo". Moreover, they will need to determine the cost-effectiveness of these programmes and identify some of the factors giving rise to the substantial heterogeneity in responses to structured lifestyle modification.
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Affiliation(s)
- Enda Murphy
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland; HRB Clinical Research Facility, University of Galway and Saolta University Health Care Group, Ireland; Cúram, University of Galway, Ireland.
| | - Francis M Finucane
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland; HRB Clinical Research Facility, University of Galway and Saolta University Health Care Group, Ireland; Cúram, University of Galway, Ireland
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Moreira SMBP, Bachi ALL, Jirjos EI, Malheiros CA, Vencio S, Alves VLS, Sousa ART, Felipe LA, Perez EA, Lino MEM, Souza SKA, Santos JMB, Oliveira MC, Fonseca AL, Silva CHM, Vieira RP, Insalaco G, Freitas Júnior WR, Oliveira LVF. Roux-en-Y Gastric Bypass Improves Adiponectin to Leptin Ratio and Inflammatory Profile in Severely Obese Women with and without Metabolic Syndrome: A Randomized Controlled Trial. Nutrients 2023; 15:3312. [PMID: 37571250 PMCID: PMC10421521 DOI: 10.3390/nu15153312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Obesity is a troubling public health problem as it increases risks of sleep disorders, respiratory complications, systemic arterial hypertension, cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome (MetS). As a measure to counteract comorbidities associated with severe obesity, bariatric surgery stands out. This study aimed to investigate the adiponectin/leptin ratio in women with severe obesity with and without MetS who had undergone Roux-en-Y gastric bypass (RYGB) and to characterize the biochemical, glucose, and inflammatory parameters of blood in women with severe obesity before and after RYGB. Were enrolled females with severe obesity undergoing RYGP with MetS (n = 11) and without (n = 39). Anthropometric data and circulating levels of glucose, total cholesterol, high-density lipoprotein (HDL), non-HDL total cholesterol, low-density lipoprotein (LDL), adiponectin, and leptin were assessed before and 6 months after RYGB. Significant reductions in weight, body mass index, and glucose, total cholesterol, LDL, and leptin were observed after surgery, with higher levels of HDL, adiponectin, and adiponectin/leptin ratio being observed after surgery compared to the preoperative values of those. This study demonstrated that weight loss induced by RYGB in patients with severe obesity with or without MetS improved biochemical and systemic inflammatory parameters, particularly the adiponectin/leptin ratio.
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Affiliation(s)
- Sandra M. B. P. Moreira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, SP, Brazil;
| | - Elias I. Jirjos
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Carlos A. Malheiros
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Sergio Vencio
- Institute of Pharmaceutical Sciences, Goiania 74175-100, GO, Brazil;
| | - Vera L. S. Alves
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Alan R. T. Sousa
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Lucenda A. Felipe
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Eduardo A. Perez
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Maria E. M. Lino
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Shayra K. A. Souza
- Scientific Initiation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.E.M.L.); (S.K.A.S.)
| | - Juliana M. B. Santos
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo 05360-000, SP, Brazil;
| | - Miriã C. Oliveira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Adriano L. Fonseca
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Carlos H. M. Silva
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Rodolfo P. Vieira
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
| | - Giuseppe Insalaco
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), 90146 Palermo, Italy;
| | - Wilson R. Freitas Júnior
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
| | - Luis V. F. Oliveira
- Post Graduation Program in Health Sciences, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil; (S.M.B.P.M.); (E.I.J.); (C.A.M.); (V.L.S.A.); (A.R.T.S.); (L.A.F.); (E.A.P.); (W.R.F.J.)
- Human Movement and Rehabilitation Post Graduation Program, Evangelical University of Goiás (UniEVANGELICA), Anápolis 75083-515, GO, Brazil; (M.C.O.); (A.L.F.); (C.H.M.S.); (R.P.V.)
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Hanipah ZN, Rubino F, Schauer PR. Remission with an Intervention: Is Metabolic Surgery the Ultimate Solution? Endocrinol Metab Clin North Am 2023; 52:65-88. [PMID: 36754498 DOI: 10.1016/j.ecl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-term remission of type 2 diabetes following lifestyle intervention or pharmacotherapy, even in patients with mild disease, is rare. Long-term remission following metabolic surgery however, is common and occurs in 23% to 98% depending on disease severity and type of surgery. Remission after surgery is associated with excellent glycemic control without reliance on pharmacotherapy, improvements in quality of life, and major reductions in microvascular and macrovascular complications. For patients with type 2 diabetes, early intervention with metabolic surgery, when beta cell function still remains intact, provides the greatest probability of long-term remission as high as 90% or more.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London; Bariatric and Metabolic Surgery King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Structured Lifestyle Modification Prior to Bariatric Surgery: How Much is Enough? Obes Surg 2021; 31:4585-4591. [PMID: 34297255 PMCID: PMC8458190 DOI: 10.1007/s11695-021-05573-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 01/06/2023]
Abstract
Many healthcare systems require patients to participate in a structured lifestyle modification programme prior to bariatric surgery, even though bariatric consensus guidelines do not recommend this. While there is good evidence that such programmes improve health in other conditions such as metabolic and cardiovascular diseases, there is no evidence that they improve outcomes after bariatric surgery. The distinction needs to be drawn between the well-established need for individualised multidisciplinary dietetic and physical activity care for bariatric surgical patients and the potential harms from mandating participation in compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery, reinforce obesity stigma, or both. Large clinical trials might help to address some of the uncertainty and provide an evidence base for clinicians and policymakers.
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Villarreal-Calderon JR, Cuellar-Tamez R, Castillo EC, Luna-Ceron E, García-Rivas G, Elizondo-Montemayor L. Metabolic shift precedes the resolution of inflammation in a cohort of patients undergoing bariatric and metabolic surgery. Sci Rep 2021; 11:12127. [PMID: 34108550 PMCID: PMC8190106 DOI: 10.1038/s41598-021-91393-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
Bariatric and metabolic surgery has shown to promote weight loss and reduce systemic inflammation. However, the sequence and timing of events regarding metabolic improvement and inflammation resolution has been rarely explored. Furthermore, data on inflammatory markers of Th17 and Th1 cell responses after bariatric surgery is scarce. We conducted a prospective study in subjects with obesity that underwent bariatric and metabolic surgery, with follow-ups at 3 and 6 months. Anthropometric and metabolic markers such as insulin levels, HOMA-IR, and lipid parameters declined significantly 3 months after surgery; while hs-CRP, TNF-α, IL-1β, IL-6, and IL-8 serum concentrations decreased 6 months after the procedure. Concentrations of Th1 signature and driver cytokines, particularly IFN-γ, IL-12, and IL-18, and of Th17 driver IL-23 also decreased significantly after 6 months. Significant positive correlations between triglyceride levels and hs-CRP, IL-1β, and IFN-γ concentrations, and between Apo B and IFN-γ levels were observed 6 months after bariatric and metabolic surgery. In addition, BMI was associated with hs-CRP and TNF-α concentrations. Fat mass correlated with hs-CRP, TNF-α, and IL-12. Analysis of the temporality of metabolic and inflammatory events suggests that improvement in the metabolic status occurs before resolution of systemic inflammation and may be a requisite for the later event.
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Affiliation(s)
- Jose Romeo Villarreal-Calderon
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey, Centro de Investigación en Obesidad y Nutrición Clínica, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Ricardo Cuellar-Tamez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Elena C Castillo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Eder Luna-Ceron
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico.,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico
| | - Gerardo García-Rivas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey, Centro de Investigación Biomédica, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico. .,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico.
| | - Leticia Elizondo-Montemayor
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey, Centro de Investigación en Obesidad y Nutrición Clínica, 64710, Monterrey, Mexico. .,Tecnologico de Monterrey. Cardiovascular Medicine and Metabolomics Research Group, Hospital Zambrano Hellion, TecSalud, 66278, San Pedro Garza García, Mexico.
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Morledge MD, Pories WJ. Mental Health in Bariatric Surgery: Selection, Access, and Outcomes. Obesity (Silver Spring) 2020; 28:689-695. [PMID: 32202073 DOI: 10.1002/oby.22752] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance-mandated preoperative psychosocial evaluation is also discussed.
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Affiliation(s)
- Michael D Morledge
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Pories WJ, Aronne LJ. It's Time for Multidisciplinary Obesity Management Centers. Obesity (Silver Spring) 2019; 27:534. [PMID: 30900404 DOI: 10.1002/oby.22450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Louis J Aronne
- Comprehensive Weight Control Program, Weill Cornell Medical College, New York, New York, USA
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