Bariatric Surgery in Adults with Obesity: the Impact on Performance, Metabolism, and Health Indices

Assessment of weight change patterns following Roux en Y gastric bypass, one anastomosis gastric bypass and sleeve gastrectomy using change-point analysis

We aimed to assess the weight loss trend following Roux en Y Gastric Bypass (RYGB), One Anastomosis Gastric Bypass (OAGB), and Sleeve Gastrectomy (SG), utilizing a change-point analysis. A retrospective cohort study was conducted on 8640 patients, from 2009 to 2023. The follow-up period extended to 7 years, with a median follow-up of 3 years (interquartile range: 1.4-5). Following metabolic bariatric surgery, four weight loss phases (three change points) were observed. The primary, secondary, and tertiary phases, transitioned at 12.64-13.73 days, 4.2-4.8 months, and 11.3-13.1 months post-operation, respectively, varying based on the type of procedure. The weight loss rate decreased following each phase and plateaued after the tertiary phase. The nadir weight was achieved 11.3-13.1 months post-procedure. There was no significant difference in the %TWL between males and females, however, males achieved their nadir weight significantly earlier. Half of the maximum %TWL was achieved within the first 5 months, with the greatest reduction rate in the first 2 weeks. Our findings inform healthcare providers of the optimal timing for maximum weight loss following each surgical method and underscore the importance of close patient monitoring in the early postoperative period.

Acupuncture for obesity and related diseases: Insight for regulating neural circuit

Obesity is defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with numerous pathological changes including insulin resistance, fatty liver, hyperlipidemias, and other obesity-related diseases. These comorbidities comprise a significant public health threat. Existing anti-obesity drugs have been limited by side effects that include depression, suicidal thoughts, cardiovascular complications and stroke. Acupuncture treatment has been shown to be effective for treating obesity and obesity-related conditions, while avoiding side effects. However, the mechanisms of acupuncture in treating obesity-related diseases, especially its effect on neural circuits, are not well understood. A growing body of research has studied acupuncture's effects on the endocrine system and other mechanisms related to the regulation of neural circuits. In this article, recent research that was relevant to the use of acupuncture to treat obesity and obesity-related diseases through the neuroendocrine system, as well as some neural circuits involved, was summarized. Based on this, acupuncture's potential ability to regulate neural circuits and its mechanisms of action in the endocrine system were reviewed, leading to a deeper mechanistic understanding of acupuncture's effects and providing insight and direction for future research about obesity. Please cite this article as: Jiang LY, Tian J, Yang YN, Jia SH, Shu Q. Acupuncture for obesity and related diseases: insight for regulating neural circuit. J Integr Med. 2024; 22(2): 93-101.

Weight Regain after Metabolic Surgery: Beyond the Surgical Failure

Patients undergoing metabolic surgery have factors ranging from anatomo-surgical, endocrine metabolic, eating patterns and physical activity, mental health and psychological factors. Some of the latter can explain the possible pathophysiological neuroendocrine, metabolic, and adaptive mechanisms that cause the high prevalence of weight regain in postbariatric patients. Even metabolic surgery has proven to be effective in reducing excess weight in patients with obesity; some of them regain weight after this intervention. In this vein, several studies have been conducted to search factors and mechanisms involved in weight regain, to stablish strategies to manage this complication by combining metabolic surgery with either lifestyle changes, behavioral therapies, pharmacotherapy, endoscopic interventions, or finally, surgical revision. The aim of this revision is to describe certain aspects and mechanisms behind weight regain after metabolic surgery, along with preventive and therapeutic strategies for this complication.

Perceived Benefits of Bariatric Surgery: Patient Perspectives

BACKGROUND

Obesity is a chronic and complex disease characterized by the excessive accumulation of adipose tissue, which has detrimental effects on health. Evaluating the changes in quality of life (QoL) after bariatric surgery complements the medical benefits which are documented by healthcare professionals.

PURPOSE

To study the perceived health benefits 1 year after substantial weight loss induced by bariatric surgery.

METHODS

This pilot study evaluated patients 1 year after bariatric surgery using 13 questions related to the health domains of the KOSS: airway, body mass, cardiovascular risk, diabetes, economic impact, functional, gonadal impact, health status perceived, image, junction of the gastro-esophagus, kidney, liver, and medication. In addition, the patients were asked to score the most significant benefit as "1," while the least beneficial benefit was scored as "13."

RESULTS

One hundred fourteen consecutive patients were evaluated (men = 37 and women = 77). The responses were divided into functional, metabolic, and mental/social benefits. Patients ranked the functional question, "I became more active, and I can do more things" as the most important (average score of 3.7 ± 0.2), followed by a question related to metabolic status: "I am less worried about my risk of heart disease" (4.5 ± 0.3), and then a social/mental question, "My clothes fit better" (5.4 ± 0.3). The three least valuable benefits for the cohort were sexual life improvements (8.9 ± 0.3), heartburn improvements (9.0 ± 0.3), and urinary incontinence improvements (9.8 ± 0.3).

CONCLUSIONS

Our observational pilot study demonstrated that patients value functional benefits after substantial weight loss the most, but that metabolic benefits and social/mental health benefits are also considered important.

Prevalence of Perceived Barriers to Physical Activity Among Pre- and Post-Metabolic and Bariatric Surgery Patients: A Cross-Sectional Study

OBJECTIVE

This study aims to describe and compare the prevalence of perceived barriers to physical activity (PBPA) in pre- and post-metabolic and bariatric surgery (MBS) patients and assess the association of these barriers with their physical activity levels.

METHODS

A cross-sectional study included pre-operative (n = 63) and post-operative (n = 119) groups. Sociodemographic characteristics, leisure-time physical activity levels, and PBPA data were collected. Descriptive statistics, chi-square, and Fisher's exact tests, and binomial logistic regression analyses were used for comparisons and associations.

RESULTS

Compared to the pre-operative group, the post-operative group had a lower prevalence of barriers in the physical domain (p = 0.036) and the behavioral domain (p = 0.004). However, there were no significant differences in the environmental (p = 0.531) or social (p = 0.597) domains. Pre-MBS patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.048) and behavioral (p = 0.048) domains. In contrast, post-surgical patients were more likely to be physically inactive when perceiving barriers in the environmental (p = 0.027), social (p = 0.020), and behavioral (p = 0.037) domains.

CONCLUSION

The results show that individuals who underwent metabolic and bariatric surgery have a lower prevalence of behavioral and physical PBPA compared to those awaiting the procedure. The perception of barriers to physical activity in the environmental and behavioral domains increases the likelihood of physical inactivity in both pre- and post-MBS patients, while in the social domain, it was only associated with physical activity in post-MBS patients.

Causal association between obesity and hypothyroidism: a two-sample bidirectional Mendelian randomization study

Introduction

Previous observational studies have reported a positive correlation between obesity and susceptibility to hypothyroidism; however, there is limited evidence from alternative methodologies to establish a causal link.

Methods

We investigated the causal relationship between obesity and hypothyroidism using a two-sample bidirectional Mendelian randomization (MR) analysis. Single-nucleotide polymorphisms (SNPs) associated with obesity-related traits were extracted from a published genome-wide association study (GWAS) of European individuals. Summarized diagnostic data of hypothyroidism were obtained from the UK Biobank. Primary analyses were conducted using the inverse variance-weighted (IVW) method with a random-effects model as well as three complementary approaches. Sensitivity analyses were performed to ascertain the correlation between obesity and hypothyroidism.

Results

MR analyses of the IVW method and the analyses of hypothyroidism/myxedema indicated that body mass index (BMI) and waist circumference (WC) were significantly associated with higher odds and risk of hypothyroidism. Reverse MR analysis demonstrated that a genetic predisposition to hypothyroidism was associated with an increased risk of elevated BMI and WC, which was not observed between WC adjusted for BMI (WCadjBMI) and hypothyroidism.

Discussion

Our current study indicates that obesity is a risk factor for hypothyroidism, suggesting that individuals with higher BMI/WC have an increased risk of developing hypothyroidism and indicating the importance of weight loss in reducing the risk of hypothyroidism.

Impact of prior bariatric surgery on outcomes of hospitalized patients with systemic lupus erythematosus: a propensity score-matched analysis of the U.S. nationwide inpatient sample

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women, has many different manifestations, and the disease severity can wax and wane.

OBJECTIVES

This study aims to determine the association between prior bariatric surgery and SLE outcomes.

SETTING

A population-based, retrospective study using data from the U.S. Nationwide Inpatient Sample (NIS) database between 2005 and 2018.

METHODS

Data of hospitalized patients with SLE and morbid obesity were extracted. Exclusion criteria were age <18 years and missing information on mortality. Patients were separated into 2 groups: with or without prior bariatric surgery. One: 4 propensity score matching (PSM) were performed to balance the characteristics between the groups. Associations between prior bariatric surgery and inpatient outcomes were determined by logistic regressions.

RESULTS

A total of 38,286 hospitalized patients with SLE and morbid obesity were identified. After exclusions and PSM, there remained 9050 subjects in the study sample (with prior bariatric surgery: 1810; without prior bariatric surgery: 7240), representing 44,952 U.S. inpatients. After adjusting for confounders in multivariable analysis, prior bariatric surgery was significantly associated with lower odds for prolonged length of stay (LOS), unfavorable discharge, and SLE-related complications. Specifically, prior bariatric surgery was significantly associated with lower risks of acute myocardial infarction (AMI)/stroke (aOR = .44, 95% CI: .30-.65), venous thromboembolism (VTE) (aOR = .74, 95% CI: .57-.96), pneumonia (aOR = .60, 95% CI: .47-.76), sepsis (aOR = .62, 95% CI: .51-.75), acute and chronic glomerulonephritis (aOR = .53, 95% CI: .38-.76), acute kidney injury (AKI) (aOR = .64, 95% CI: .52-.77), and anemia (aOR = .77, 95% CI: .68-.87).

CONCLUSIONS

Prior bariatric surgery is associated with favorable in-hospital outcomes in hospitalized patients with SLE and decreased likelihood for several SLE-related complications.

Identification of Medication-Related Risks in Bariatric Surgery Patients by Performing Structured Medication Reviews

PURPOSE

More medication-related issues are seen with the growing demand for bariatric surgery, because of possible altered pharmacokinetics after surgery. Collaboration with a pharmacist could improve the short- and long-term safety and efficacy of pharmacotherapy in patients undergoing bariatric surgery. The aim of this study was to evaluate the impact of a structured medication review to identify medication-related risks before bariatric surgery.

MATERIALS AND METHODS

The impact on pharmacy-led interventions of introducing a structured medication review was evaluated in a historically controlled study. In the retrospective part, we evaluated patient characteristics, medication use, and number of pre-surgery consultations with a pharmacist before the introduction of medication reviews. A flowchart was developed to detect the use of medicines with risks associated with bariatric surgery. In the prospective part, we evaluated pharmacy-led interventions after the introduction of structured medication reviews using the flowchart. Outcome effectiveness was measured through the number of pre-surgery pharmacy-led interventions.

RESULTS

Before using the flowchart for screening on risk medicines, 40 (2.6%) pharmacy-led interventions were identified in 1536 patients. In the prospective group, 195 patients were included and 88 (45%) interventions were identified (p < 0.001).

CONCLUSION

A structured medication review before bariatric surgery significantly increased the number of pharmacy-led interventions in bariatric surgery patients. This procedure will shift interventions to pre-surgery instead of post-surgery, contributing to the optimization of pharmacotherapy at an early stage.

Duodenal-Jejunal bypass improves metabolism and re-models extra cellular matrix through modulating ceRNA network

BACKGROUND

Bariatric surgery (BS) is an effective approach in treating obesity and ameliorating T2DM with obesity. Our previous studies demonstrated that duodenal-jejunal bypass (DJB) altered long non-coding RNAs (lncRNAs) in the gastrointestinal system, which is associated with modulation of lipid metabolism, and glycemic control through entero-pancreatic axis and gut-brain axis. The adipose non-coding RNA expression profile and the underlying competing endogenous RNA (ceRNA) regulatory network pattern post DJB needs further research and investigation.

RESULTS

In this study, we compared the lncRNAs, circular RNAs (circRNAs) and messenger RNAs (mRNAs) expression in adipose tissues between the sham group and the DJB group. 2219 differentially expressed mRNAs (DEmRNAs), 722 differential expression of lncRNAs (DElncRNAs) and 425 differential expression of circRNAs (DEcircRNAs) were identified. GO terms and KEGG pathways analysis of the DEmRNAs implied that the dysregulated adipose mRNAs were associated with lipid, amino acid metabolism, insulin resistance, and extra cellular matrix (ECM)-related pathways. Moreover, via analyzing ceRNA regulatory networks of DElncRNAs and DEcircRNAs, 31 hub DE mRNAs, especially Mpp7, 9330159F19Rik, Trhde. Trdn, Sorbs2, were found on these pathways.

CONCLUSIONS

The role of DJB in adipose tends to remodel ECM and improve the energy metabolism through the ceRNA regulatory network.

Psychopathological profile before and after bariatric surgery

Presurgical psychopathological assessment usually focuses on detecting severe mental disorders. However, mild intensity psychopathology and eating behaviour pattern may also influence postsurgical outcomes. The aim was to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery. A cohort of 32 patients seeking bariatric surgery in a university hospital between March 2016 and March 2017 were evaluated with Personality Assessment Inventory (PAI), 36-item EDE-Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included. The PAI presurgical psychometric profile suggested a mild mixed adjustment disorder focused on somatic complaints. After surgery, patients improved in somatic complaints (p < 0.001), and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p < 0.001) and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p < 0.001). In our cohort ready for bariatric surgery a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery. Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery.

The effect of marijuana use on short-term outcomes with bariatric surgery

BACKGROUND

Despite increasing marijuana use nationwide, there are limited data on implications of marijuana use on bariatric surgery outcomes.

OBJECTIVE

We investigated associations between marijuana use and bariatric surgery outcomes.

SETTING

Multicenter statewide study utilizing data from the Michigan Bariatric Surgery Collaborative, a payor-funded consortium including over 40 hospitals and 80 surgeons performing bariatric surgery statewide.

METHODS

We analyzed data from the Michigan Bariatric Surgery Collaborative clinical registry on patients who underwent a laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between June 2019 and June 2020. Patients were surveyed at baseline and annually on medication use, depression symptoms, and substance use. Regression analysis was performed to compare 30-day and 1-year outcomes between marijuana users and nonusers.

RESULTS

Of 6879 patients, 574 reported baseline marijuana use and 139 reported use at baseline and 1 year. Marijuana users were more likely to be current smokers (14% versus 8%, P < .0001), screen positive for alcohol use disorder (20.0% versus 8.4%, P < .0001), and score higher on the Patient Health Questionnaire-8 (6.1 versus 3.0, P < .0001). There were no statistically significant differences in 30-day outcomes or co-morbidity remission at 1 year. Marijuana users had higher adjusted total mean weight loss (47.6 versus 38.1 kg, P < .0001) and body mass index reduction (17 versus 14 kg/m2, P < .0001).

CONCLUSIONS

Marijuana use is not associated with worse 30-day outcomes or 1-year weight loss outcomes and should not be a barrier to bariatric surgery. However, marijuana use is associated with higher rates of smoking, substance use, and depression. These patients may benefit from additional mental health and substance abuse counseling.

Down-staging of obesity one year after bariatric surgery: a new proposal of Edmonton obesity staging system

Background

Different approaches are used to classify obesity severity. The Edmonton Obesity Staging System (EOSS) considers medical, physical and psychological parameters. A new modified EOSS with a different functional evaluation method, measuring Cardiorespiratory Fitness (CRF), has been recently proposed, EOSS-CRF. Bariatric surgery (BS) is one of the most efficient treatments of obesity and all aspect of related disorders. No studies have yet applied EOSS-CRF after BS. Therefore, the aim of this study was to evaluate modifications in EOSS and EOSS-CRF before and after BS.

Methods

This observational study finally enrolled 72 patients affected by obesity. A multi-disciplinary assessment in order to evaluate eligibility to surgical treatment has been performed, including anamnesis, physical evaluation, anthropometric data measurement, biochemical blood exams and cardiopulmonary exercise testing. One year after BS the same protocol was applied. Patients have been classified according to EOSS and EOSS-CRF before and one year after BS.

Results

After BS, patients categorized in classes associated to severe obesity (EOSS ≥ 2 or EOSS-CRF ≥ 2) reduced significantly. Using EOSS, patients without functional impairment were 61% before surgery and 69% after BS (p=0.383). Using EOSS-CRF, patients considered without functional impairment were only 9.7% before BS; this percentage significantly raised to 50% after BS (p<0.001). The impact of functional domains before and after BS is different in grading patients in EOSS and EOSS-CRF, respectively.

Conclusions

Improvements obtained after BS are adequately summarized by EOSS and EOSS-CRF. The EOSS-CRF grading method for functional impairment seems to better reflect the known amelioration obtained after BS. Objective measurements of CRF may provide additional value to classify severity of obesity, also in the follow-up after BS.

Maternal and perinatal outcomes in women conceiving after bariatric surgery: A cohort study

Obesity in women, a global issue, is being widely managed with bariatric surgery worldwide. According to recommended guidelines, pregnancy should be avoided for 12 to 24 months following surgery due to various risks. We assessed if surgery-to-conception time has a relation with pregnancy outcomes taking into account gestational weight gain. A cohort study between 2015 and 2019 followed-up pregnancies after various types of bariatric surgeries performed (e.g. Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, gastric bypass with Roux-en-Y gastroenterostomy) in Tawam Hospital, Al Ain, United Arab Emirates. There were 5 surgery-to-conception groups: <6 months, 6 to 12 months, 13 to 18 months, 19 to 24 months, and >24 months. There were 3 gestational weight gain groups: inadequate, adequate, or excessive (based on the National Academy of Medicine classification). Maternal and neonatal outcomes were compared using analysis of variance and chi-square tests. There were 158 pregnancies. Booking maternal body mass index and weight were higher among mothers who conceived <6 months following surgery (P < .001). Gestational weight gain was not related to the type of bariatric surgery (P = .24), but it was far more often inadequate in mothers who conceived <12 months following surgery (P = .002). Maternal (including pregnancy-induced hypertension and gestational diabetes mellitus) and neonatal outcomes were not statistically significantly associated with surgery-to-conception duration. However, birth weight was lower when gestational weight gain was inadequate (P = .03). There is a negative relationship between shorter bariatric surgery-to-conception interval and gestational weight gain, a feature related to neonatal birth weight. Conception should be delayed to improve pregnancy outcomes following bariatric surgery.

Effectiveness of Bariatric Surgery for Improving Thyroid Function and Reducing Levothyroxine Dose in Patients With Obesity and Overt Hypothyroidism

BACKGROUND

 Hypothyroidism is a major hormonal condition that affects more women than men in Saudi Arabia. Studies indicate a bidirectional link between hypothyroidism and obesity, which may improve following bariatric surgery (BS). The focus of this research is to assess how hypothyroidism patients' thyroid function and levothyroxine dosage are impacted by bariatric surgery.

METHODOLOGY

This was an observational retrospective study conducted in two centres at Taif, Saudi Arabia. All morbidly obese patients who were diagnosed with overt hypothyroidism and underwent laparoscopic sleeve gastrectomy from January 2016 to December 2021 were included. The changes in the thyroid profile and the changes in the doses or cessation of levothyroxine were evaluated after the laparoscopic sleeve gastrectomy.

RESULTS

Our results demonstrate that a total of 70 patients dominated by women out of 1202 from both centers who meet our inclusion criteria showed a statistically significant decrease on comparison of clinical parameters (thyroid-stimulating hormone [TSH], free T4 [FT4], free T3 [FT3], levothyroxine [L-T4]) before and after BS. The average TSH levels were determined to be 4.45 ± 4.41 mIU/L prior to BS, and they significantly decreased (3.17 ± 2.77 mIU/L) following BS (p=0.009). When compared to before BS (13.17 ± 2.73 pmol/L), the mean FT4 levels after BS (11.63 ± 5.88 pmol/L) exhibited a significant decline (p=0.046). The mean FT3 levels before and after BS also were statistically significantly lower (1.94 ± 2.12 pg/mL) than before (2.75 ± 1.96 pg/mL), p=0.009. The mean L-T4 levels after BS considerably decreased from before BS (98.68 ± 56.18 mcg) to after BS (79.39 ± 41.49 mcg), p=0.046.

CONCLUSION

Better thyroid profiles and lower levothyroxine dosage show that bariatric surgery improves hypothyroidism.

Heart rate variability after bariatric surgery: The add-on value of exercise

PURPOSE

To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity.

METHODS

Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months.

RESULTS

After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms²), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms²) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms²), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms²) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters).

CONCLUSION

Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.

The effect of bariatric surgery on metabolic syndrome: A retrospective cohort study in Colombia

Introduction and Objective

Metabolic syndrome (MetS) represents a group of metabolic abnormalities. It is currently a pandemic, and its prevalence is on the rise. MetS has a direct relationship with obesity, for this reason, bariatric and metabolic surgery has been proposed as a method to simultaneously control obesity and MetS. However, in Colombia the results of this intervention are unknown. This study aims to compare metabolic syndrome before and after bariatric surgery in a Colombian population.

Methods

Retrospective cohort study conducted in a highly complex institution in Colombia, where comparing the prevalence of metabolic syndrome in patients who underwent bariatric surgery during a 1-year follow-up period, between January 2015 and December 2019. Of these patients, 48 underwent Roux-en-Y gastric bypass, and 32 underwent sleeve gastrectomy by laparoscopic technique.

Results

A total of 80 patients were included, of which 67.5% were women and the mean age was 42.8 ± 12.9 years. The most frequent preprocedure comorbidities were arterial hypertension (36.2%), dyslipidemia (32.4%), and sleep apnea (20%). After bariatric surgery, the prevalence of metabolic syndrome decreased from 66.2% to 3.7% (p < 0.05). In addition, a reduction in the Homeostatic Model Assessment for Insulin Resistance score from 77.5% to 22.5% was observed during the follow-up period. HbA1c, creatinine, and thyroid-stimulating hormone, were the only parameters without significant changes.

Conclusions

Metabolic and bariatric surgery is an effective treatment for weight reduction, with a high impact in reducing the prevalence of metabolic syndrome and insulin resistance in the short and medium term in the Colombian population.

Changes of Facial Features After Bariatric Surgery: a Systematic Review

This study aims to provide an overview of the facial features and structure after bariatric surgery in the existing literature. A systematic literature search was performed in electronic databases until 15th February 2022. Four cohort studies including 129 patients from 3 countries were included between time period 2011 and 2020. Overall, bariatric surgery would promote massive weight loss associated with positive effects on facial aging. Analysis revealed a proportional relationship between body mass index (BMI) and faster facial aging and more attractive. Undergoing bariatric surgery would result in facial skin sagging and a favorable effect on the upper airway. Bariatric surgery was found to have a significant impact on changes in facial features but the current evidence remains inconclusive and further studies are required to illustrate facial changes post-bariatric surgery.

Multidisciplinary Progress in Obesity Research

Obesity is a chronic disease that endangers human health. In recent years, the phenomenon of obesity has become more and more common, and it has become a global epidemic. Obesity is closely associated with many adverse metabolic changes and diseases, such as insulin resistance, type 2 diabetes mellitus, coronary heart disease, nervous system diseases and some malignant tumors, which have caused a huge burden on the country's medical finance. In most countries of the world, the incidence of cancer caused by obesity is increasing year on year. Diabetes associated with obesity can lead to secondary neuropathy. How to treat obesity and its secondary diseases has become an urgent problem for patients, doctors and society. This article will summarize the multidisciplinary research on obesity and its complications.

Preoperative Physical Activity Level and Exercise Prescription in Adults With Obesity: The Effect on Post-Bariatric Surgery Outcomes

This systematic review summarizes current evidence on the relation between preoperative physical activity (PA) levels with bariatric surgery (BS) outcomes and on the beneficial role of preoperative exercise/PA program among BS candidates. This systematic review suggests that candidate patients accumulating the preoperative PA level improved several BS outcomes. These improvements were reported mainly for anthropometric and cardiometabolic parameters and physical function. Observed improvements manifested during a distinct period of time in response to a wide variety of exercise programs. Evidence on the preoperative PA level as well as on preoperative exercise implementation on BS outcomes is advocated despite the small number of participants and lack of control. Thus, further studies are required to explore the most effective and suitable form of exercise prescription prior to BS while considering physical and psychological limitations of obese patients.

Non-invasive cooling wear as an effective means of reducing subcutaneous adipose tissue mass: an in-vivo study

Objective

The increasing prevalence of obesity is a major health problem worldwide. Several non-surgical treatments are now available that reduce body and subcutaneous fat mass. We aimed to determine the efficacy of mild cold for body mass reduction.

Methods

Novel cooling wear, which induces mild cooling via evaporation, was worn by 29 women with overweight for 4 weeks. Specifically, the participants wore a cooling waist belt and chaps for 1 hour per day. Non-invasive lipometry was used to determine their subcutaneous adipose tissue thicknesses, and the total weight loss, abdominal circumference, and body mass index (BMI) of the participants were measured.

Results

The participants achieved a significant total weight loss of 0.7 kg (0.9%), and significant reductions in BMI (0.2 kg/m²) and abdominal circumference (1.9 cm, 1.7%). Furthermore, there was a trend towards a reduction in abdominal subcutaneous fat thickness and a significant reduction in thickness of the anterior thigh was noted. A questionnaire-based evaluation indicated high usability and comfort of the cooling wear.

Conclusion

There is a high and growing demand for non-invasive treatment strategies for obesity. Cooling wear represents a novel and promising approach that may be of particular use for individuals who do not require bariatric surgery.

Impact of Bariatric Surgery on Outcomes of Patients with Rheumatoid Arthritis: a Propensity Score-Matched Analysis of US Nationwide Inpatient Sample, 2005-2018

PURPOSE

Obesity has been considered one of the risk factors with more critical disease progression and poor treatment response in rheumatoid arthritis (RA). We herein utilized an extensive, nationally representative database to examine the impact of bariatric surgery on clinical outcomes in RA patients.

MATERIALS AND METHODS

This retrospective analysis utilized nationally representative data of the Healthcare Cost and Utilization Project-National Inpatient Sample database (HCUP-NIS) from 2005 to 2018. Associations between bariatric surgery and in-hospital outcomes of RA patients were determined by the univariate and multivariate logistic regression analyses.

RESULTS

After 1:4 propensity score (PS) matching, totally 33,075 hospitalized adults with RA were included as primary cohort for subsequent analyses. Among them, 6615 patients had prior bariatric surgery and 26,460 patients had not. After adjusting for relevant confounders in the multivariate analysis, prior bariatric surgery was significantly and independently associated with reduced odds for any morbidity and in-hospital mortality (aOR: 0.41, 95% CI: 0.27-0.61, p < 0.01) as compared with no prior bariatric surgery. Adults with RA who had prior bariatric surgery also had a significantly lower odds for having unfavorable discharge and prolonged length of stay (LOS) as compared with those without bariatric surgery (aOR: 0.43, 95% CI: 0.39-0.46, p < 0.01).

CONCLUSIONS

Prior bariatric surgery is associated with better in-patient outcomes among RA, including in-hospital mortality, major morbidities, discharge destination, and LOS.

Dietary supplements and bariatric surgery

Bariatric surgery or weight loss surgery has been in practice for achieving significant weight loss in patients who have failed to achieve weight loss after pharmacological interventions. The rising cases of obesity are a triggering factor for more bariatric surgeries worldwide. Interestingly, sustained weight loss achieved post-bariatric surgery offers metabolic advantages, and patients show improved glucose and lipid metabolisms. Bariatric surgery is directly linked to higher incidences of vitamin, mineral, and trace element deficiencies, thus making patients susceptible to anemia, osteoporosis, and cardiomyopathy. Reduced nutrient absorption capacity, dietary changes, dietary restriction, and altered gastrointestinal tract morphology are some reasons for nutritional deficiency observed in post-bariatric surgery procedures. Micro-and-macronutrient deficiency observed in patients during the postoperative phase requires continuous monitoring of nutritional parameters. Therefore, adequate multivitamin and mineral supplements become essential to prevent/overcome micronutrient deficiencies. Bariatric surgery also raises the risk of small for gestational age (SGA) babies. Hence, a 12 - 24 months gap is recommended between bariatric surgery and pregnancy to achieve desired weight loss targets. The topic of this review is the impact of bariatric surgery procedures on vitamin and mineral absorption and the role of dietary supplements in maintaining a healthy nutritional balance during the postoperative phase.

Cortisol/DHEA ratio in morbidly obese patients before and after bariatric surgery: Relation to metabolic parameters and cardiovascular performance

INTRODUCTION

Bariatric surgery (BS) is the most effective therapy for morbid obesity. Cortisol and DHEA are steroid hormones with opposing effects, thus using Cortisol/DHEA ratio (C/D) rather than the use of either hormone alone has been found to predict health outcomes more reliably. It was interesting to study C/D as an indicator of favorable metabolic and cardiovascular outcomes after BS.

OBJECTIVE

To assess C/D in morbidly obese patients before and after BS in relation to metabolic parameters and cardiovascular performance.

PATIENTS AND METHODS

Forty morbidly obese patients were followed prospectively for 1 year after BS. Fasting blood glucose (FBG), fasting insulin (FI), C/D, lipid profile, high-sensitive CRP (hs-CRP), and echocardiography were done before BS and at 3 months and 1 year post BS.

RESULTS

A total of 40 morbidly obese patients undergone sleeve gastrectomy. Blood pressure, FBG, FI, hs-CRP, C/D were significantly decreased after BS (p < 0.001). At 1 year post BS; significant reduction in left ventricular posterior wall thickness (LVPW) (p < 0.001), left ventricular mass (LVM) (p = 0.003), relative wall thickness (RWT) (p < 0.001) with a significant improvement in early diastolic velocity (E) (p < 0.001), early diastolic velocity/late diastolic velocity (E/A) (p = 0.01). After BS; C/D significantly positively correlated with FBG (p = 0.019), hs-CRP (p = 0.008), interventricular septum thickness (IVS) (p = 0.028), LVPW (p = 0.028), relative wall thickness (RWT) (p = 0.022), early diastolic velocity /early diastolic velocity (E') measured by pulsed tissue Doppler imaging (E/E') (p = 0.001), and significantly negatively correlated with E' (p = 0.032). C/D was the single significant independent variable affecting E' and E/E' post BS.

CONCLUSION

C/D can be used as a surrogate marker of the improved FBG and the resolution of inflammation post BS. C/D is an independent predictor of diastolic function improvement post BS.

Dysregulation of Components of the Inflammasome Machinery After Bariatric Surgery: Novel Targets for a Chronic Disease

BACKGROUND

Obesity is a metabolic chronic disease with important associated morbidities and mortality. Bariatric surgery is the most effective treatment for maintaining long-term weight loss in severe obesity and, consequently, for decreasing obesity-related complications, including chronic inflammation.

AIM

To explore changes in components of the inflammasome machinery after bariatric surgery and their relation with clinical/biochemical parameters at baseline and 6 months after bariatric surgery.

PATIENTS AND METHODS

Twenty-two patients with morbid-obesity that underwent bariatric surgery (sleeve gastrectomy and Roux-en-Y gastric bypass) were included. Epidemiological/clinical/anthropometric/biochemical evaluation was performed at baseline and 6 months after bariatric surgery. Inflammasome components and inflammatory-associated factors [nucleotide-binding oligomerization domain-like receptors (NLRs), inflammasome activation components, cytokines and inflammation/apoptosis-related components, and cell-cycle and DNA-damage regulators) were evaluated in peripheral blood mononuclear cells (PBMCs) at baseline and 6 months after bariatric surgery. Clinical molecular correlations/associations were analyzed. Functional parameters (lipid accumulation/viability/apoptosis) were analyzed in response to specific inflammasome components silencing in liver HepG2 cells).

RESULTS

A profound dysregulation of inflammasome components after bariatric surgery was found, especially in NLRs and cell-cycle and DNA damage regulators. Several components were associated with baseline metabolic comorbidities including type 2 diabetes (C-C motif chemokine ligand 2/C-X-C motif chemokine receptor 1/sirtuin 1), hypertension (absent in melanoma 2/ASC/purinergic receptor P2X 7), and dyslipidemia [C-X-C motif chemokine ligand 3 (CXCL3)/NLR family pyrin domain containing (NLRP) 7) and displayed changes in their molecular profile 6 months after bariatric surgery. The gene expression fingerprint of certain factors NLR family CARD domain containing 4 (NLRC4)/NLRP12/CXCL3)/C-C motif chemokine ligand 8/toll-like receptor 4) accurately differentiated pre- and postoperative PBMCs. Most changes were independent of the performed surgical technique. Silencing of NLRC4/NLRP12 resulted in altered lipid accumulation, apoptosis rate, and cell viability in HepG2 cells.

CONCLUSION

Bariatric surgery induces a profound alteration in the gene expression pattern of components of the inflammasome machinery in PBMCs. Expression and changes of certain inflammasome components are associated to baseline metabolic comorbidities, including type 2 diabetes, and may be related to the improvement and reversion of some obesity-related comorbidities after bariatric surgery.

Time Course of Metabolic, Neuroendocrine, and Adipose Effects During 2 Years of Follow-up After Gastric Bypass in Patients With Type 2 Diabetes

CONTEXT

Roux-en-Y gastric bypass surgery (RYGB) markedly improves glycemia in patients with type 2 diabetes (T2D), but underlying mechanisms and changes over time are incompletely understood.

OBJECTIVE

Integrated assessment of neuroendocrine and metabolic changes over time in T2D patients undergoing RYGB.

DESIGN AND SETTING

Follow-up of single-center randomized study.

PATIENTS

Thirteen patients with obesity and T2D compared to 22 healthy subjects.

INTERVENTIONS

Blood chemistry, adipose biopsies, and heart rate variability were obtained before and 4, 24, and 104 weeks post-RYGB.

RESULTS

After RYGB, glucose-lowering drugs were discontinued and hemoglobin A1c fell from mean 55 to 41 mmol/mol by 104 weeks (P < 0.001). At 4 weeks, morning cortisol (P < 0.05) and adrenocorticotropin (P = 0.09) were reduced by 20%. Parasympathetic nerve activity (heart rate variability derived) increased at 4 weeks (P < 0.05) and peaked at 24 weeks (P < 0.01). C-reactive protein (CRP) and white blood cells were rapidly reduced (P < 0.01). At 104 weeks, basal and insulin-stimulated adipocyte glucose uptake increased by 3-fold vs baseline and expression of genes involved in glucose transport, fatty acid oxidation, and adipogenesis was upregulated (P < 0.01). Adipocyte volume was reduced by 4 weeks and more markedly at 104 weeks, by about 40% vs baseline (P < 0.01).

CONCLUSIONS

We propose this order of events: (1) rapid glucose lowering (days); (2) attenuated cortisol axis activity and inflammation and increased parasympathetic tone (weeks); and (3) body fat and weight loss, increased adipose glucose uptake, and whole-body insulin sensitivity (months-years; similar to healthy controls). Thus, neuroendocrine pathways can partly mediate early glycemic improvement after RYGB, and adipose factors may promote long-term insulin sensitivity and normoglycemia.

Association between weight loss and reduced use of antihypertensive, hypoglycemic, psychotropic, and lipid-lowering drugs in patients undergoing bariatric surgery

Objectives: To analyze whether the weight reduction observed in bariatric surgery (Roux-en-Y gastric bypass; BGYR) is accompanied by a reduction in the use of antihypertensive, hypoglycemic, antilipidemic, and psychotropic drugs after 6 and 12 months. Methods: Longitudinal, retrospective study of 100 adult patients undergoing RYGB from May 2015 to January 2019, by laparotomy or laparoscopy. Data on age, body mass index (BMI), and the number of drugs used were recorded 6 and 12 months after surgery. Results: The mean age was 39.7 ± 9.7 years, and the majority were female (n = 78). The mean preoperative BMI was 43.7 ± 5.1 kg/m2, and the mean reduction in BMI after 6 months was 12.1 kg/m2 and 14.9 kg/m2 after 12 months. The reduction in antihypertensive drugs was 65.2% after 6 months and 96% after 12 months. The reduction in 6 months of hypoglycemic agents was 84.3%, and in 12 months, 98.3%. The average reduction in antidyslipidemic drugs was 86.7% in 6 months, and there was no record of using this medication after 12 months. Psychotropics showed a temporary reduction in use after 6 months with a return to levels close to the baseline after 1 year.There was no correlation between the variation in BMI and the use of drugs. Conclusions: there was a significant reduction in the use of drugs after 6 and 12 m, except for psychotropic drugs. The reduction in the use of drugs was not correlated with a reduction in BMI.