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Castellanos LD, Anselmetti P, Acosta G AJ, Tomey D, Araujo-Contreras R, Puche E, Elzein S, Graham Y, Mahawar K, Marshall S, Abou-Mrad A, Oviedo RJ. The role of metabolic and bariatric surgery on the obesity pandemic in Latin America: A review of current practices and future directions. Obes Rev 2024; 25:e13793. [PMID: 38885965 DOI: 10.1111/obr.13793] [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: 09/18/2023] [Revised: 04/07/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
Latin America faces a significant public health challenge due to the high prevalence of obesity and its associated diseases. Metabolic and bariatric surgery is effective and safe to treat obesity when other treatments fail; however, its implementation in Latin America remains unsatisfactory. This review explores the current status, challenges, and innovations of metabolic and bariatric surgery in Latin America. We searched peer-reviewed journals in English and Spanish for relevant articles published between 1998 and 2023. We found that more than 20% of the Latin American population is affected by obesity. Unfortunately, only a limited number of patients have access to metabolic and bariatric surgery due to high cost, limited availability, and shortage of specialists. The review found that ongoing clinical trials are being conducted in Brazil, Mexico, Chile, and Venezuela, indicating some regional progress. However, published studies remain low in number compared with other regions. Furthermore, we summarized the clinical outcomes, risks, and perioperative assessments associated with metabolic and bariatric surgery. We discussed potential strategies to enhance the availability and affordability of this intervention. This review emphasizes the significance of metabolic and bariatric surgery in addressing the obesity pandemic, specifically for Latin America, and proposes directions for future research and innovation.
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Affiliation(s)
| | | | | | - Daniel Tomey
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Emiro Puche
- School of Medicine, Universidad Francisco de Miranda, Coro, Venezuela
| | - Steven Elzein
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Yitka Graham
- Helen McArdle Nursing and Care Research Institute, Sunderland, UK
| | - Kamal Mahawar
- Department of Surgery, University of Sunderland, Sunderland, UK
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland Australia; Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, Queensland, Australia; and Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Adel Abou-Mrad
- Centre Hospitalier Universitaire d'Orléans, Loire, France
| | - Rodolfo J Oviedo
- Nacogdoches Center for Metabolic & Weight Loss Surgery, Nacogdoches, Texas, USA
- Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
- Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas, USA
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2
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Ansari S, Khoo B, Tan T. Targeting the incretin system in obesity and type 2 diabetes mellitus. Nat Rev Endocrinol 2024; 20:447-459. [PMID: 38632474 DOI: 10.1038/s41574-024-00979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are widespread, non-communicable diseases that are responsible for considerable levels of morbidity and mortality globally, primarily in the form of cardiovascular disease (CVD). Changes to lifestyle and behaviour have insufficient long-term efficacy in most patients with these diseases; metabolic surgery, although effective, is not practically deliverable on the scale that is required. Over the past two decades, therapies based on incretin hormones, spearheaded by glucagon-like peptide 1 (GLP1) receptor agonists (GLP1RAs), have become the treatment of choice for obesity and T2DM, and clinical evidence now suggests that these agents have benefits for CVD. We review the latest advances in incretin-based pharmacotherapy. These include 'GLP1 plus' agents, which combine the known advantages of GLP1RAs with the activity of additional hormones, such as glucose-dependent insulinotropic peptide, glucagon and amylin, to achieve desired therapeutic goals. Second-generation non-peptidic oral GLP1RAs promise to extend the benefits of GLP1 therapy to those who do not want, or cannot have, subcutaneous injection therapy. We conclude with a discussion of the knowledge gaps that must be addressed before incretin-based therapies can be properly deployed for maximum benefit in the treatment of obesity and T2DM.
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Affiliation(s)
- Saleem Ansari
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
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3
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Rothberg AE, Herman WH. How to assess kidney outcomes in obese people with substantial weight loss: the case of GLP1- and dual-receptor agonists. Nephrol Dial Transplant 2024; 39:1060-1062. [PMID: 38299776 PMCID: PMC11210982 DOI: 10.1093/ndt/gfae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Amy E Rothberg
- Internal Medicine and Nutritional Sciences, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Funes DR, Blanco DG, Lo Menzo E, Szomstein S, Rosenthal RJ. Changes in renal blood flow after surgically induced weight loss: can bariatric surgery halt the progression of chronic kidney disease? Surg Obes Relat Dis 2024; 20:439-444. [PMID: 38158311 DOI: 10.1016/j.soard.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We previously demonstrated how kidney injury in patients with morbid obesity can be reversed by bariatric surgery (BaS). OBJECTIVE(S) Based on previous experience, we hypothesize patients' potentially reversible kidney injury might be secondary to reduction in renal blood flow (RBF), which improves following BaS. SETTING Academic Hospital. METHODS We conducted a retrospective analysis of patients who underwent BaS at our institution from 2002 to 2019. We identified patients with chronic kidney disease (CKD) using the estimated glomerular filtration rate (eGFR) from the CKD Epidemiology Collaboration Study (CKD-EPI) classification system. We used the BUN/Creatinine (Cr) ratio pre- and postoperatively to determine a prerenal (decreased RBF) versus intrinsic component as the responsible cause of CKD in this patient population. Decreased RBF was defined as BUN/Cr > 20 preoperatively. RESULTS Our analysis included n = 2924 patients, of which 11% (n = 325) presented decreased RBF. From our original sample, only n = 228 patients had the complete data necessary to assess both eGFR and RBF (BUN/Cr). Patients with baseline CKD stage 2 demonstrated preoperative BUN/Cr 20.85 ± 10.23 decreasing to 14.99 ± 9.10 at 12-month follow-up (P < .01). Patients with baseline CKD stage 3 presented with preoperative BUN/Cr 23.88 ± 8.75; after 12-month follow-up, BUN/Cr ratio decreased to 16.38 ± 9.27 (P < .01). Patients with CKD stage 4 and ESRD (eGFR < 30) did not demonstrate a difference for pre- and postoperative BUN/Cr 21.71 ± 9.28 and 19.21 ± 14.58, respectively. CONCLUSION(S) According to our findings, patients with CKD stages 1-3 present improvement of their kidney function after BaS. This amelioration could be secondary to improvement of the RBF, an unstudied reversible mechanism of kidney injury in the bariatric population.
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Affiliation(s)
- David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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5
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Gong X, Zeng X, Fu P. The impact of weight loss on renal function in individuals with obesity and type 2 diabetes: a comprehensive review. Front Endocrinol (Lausanne) 2024; 15:1320627. [PMID: 38362272 PMCID: PMC10867247 DOI: 10.3389/fendo.2024.1320627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Obesity and Type 2 Diabetes (T2D) are two highly prevalent diseases that exhibit a complex interplay between them. Obesity serves as a primary risk factor for the development of T2D, and conversely, individuals with T2D often exhibit comorbid obesity. Renal dysfunction emerges as a critical consequence of the convergence of obesity and Type 2 Diabetes, contributing significantly to the overall burden of complications associated with these conditions. Recognizing the profound implications of renal dysfunction in individuals contending with both obesity and Type 2 Diabetes, interventions targeting weight loss have gained prominence as potential therapeutic avenues. Weight loss not only addresses the primary risk factor of obesity but also holds the promise of mitigating the progression of Type 2 Diabetes and its associated renal complications. This comprehensive review aims to explore the impact of weight loss on renal function in individuals contending with the convergence of obesity and T2D.
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Affiliation(s)
- Xuemei Gong
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Fu
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- Division of Nephrology, Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Courcoulas AP, Daigle CR, Arterburn DE. Long term outcomes of metabolic/bariatric surgery in adults. BMJ 2023; 383:e071027. [PMID: 38110235 DOI: 10.1136/bmj-2022-071027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
The prevalence of obesity continues to rise around the world, driving up the need for effective and durable treatments. The field of metabolic/bariatric surgery has grown rapidly in the past 25 years, with observational studies and randomized controlled trials investigating a broad range of long term outcomes. Metabolic/bariatric surgery results in durable and significant weight loss and improvements in comorbid conditions, including type 2 diabetes. Observational studies show that metabolic/bariatric surgery is associated with a lower incidence of cardiovascular events, cancer, and death. Weight regain is a risk in a fraction of patients, and an association exists between metabolic/bariatric surgery and an increased risk of developing substance and alcohol use disorders, suicidal ideation/attempts, and accidental death. Patients need lifelong follow-up to help to reduce the risk of these complications and other nutritional deficiencies. Different surgical procedures have important differences in risks and benefits, and a clear need exists for more long term research about less invasive and emerging procedures. Recent guidelines for the treatment of obesity and metabolic conditions have been updated to reflect this growth in knowledge, with an expansion of eligibility criteria, particularly people with type 2 diabetes and a body mass index between 30.0 and 34.9.
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Affiliation(s)
- Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher R Daigle
- Bariatric Surgery Program, Washington Permanente Medical Group, Bellevue, WA, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Yang SM, Myeong S, Yun SK, Kwak MH, Cho YK, Choi MG, Park JM. Duodenal mucosal resurfacing with photodynamic therapy using methylene blue in a mouse model. Photodiagnosis Photodyn Ther 2023; 44:103733. [PMID: 37536555 DOI: 10.1016/j.pdpdt.2023.103733] [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] [Received: 03/15/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The duodenum has emerged as a key player in metabolic diseases. The objective was to evaluate the safety and efficacy of intra-duodenal PDT using methylene blue in managing glycemic control and weight reduction. METHODS Optimal concentration of methylene blue and conditions for intra-duodenal PDT were determined through in vitro experiments. After injecting methylene blue into the duodenum, we performed intra-duodenal PDT. High-fat diet rats were used to assess the efficacy of intra-duodenal PDT through measures of oral glucose tolerance, insulin sensitivity, and weight change. Immunohistochemical staining was also conducted to examine GLP-1 and GIP-producing cells in the ileum and duodenum, respectively. RESULTS Introduodenal PDT reduced villous height of duodenum at 48 h, which was fully recovered at 30 days without complications. Rats treated with PDT showed significantly lower blood glucose levels with glucose loading and improved insulin sensitivity than rats in the sham-treatment group. The PDT group also had a significant reduction in body weight compared to the sham-treatment group at 30 days after intervention, although food intake was not significantly different between the two groups. Numbers of GLP-1 and GIP producing cells in the ileum and irradiated area were significantly higher in the PDT group than in the sham-treatment group. CONCLUSIONS Intra-duodenal PDT using methylene blue showed a feasible therapeutic modality in improving metabolic parameters. However, large animal experiments and mechanism studies are needed to determine the clinical relevance. The possibility of repeating this treatment every 30 days and its accompanying complications should be further studied.
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Affiliation(s)
- Seung Mok Yang
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul 06591, the Republic of Korea South Korea
| | - Seokho Myeong
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-GU, Seoul 06591, the Republic of Korea South Korea
| | - Seul Ki Yun
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul 06591, the Republic of Korea South Korea; Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-GU, Seoul 06591, the Republic of Korea South Korea
| | - Moon Hwa Kwak
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul 06591, the Republic of Korea South Korea; Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, the Republic of Korea South Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-GU, Seoul 06591, the Republic of Korea South Korea
| | - Myung-Gyu Choi
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul 06591, the Republic of Korea South Korea; Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-GU, Seoul 06591, the Republic of Korea South Korea
| | - Jae Myung Park
- Catholic Photomedicine Research Institute, The Catholic University of Korea, Seoul 06591, the Republic of Korea South Korea; Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-GU, Seoul 06591, the Republic of Korea South Korea; Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul, the Republic of Korea South Korea.
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8
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Zeitler EM, Dabb K, Nadeem D, Still CD, Chang AR. Blockbuster Medications for Obesity: A Primer for Nephrologists. Am J Kidney Dis 2023; 82:762-771. [PMID: 37500048 DOI: 10.1053/j.ajkd.2023.04.009] [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] [Received: 02/02/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 07/29/2023]
Abstract
The prevalence of obesity in the United States and across the world continues to climb, imparting increased risk of chronic disease. This impact is doubly felt in nephrology because obesity not only increases the risk of chronic kidney disease (CKD) but also exacerbates existing cardiovascular morbidity and mortality. The role of medical weight loss therapy in CKD has been debated, but increasing evidence suggests that intentional weight loss is protective against adverse kidney and cardiovascular outcomes. This may be particularly true with the advent of novel pharmacotherapies taking advantage of the incretin system, resulting in weight loss approaching that seen with surgical interventions. Moreover, these novel therapies have repeatedly demonstrated protective effects on the cardiovascular system. Here, we review the impact of obesity and weight loss on CKD, and the biological basis and clinical evidence for incretin therapy. This perspective provides recommended prescribing practices as a practical tool to engage nephrologists and patients with CKD in the treatment of obesity-related morbidity.
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Affiliation(s)
- Evan M Zeitler
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kulveer Dabb
- Department of Gastroenterology and Nutrition, Geisinger, Danville, Pennsylvania
| | - Danial Nadeem
- Department of Gastroenterology and Nutrition, Geisinger, Danville, Pennsylvania
| | - Christopher D Still
- Department of Gastroenterology and Nutrition, Geisinger, Danville, Pennsylvania; Center for Obesity and Metabolic Research, Geisinger, Danville, Pennsylvania
| | - Alexander R Chang
- Center for Kidney Health Research, Departments of Population Health Sciences and Nephrology, Geisinger, Danville, Pennsylvania.
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9
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Alabduljabbar K, le Roux CW. Pharmacotherapy before and after bariatric surgery. Metabolism 2023; 148:155692. [PMID: 37730085 DOI: 10.1016/j.metabol.2023.155692] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
Diabetes is a chronic disease that affects a vast number of individuals globally, and without optimal treatment, can lead to significant health complications. Moreover, obesity is another chronic disease with several complications, which includes type 2 diabetes. Bariatric surgery is a viable long-term choice for managing diseases such as obesity and type 2 diabetes. However, the impact of pharmacotherapy before and after surgery remains unclear. In this review, we assessed the use of pharmacotherapy in patients with obesity with or without diabetes before and after bariatric surgery, focusing on weight loss, glycemic control, and the risk of postoperative complications. We showed that anti-obesity medication has become increasingly important in managing obesity and type 2 diabetes, both before and after bariatric surgery. The use of preoperative pharmacotherapy can optimize patients for surgery and reduce perioperative complications. Meanwhile, postoperative pharmacotherapy can maximize weight loss, improve metabolic outcomes, and lower the risk of weight regain. Medications such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and combination therapies, are now very effective for treating obesity and type 2 diabetes mellitus. However, optimal timing, duration, and which combinations of pharmacotherapy to use with bariatric surgery remain unclear. Additionally, the long-term safety and efficacy of these treatments should be assessed. Integrating pharmacotherapy with bariatric surgery is a promising approach to managing obesity and type 2 diabetes, providing patients with additional options for achieving sustainable weight loss and improving their metabolic health.
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Affiliation(s)
- Khaled Alabduljabbar
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, D04V1W8 Dublin, Ireland; Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, D04V1W8 Dublin, Ireland.
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10
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Bashir B, Iqbal Z, Adam S, Ferdousi M, Chick W, Hussein HA, Syed AA, Le Roux CW, Cohen RV, Malik RA, Soran H. Microvascular complications of obesity and diabetes-Role of bariatric surgery. Obes Rev 2023; 24:e13602. [PMID: 37515402 DOI: 10.1111/obr.13602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
Bariatric surgery in people with obesity can lead to long-term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia-independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes.
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Affiliation(s)
- Bilal Bashir
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William Chick
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | | | - Akheel A Syed
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Endocrinology, Diabetes and Obesity Medicine, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Carel W Le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Ricardo V Cohen
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
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Lingvay I, Sumithran P, le Roux CW, Cohen RV. There is no magic bullet for obesity. Lancet Diabetes Endocrinol 2023; 11:541. [PMID: 37500191 DOI: 10.1016/s2213-8587(23)00191-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Priya Sumithran
- Monash University, Central Clinical School, Melbourne, VIC, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
| | - Ricardo V Cohen
- The Center for the Treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01327-001, Brazil.
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