Weight loss maintenance after bariatric surgery

Impact of medical versus surgical weight loss on cardiovascular outcomes

Obesity contributes to cardiovascular disease in two ways - directly, as an independent risk factor, and indirectly, through its contribution to comorbidities such as hypertension, diabetes, dyslipidemia. This cascade of multiplicative effects means that early management of obesity is instrumental in risk reduction and prevention of adverse cardiovascular outcomes. The amount and sustainability of weight loss has been extensively studied and stratified by medical versus surgical weight loss. Medical weight loss has historically been inferior by both parameters; however, new therapies targeting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptors have demonstrated very promising results independently for both weight loss and cardiovascular disease. In this review, we compare cardiovascular outcomes between bariatric surgical approaches and novel GLP-1/GIP medications. We aim to answer the following question: In this era of new pharmacological weight loss options, does the method of weight loss-surgical or medical-impact cardiovascular risk mitigation, or is the key factor the maintenance of a healthier weight, regardless of the method?

Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results

BACKGROUND

The ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.

METHODS

All consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.

RESULTS

In total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09-5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38-0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.

CONCLUSIONS

At 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.

Application value of continuous nursing in the treatment of obese patients with laparoscopic sleeve gastrectomy

AIM

To explore the value and effectiveness of continuous nursing in obese patients undergoing laparoscopic sleeve gastrectomy.

METHODS

A total of 164 obese patients who were admitted to Nanjing Drum Tower Hospital and underwent planned laparoscopic sleeve gastrectomy in 2022 were retrospectively selected as the control group, and another 164 obese patients undergoing the same surgery in 2022 were chosen as the research group. The control group received routine care, while the research group received continuous nursing care. Comparisons were made between the two groups regarding the patient's body weight, fasting blood glucose levels, dietary habits, exercise and rest compliance, anxiety and depression status, quality of life and sleep, postoperative complications, and satisfaction.

RESULTS

Compared with the control group, the research group showed significant decreases in the patient's body weight, body mass index (BMI), and fasting blood glucose levels, with a significant increase in excess weight loss percentage (%EWL) (all P<0.05). Dietary, exercise, and rest compliance were significantly higher in the research group than those in the control group (all P<0.05). Additionally, patients in the research group scored higher in dimensions such as physical function, general health, social function, emotional role, and mental health compared to the control group (all P<0.05). The Pittsburgh sleep quality index (PSQI) was significantly lower in the research group than that in the control group (P<0.05). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores were significantly lower in the research group than those in the control group (all P<0.05). The complication rate in the research group was significantly lower than that in the control group (all P<0.05). Patient satisfaction with outpatient continuous nursing care was significantly higher in the research group than that in the control group (all P<0.05).

CONCLUSION

Continuous care applied following laparoscopic sleeve gastrectomy significantly improves patients' body weight, BMI, and %EWL. It can also effectively reduce fasting blood sugar levels and improve overall quality of life. Additionally, continuous care significantly enhances patients' compliance with dietary, exercise, and rest recommendations, thereby leading to a significant decrease in anxiety and depression symptoms, and an improvement in patient satisfaction and sleep quality.

Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review

The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.