A multifaceted training tool to reduce weight bias among healthcare students: A randomized controlled trial

BACKGROUND

Weight bias toward people with obesity (PwO) is common in healthcare settings. Efforts to address weight bias in healthcare settings should begin during university studies. This study aimed to explore the effect of a multifaceted intervention on weight bias among undergraduate healthcare students.

METHODS

An open label randomized controlled trial. The intervention tool consisted of short video lectures on obesity, vignettes simulating interactions between health professionals and PwO, and open discourse with a PwO. The control group received a short-written document on obesity. Online questionnaires on Anti-Fat Attitudes ('AFA'), short form of the Fat-Phobia Scale ('FPS'), Weight Implicit Association Test ('Weight-IAT'), and knowledge about obesity were administered at baseline, 1-week, and 6-week post-intervention.

RESULTS

A total of 162, 152, and 146 students participated in the study at baseline, 1-week, and 6-week post-intervention, respectively. Their mean age was 25.8 ± 6.7 years and 88.3% were women. Means of AFA total scores and FPS scores decreased significantly over time only within the intervention group (P Time*Group = 0.002 and 0.014). Both groups showed a similar trend over time in mean scores of Weight-IAT (P Time*Group = 0.868) and knowledge about obesity (P Time*Group = 0.115).

CONCLUSIONS

A multifaceted intervention resulted in a significant reduction in explicit weight bias but did not yield any additional advantages over the control group in implicit weight bias and knowledge about obesity.

CLINICALTRIALS

GOV NUMBER

NCT05482802.

One Anastomosis Gastric Bypass in 6722 Patients: Early Outcomes from a Private Hospital Registry

BACKGROUND

One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications.

METHODS

Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients' characteristics, surgical procedure, and ≤30-day complications with Clavien-Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB.

RESULTS

A total of 6722 patients underwent a pOAGB (n = 5088, 75.7%) or rOAGB (n = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m2, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (n = 133, 2.0%), leaks (n = 31, 0.5%), and obstruction/strictures (n = 19, 0.3%). CDC complications for grades 1-2 and grades 3a--5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (n = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB.

CONCLUSIONS

OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture.

Gastrointestinal reported outcomes following One Anastomosis Gastric Bypass based on a multicenter study

OBJECTIVES

To describe gastrointestinal-related side-effects reported following One Anastomosis Gastric Bypass (OAGB).

METHODS

A multicenter study among OAGB patients across Israel (n=277) and Portugal (n=111) who were recruited to the study based on time elapsed since surgery was performed. An online survey with information on demographics, anthropometrics, medical conditions, and gastrointestinal outcomes was administered in both countries simultaneously.

RESULTS

Respondents from Israel (pre-surgery age of 41.6±11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6±12.3 years, 79.3% females) presented mean excess weight loss of 51.0±19.9 and 62.4±26.5%, 89.0±22.0 and 86.2±21.4%, and 89.9±23.6 and 98.2±20.9% (P<0.001 for both countries), at 1-6 months, 6-12 months, and 1-5 years post-surgery, respectively. Median Gastrointestinal Symptom Rating Scale score was similar between time elapsed since surgery groups among respondents from Israel and Portugal (≤1.97 and ≤2.12). A notable proportion of respondents from Israel and Portugal at all time points reported 1-3 bowel movements per day (≤62.8 and ≤87.6%), Bristol stool scale categories which represent diarrhea-like stools (≤51.9 and ≤56.3%), having discomfort due to flatulence (≤79.4 and ≤90.2%), and mild to severe dyspepsia symptoms (≤50.5 and ≤73.0%).

CONCLUSIONS

A notable proportion of OAGB patients might experience certain gastrointestinal symptoms postoperatively, including flatulence, dyspepsia, and diarrhea-like stools.

Nutritional and Lifestyle Behaviors Reported Following One Anastomosis Gastric Bypass Based on a Multicenter Study

This study aimed to describe nutritional and lifestyle parameters following one-anastomosis gastric bypass (OAGB). A multicenter study among OAGB patients across Israel (n = 277) and Portugal (n = 111) was performed. Patients were approached according to the time elapsed since surgery. An online survey with information regarding demographics, anthropometrics, and nutritional and lifestyle aspects was administered in both countries simultaneously. Respondents from Israel (pre-surgery age of 41.6 ± 11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6 ± 12.3 years, 79.3% females) reported changes in their appetite (≤94.0% and ≤94.6%), changes in their taste (≤51.0 and ≤51.4%), and intolerance to specific foods (i.e., red meat, pasta, bread, and rice). Bariatric surgery-related eating recommendations were generally followed well, but a trend toward lower adherence was evident in groups with longer time elapsed since surgery in both countries. Most respondents from Israel and Portugal reported participation in follow-up meetings with a surgeon (≤94.0% and 100%) and a dietitian (≤92.6% and ≤100%), while far fewer reported participation in any follow-up meeting with a psychologist/social worker (≤37.9% and ≤56.1%). Patients following OAGB might experience changes in appetite, taste, and intolerance to specific foods. Adherence to bariatric surgery-related eating recommendations is not always satisfying, especially in the longer term post-surgery.

The Effects of One Anastomosis Gastric Bypass Surgery on the Gastrointestinal Tract

One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, yet data on its effect on the gastrointestinal tract are lacking. This study sought to evaluate the incidence of small-intestinal bacterial overgrowth (SIBO) following OAGB; explore its effect on nutritional, gastrointestinal, and weight outcomes; and assess post-OABG occurrence of pancreatic exocrine insufficiency (PEI) and altered gut microbiota composition. A prospective pilot cohort study of patients who underwent primary-OAGB surgery is here reported. The pre-surgical and 6-months-post-surgery measurements included anthropometrics, glucose breath-tests, biochemical tests, gastrointestinal symptoms, quality-of-life, dietary intake, and fecal sample collection. Thirty-two patients (50% females, 44.5 ± 12.3 years) participated in this study, and 29 attended the 6-month follow-up visit. The mean excess weight loss at 6 months post-OAGB was 67.8 ± 21.2%. The glucose breath-test was negative in all pre-surgery and positive in 37.0% at 6 months (p = 0.004). Positive glucose breath-test was associated with lower reported dietary intake and folate levels and higher vitamin A deficiency rates (p ≤ 0.036). Fecal elastase-1 test (FE1) was negative for all pre-surgery and positive in 26.1% at 6 months (p = 0.500). Both alpha and beta diversity decreased at 6 months post-surgery compared to pre-surgery (p ≤ 0.026). Relatively high incidences of SIBO and PEI were observed at 6 months post-OAGB, which may explain some gastrointestinal symptoms and nutritional deficiencies.

The Effect of an Education Module to Reduce Weight Bias among Medical Centers Employees: A Randomized Controlled Trial

INTRODUCTION

Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting.

METHODS

An open-label randomized controlled trial was conducted among all employees of a chain of private medical centers in Israel (n = 3,290). Employees who confirmed their consent to participate in the study were randomized into intervention or control (i.e., "no intervention") arms. The study intervention was an online 15-min educational module that included obesity, weight bias, stigma, and discrimination information. Questionnaires on Anti-Fat Attitudes (AFA), fat-phobia scale (F-scale), and beliefs about the causes of obesity were answered at baseline (i.e., right before the intervention), 7 days, and 30 days post-intervention.

RESULTS

A total of 506, 230, and 145 employees responded to the baseline, 7-day, and 30-day post-intervention questionnaires, respectively. Mean participant age was 43.3 ± 11.6 years, 84.6% were women, and 67.4% held an academic degree. Mean F-scale scores and percentage of participants with above-average fat-phobic attitudes (≥3.6) significantly decreased only within the intervention group over time (p ≤ 0.042). However, no significant differences between groups over time were observed for AFA scores or factors beliefs to cause obesity.

CONCLUSIONS

A single exposure to an online education module on weight bias and knowledge about obesity may confer only a modest short-term improvement in medical center employees' fat-phobic attitudes toward people with obesity. Future studies should examine if reexposure to such intervention could impact weight bias, stigma, and discrimination among medical center staff in the long-term.

Early Outcomes and Mid-Term Safety of One Anastomosis Gastric Bypass Are Comparable with Roux-en-Y Gastric Bypass: a Single Center Experience

BACKGROUND

The use of one anastomosis gastric bypass (OAGB) has increased in recent years. However, the efficacy and safety outcomes of this procedure remain under debate. Here, we compare our early outcome and mid-term safety of OAGB with primary Roux-en-Y gastric bypass (RYGB).

METHODS

This was a retrospective study using computerized electronic medical records data of patients who underwent RYGB or OAGB as a primary procedure from February 2012 to February 2019 in our bariatric center. Data collected included demographics, weight-outcomes, adverse events, hospital readmission, reoperation rates, and mortality following both procedures.

RESULTS

A total of 314 patients were included (132 RYGB and 182 OAGB). Operative time and costs were significantly lower for OAGB (80 vs. 125 min, p<0.01 and 2018.8 vs. 2912.3 USD, p < 0.01, respectively), but length of hospital stay was longer (4.06 ± 0.67 days vs. 3.58 ± 0.79, p < 0.0001). At 12 months post-surgery, the percentage of excess body mass index loss was comparable between the two groups, but the change in body mass index (BMI) was significantly higher in the OAGB group. Early (< 30 days) and late (> 30 days) surgical adverse events were also similar between the two groups.

CONCLUSION

Comparable short- and mid-term outcomes and adverse events are found for primary OAGB and RYGB. OAGB is not inferior to RYGB as a primary bariatric procedure for the treatment of obesity.

Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice

Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.

Factors Associated with the Development of Anemia During Pregnancy After Sleeve Gastrectomy

PURPOSE

Nutritional deficiencies, particularly anemia, are commonly encountered following bariatric surgery. While anemia during pregnancy is associated with various adverse maternal and perinatal outcomes, the factors associated with its occurrence following bariatric surgery have not been established. We explored the factors associated with the development of anemia during pregnancy after laparoscopic sleeve gastrectomy (SG).

MATERIALS AND METHODS

We reviewed the records of women who underwent SG and delivered during 2010-2018 in a single university hospital.

RESULTS

Of 121 women, 68 (56.2%) had evidence of anemia (hemoglobin < 11.0 g/dL) prior to delivery, with significantly lower hemoglobin levels compared with those (n = 53) without anemia (median 9.9 vs. 11.4 g/dL, P < 0.001). Significantly lower hemoglobin levels were found among those with pre-delivery anemia, both at the pre-operative stage (median 12.9 vs. 13.3 g/dL, P = 0.02) and at early pregnancy (median 12.0 vs. 12.6 g/dL, P = 0.05), compared with those without anemia. In multivariate analysis, a lower pre-operative hemoglobin level was the only independent factor associated with pre-delivery anemia (OR (95% CI) 1.59 (1.05, 2.40), P = 0.03). The rate of blood transfusion was significantly higher in women with pre-delivery anemia than in women without anemia (7.4% vs. 0, P = 0.04).

CONCLUSIONS

Anemia during pregnancy after SG was common; pre-operative hemoglobin level was identified as an independent predictor of its occurrence. Efforts should be invested to implement anemia risk stratification before surgery among reproductive-age women, and to optimize maternal nutritional status prior to pregnancy, as well as during the prenatal course.

Health Status, Eating, and Lifestyle Habits in the Long Term Following Sleeve Gastrectomy

INTRODUCTION

Sleeve gastrectomy (SG) is an established bariatric procedure. However, long-term data on eating and lifestyle behaviors and their effect on weight outcomes are scarce. Therefore, this study aimed to examine these long-term behaviors and their associations to weight outcomes following SG.

METHODS

A long-term follow-up study (>5 years post-surgery) of 266 adult patients admitted to a primary SG surgery during 2008-2012 and who participated in a pre-surgery study was conducted. Data on pre-surgery demographics, anthropometrics, and medical status were obtained from the patients' medical records. Data on long-term health status, anthropometrics, lifestyle and eating habits, eating pathologies, follow-up regime, and satisfaction from the surgery were collected by an interview phone calls according to a structured questionnaire.

RESULTS

Data of 169 patients were available before and 7.8±1.0 years post-SG. Their baseline mean age was 41.8±11.3 years, and 71.6% of them were females. The mean post-surgery excess weight loss (EWL) was 53.2±31.2%, and 54.2% had EWL of ≥50%. Eating 3-6 meals per day, not having the urge to eat after dinner, separating liquids from solids, avoiding carbonated beverages, and performing physical activity were related to better weight-loss outcomes (P≤0.026). However, frequent need for eating sweets, binge eating, and feeling guilty or sad after eating were related to worse weight-loss outcomes (P≤0.010). Furthermore, only a minority reported taking a multivitamin and participating in follow-up meetings after more than 1 year since the surgery (≤21.3%).

CONCLUSIONS

In the long term following SG, approximately half achieved EWL of ≥50%, and physical activity, certain eating patterns, and eating pathologies were related to weight outcomes.

Food Addiction and Binge Eating During One Year Following Sleeve Gastrectomy: Prevalence and Implications for Postoperative Outcomes

BACKGROUND

Food addiction and binge eating are common among individuals with obesity. However, a paucity of studies prospectively examined the prevalence and implications of food addiction before and post-bariatric surgery. We aimed to examine the prevalence of food addiction and binge eating before and after sleeve gastrectomy (SG) and to assess their associations with behavioral and weight loss outcomes.

METHODS

We followed at 3 (M3), 6 (M6), and 12 (M12) months postoperative, 54 women who underwent SG. Data collected including anthropometrics, nutritional intake, food tolerance, and physical activity measures. The Yale Food Addiction Scale and the Binge Eating Scale were used to characterize food addiction and binge eating, respectively.

RESULTS

The mean baseline age and BMI were 32.1 ± 11.1 years and 44.9 ± 4.9 kg/m², respectively. Pre-surgery, food addiction, and binge eating were identified in 40.7% and 48.1% of patients, respectively. The prevalence of food addiction decreased significantly up to M6, but increased to 29.3% at M12. The prevalence of binge eating decreased significantly through the follow-up up to 17.4% at M12. Those who met criteria for food addiction at M12 achieved significantly lower excess weight loss at M12 compared with those not meeting this criterion (P = 0.005). Food addiction scores at M12 negatively correlated with weekly physical activity (r = - 0.559; P < 0.001) and food tolerance scores (r = - 0.428; P = 0.005).

CONCLUSIONS

The reduction in food addiction observed at M6 was not maintained at M12. Food addiction at M12 was associated with poorer weight loss, eating, and lifestyle behaviors. Clinical practice should focus on the psychological aspects associated with obesity.

Frequently used medicinal herbs and spices in weight management: a review

Background: Obesity rates have increased globally during the last half, and with it there has been increased interest in herbs and dietary supplements for weight managementObjectives: The purpose of the present review is to examine evidence for the efficacy and safety of herbal preparations including cinnamon, capsaicin, black pepper, and curcumin, which are popularly used for weight reduction.Methods: A list of herbs and dietary supplements frequently used in weight management was developed by reviewing both scientific and popular literature. Included herbs/supplements were evaluated in terms of pre-clinical and clinical studies.Results: Included in the review were cinnamon, capsaicin, black pepper and curcumin. For all of the included herbs, proof of concept could be demonstrated. Few well-designed, adequately powered clinical trials were available but those that were suggested efficacy.Conclusions: While underlying metabolic/physiological mechanisms have been identified in pre-clinical studies, human studies of efficacy are sparse. An indication towards efficacy in humans exists for all of these products; however, treatment guidelines cannot be developed until better-quality randomized clinical trials can provide clear findings.Keywords: Cinnamon; Capsaicin; Black Pepper; Curcumin; Weight Management

The use of Ursolit for gallstone prophylaxis following bariatric surgery: a randomized-controlled trial

BACKGROUND

Although bariatric surgery (BS) predisposes patients to development of gallstone formation, a preventive strategy is still in debate.

AIM

To compare the incidence of gallstone formation between patients treated with ursodeoxycholic acid (UDCA) vs. placebo for a duration of 6 months following BS.

METHODS

This multicenter randomized, double-blind controlled trial entails treatment with UDCA vs. an identical-looking placebo. The primary outcome was gallstone formation, as measured by abdominal ultrasound.

RESULTS

The data of 209 subjects were enrolled in the study, and 92 subjects completed the study and were analyzed (n = 46 for each study group). The high dropout rate was mainly due to difficulties in adding more medications and swallowing the pill. Among the subjects who completed the study, 77.2% were women, and their mean age and pre-surgery BMI were 42.2 ± 10.2 years and 44.4 ± 6.1 kg/m², respectively. Gallstone formation was recorded in 45.7% (n = 21) vs. 23.9% (n = 11) of subjects among placebo vs. UDCA groups, respectively, p = 0.029. Subgroup-analysis, according to surgery type, found that the results were significant only for SG subjects (p = 0.041), although the same trend was observed for OAGB/RYGB. Excess Weight Loss percent (%EWL) at 6 months post-surgery was 66.0 ± 17.1% vs. 71.8 ± 19.5% for the placebo and UDCA groups, respectively; p = 0.136. A trend towards a reduction in prescribed comorbidity medications was noted within-groups during the follow-up period, as compared to baseline, with no between-group differences (p ≥ 0.246). Moreover, no between-group differences were found for blood test results (p ≥ 0.063 for all).

CONCLUSION

Administration of UDCA significantly decreased gallstone formation at 6 months at following BS. CLINICALTRIALS.

GOV NUMBER

NCT02319629.

The rise of one anastomosis gastric bypass: insights from surgeons and dietitians

One anastomosis gastric bypass/Mini Gastric Bypass (OAGB/MGB) is an emerging bariatric surgery (BS) technique. We evaluated and compared attitudes of bariatric surgeons and dietitians towards the considerations for choosing BS-type ("Decision-making"), the contributing factors to the rise of OAGB/MGB in Israel ("OAGB/MGB-rise") and notions regarding the occurrence of gastrointestinal (GI) symptoms and nutritional deficiencies following OAGB/MGB. Anonymous online surveys were distributed. The participants were asked to rate by a 10-point Likert scale (0 = not at all; 100 = very much/often) their attitudes towards "Decision-making", "OAGB/MGB-rise" and occurrence of GI symptoms and nutritional deficiencies following OAGB/MGB. For "Decision-making" and "OAGB/MGB-rise", items were considered prioritized where ≥ 50% of the group considered them as 'very-important' (rating ≥ 80). Data on age, sex, years-in-practice and main workplace were also collected. A total of 106 professionals participated in the survey (42 surgeons; 64 dietitians). The respective mean age, years-in-practice and sex were 52.3 ± 8.7 vs. 42.3 ± 9.0 years, 21.0 ± 10.8 vs. 15.5 ± 9.2 years and 85.7% vs. 3.1% males. The inter-observer agreement for prioritized items related to "Decision-making" was fair (Kappa = 0.250; P = 0.257) and both groups prioritized patient's BMI, comorbidities and compliance. The inter-observer agreement for prioritized items related to "OAGB/MGB-rise" was moderate (Kappa = 0.550; P = 0.099) and both groups prioritized ease of performance, shorter operation duration and failure of former restrictive BS. Surgeons reported lower occurrence of nutritional deficiencies and GI symptoms as adverse effects of OAGB/MGB (P ≤ 0.033). The study highlights the views of bariatric surgeons and dietitians concerning factors that underpin the rise of OABG/MGB in Israel and possible rates of GI symptoms and nutritional deficiencies associated with this modality.

Circulating Endocannabinoids Are Reduced Following Bariatric Surgery and Associated with Improved Metabolic Homeostasis in Humans

BACKGROUND

The endocannabinoid (eCB) system plays a key role in the development of obesity and its comorbidities. Limited information exists on the changes in circulating eCBs following bariatric surgery.

OBJECTIVES

This study aims to (i) assess the circulating levels of eCBs and related molecules and (ii) examine the association between their levels and numerous clinical/metabolic features pre- and post-operatively.

METHODS

Sixty-five morbidly obese patients (age 42.78 ± 9.27 years; BMI 42.00 ± 5.01 kg/m²) underwent laparoscopic sleeve gastrectomy (LSG) surgery, and were followed up for 12 months. Data collected included anthropometrics and metabolic parameters. The serum levels of the eCBs, 2-arachidonoylglycerol (2-AG), anandamide (AEA); and their related molecules, arachidonic acid (AA) and oleoylethanolamine (OEA) were measured by liquid chromatography-mass spectrometry.

RESULTS

Levels of 2-AG, AEA, and AA were reduced post operatively with no differences in serum OEA levels. The delta changes in eCB levels between pre- and post-operation were correlated with the delta of different metabolic parameters. Positive correlations were found between delta AA and waist circumference (WC) (r = 0.28, P < 0.05), free fat mass (r = 0.26, P < 0.05), SteatoTest score (r = 0.45, P < 0.05), and ALT (r = 0.32, P < 0.05). Delta AEA levels positively correlated with WC (r = 0.30, P < 0.05). Delta 2-AG levels positively correlated with total cholesterol (r = 0.27, P < 0.05), triglycerides (r = 0.55, P < 0.05), and SteatoTest score (r = 0.27, P < 0.05). Delta OEA levels negatively correlated with fasting glucose levels (r = - 0.27, P < 0.05).

CONCLUSIONS

This study provides compelling evidence that LSG surgery induces reductions in the circulating 2-AG, AEA, and AA levels, and that these changes are associated with clinical benefits related to the surgery including reduced fat mass, hepatic steatosis, glucose, and improved lipid profile.

Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment?

BACKGROUND

Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies.

OBJECTIVE

The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup.

DESIGN

A cross-sectional study of data collected at the time of the preoperative evaluation.

PARTICIPANTS/SETTING

Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected.

STATISTICAL ANALYSES

Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ² test.

RESULTS

Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively).

CONCLUSIONS

The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

The Effect of Pre-Surgery Information Online Lecture on Nutrition Knowledge and Anxiety Among Bariatric Surgery Candidates

INTRODUCTION

Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS.

METHODS

An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1-2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records.

RESULTS

Data for paired study questionnaires scores were available for 128 patients (n = 69 and n = 59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3 ± 11.4 years and 41.3 ± 4.9 kg/m², respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P ≤ 0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P = 0.030). No within or between-group differences were found for the trait anxiety items score. The "dream" and "realistic" weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P < 0.001 for all).

CONCLUSION

Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.

Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy

BACKGROUND AND AIMS

Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG).

METHODS

A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery.

RESULTS

Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss "failure" (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up.

CONCLUSIONS

Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.

Vitamin K-what is known regarding bariatric surgery patients: a systematic review

Vitamin K, a fat-soluble vitamin, is involved in blood coagulation, bone mineralization, inhibition of vascular calcification, and regulation of numerous enzyme systems. Patients who undergo bariatric surgery (BS), especially procedures that involve a malabsorptive component, are prone to develop vitamin K deficiency (VKD). The causes of VKD include decreased absorptive surface areas, steatorrhea, bacterial overgrowth, marked reduction of carriers of vitamin K, decrease in vitamin K intake, and modifications of gut microbiota. Data on vitamin K status among BS patients are scarce and the strength of evidence supporting vitamin K supplementation is weak. Thus, this systematic review summarized the scientific literature on vitamin K and examined the status among patients before and after BS, as well as among pregnant women with a history of BS. A MEDLINE/Pubmed and Embase electronic search was performed. After a thorough screening of 204 titles, 19 articles were selected by 2 independent reviewers. Five studies on BS candidates (n = 750), 12 studies after BS (n = 1442), and 4 studies on pregnant woman after BS (n = 83, of them n = 7 from case reports) were included. Results of the current review suggest that patients who undergo major malabsorptive surgeries are at a higher risk of developing VKD and should be better monitored. At this point, it is still unclear whether supplementation of vitamin K is required, and what oral dose or vitamer type should be used to normalize serum levels after different types of bariatric procedures. It should be noted that the current protocols for VKD treatment are still experiential in these patients. It is also unknown at what intervals screening tests for vitamin K should be performed and what assay is most appropriate for screening purposes. Future studies are needed to answer these unresolved issues.

Nutritional status following One Anastomosis Gastric Bypass

BACKGROUND & AIMS

One Anastomosis Gastric Bypass (OAGB) has been accepted as an effective treatment for morbid obesity. However, data are scarce regarding nutritional implications of this procedure. Thus, our aim was to describe the health and nutritional status 12-20 months following OAGB surgery.

METHODS

A prospective cohort study on patients who underwent OAGB surgery from January 2016 to May 2017 in a large, multi-disciplinary, bariatric clinic. Pre-surgery data including demographic details, anthropometrics, co-morbidities, blood tests and lifestyle habits were obtained from the patients' medical records. Follow-up evaluations were performed 12-20 months post-surgery and data collected included anthropometrics, blood tests, eating and lifestyle parameters, adherence to follow-up regime and gastrointestinal (GI) related side effects. In addition, patients were asked to rate their overall state of health (OSH) from 0 to 100 using a visual analogue scale (VAS).

RESULTS

Eighty-six OAGB patients (72.1% women) were tested 14.7 ± 2.0 months post-operatively. Their mean age and BMI preoperatively were 46.1 ± 11.4 years and 42.0 ± 4.9 kg/m², respectively. The mean % excess weight loss at 12-20 months postoperatively was 88.4 ± 19.3%. Lipid and glucose profiles were significantly improved at 12-20 months postoperatively compared to baseline (P < 0.001 for all). Relatively high proportions of nutritional deficiencies were found pre-operatively and postoperatively for iron (33.9% vs. 23.7%, P = 0.238), folate (30.9% vs. 11.8%, P = 0.004), vitamin D (56.6% vs. 17.0%, P < 0.001) and hemoglobin (16.7% vs. 42.9%, P < 0.001). Postoperatively, most participants reported taking multivitamin, calcium, vitamin D and vitamin B12 supplementation (≥62.8%), having participated in at least 6 meetings with a dietitian (51.8%) and presently doing physical activity (69.4%). The mean postoperative OSH VAS score was 88.2 ± 12.3, but most participants reported on flatulence (67.4%) and some reported on diarrhea (25.6%) as GI side effects of the surgery.

CONCLUSIONS

Substantial improvements in health and anthropometric parameters are found in the short-term follow-up after OAGB, with a satisfactory reported quality of life and adherence to recommendations. However, a high prevalence of some GI side effects, nutritional deficiencies and specially anemia is a matter of concern.

Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review

Bariatric surgery (BS) may be effective for chronic kidney disease (CKD) patients by reducing microalbuminuria and proteinuria, and by facilitating their meeting inclusion criteria for kidney transplantation. However, nutritional management for this population is complex and specific guidelines are scarce. A literature search was performed to create dietetic practice for these patients based on the most recent evidence. For the purposes of nutritional recommendations, we divided the patients into 2 subgroups: 1) patients with CKD and dialysis, and 2) patients after kidney transplantation. Before surgery, nutritional care includes nutritional status evaluation and adjusting doses of supplements to treat deficiencies and daily nutrient intake according to the dietary restrictions derived from kidney disease, including quantities of fluids, protein, phosphorus, potassium, and vitamins. After BS, these patients are at major risk for lean body mass loss, malnutrition and dehydration because of fluid restriction and diuretics. Postoperative nutritional recommendations should be carefully tailored according to CKD nutritional limitations and include specific considerations regarding protein, fluids, and supplementation, in particular calcium, vitamin A, and vitamin D. Nutritional management of CKD and kidney transplant patients undergoing BS is challenging and future studies are required to establish uniform high-level evidence-based guidelines.

Perceptions of Success in Bariatric Surgery: a Nationwide Survey Among Medical Professionals

INTRODUCTION

Various definitions for bariatric surgery (BS) success exist, with weight loss and comorbidity resolution outcomes being the most prominent. The study's aim was to compare how various healthcare professionals perceive success in BS.

METHODS

A 29-item, 10-point Likert scale online survey was distributed via email to Israeli healthcare professionals involved in the different BS aspects using common national professional organizations. These included bariatric surgeons, dietitians, social workers, psychologists, psychiatrists, primary care physicians, gastroenterologists, and nurses. Statement relevancy to BS success was rated. An item was classed as "very important" for BS success if at least 70% of participants rated it 8 or higher in each subgroup. Inter-observer agreement was calculated using kappa statistics. Data on specific occupation, years-in-practice, and major workplace were collected as well.

RESULTS

A total of 155 responses was obtained. The majority of respondents were dietitians (34.8%, n = 54), followed by bariatric surgeons (31.0%, n = 48) and nurses (14.8%, n = 23). Most respondents work mainly at public hospitals (32.9%, n = 51), followed by private hospitals (26.5%, n = 41). The mean years-in-practice among all healthcare professionals was 8.5 ± 8.5 years. Overall inter-observer agreement for prioritized items in accordance to BS success among all health professional subgroups was fair (Fleiss kappa = 0.278, P < 0.001), while dietitians and mental health specialists showed the highest agreement rate (Cohen's kappa = 0.592, P < 0.001).

CONCLUSION

The study highlights the various views on defining BS success by different healthcare professionals, although there was some overlap of core outcomes prioritized by all professionals. International uniform definitions for BS success are required.

Correction to: Incidence and Risk Factors for Mortality Following Bariatric Surgery: a Nationwide Registry Study

In Table 5 the P value for the parameter "More than one chronic disease" is incorrect. The correct value is 0.387, not 0.0387.

Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss

Bariatric surgery (BS) is an effective treatment for morbid obesity and its associated comorbidities. Following such a procedure, however, patients are at risk of developing metabolic bone disease owing to the combination of rapid weight loss, severely restricted dietary intake, and reduced intestinal nutrient absorption. Patients undergoing malabsorptive procedures are at a higher risk of postoperative bone health deterioration than those undergoing restrictive procedures; however, studies have demonstrated negative skeletal consequences of restrictive procedures as well. The clinical practice guidelines of some international associations have previously addressed preoperative evaluation and postoperative clinical care in order to maintain bone health in BS patients. Nevertheless, some issues regarding bone health in BS patients remain unclear owing to the lack of relevant randomized clinical trials, including doses of nutritional supplements pre- and post-BS. This review summarizes the current data regarding the skeletal consequences of BS and its mechanisms, with an emphasis on the preventive strategies and nutritional care that may be warranted in order to attenuate bone deterioration following BS.