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The Surgical Clinics of North America Apr 2021Intragastric balloon therapy is an endoluminal treatment of obesity that is indicated for patients with moderate obesity (body mass index, 30-35 kg/m) who have failed... (Review)
Review
Intragastric balloon therapy is an endoluminal treatment of obesity that is indicated for patients with moderate obesity (body mass index, 30-35 kg/m) who have failed to lose weight with lifestyle and medical management. Treatment duration ranges from 4 to 12 months, and percent total body weight loss ranges from 6% to 15% at the time of balloon removal. Adverse events, such as bowel obstruction or gastric perforation, are rare, and early balloon removal because of intolerance is the most common complication. Long-term data are lacking, although weight regain after balloon removal seems to be common.
Topics: Body Mass Index; Endoscopy, Gastrointestinal; Gastric Balloon; Humans; Obesity, Morbid; Weight Loss
PubMed: 33743974
DOI: 10.1016/j.suc.2020.12.009 -
Current Opinion in Clinical Nutrition... Jul 2020To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. (Review)
Review
PURPOSE OF REVIEW
To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery.
RECENT FINDINGS
The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity.
SUMMARY
At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.
Topics: Bariatric Surgery; Blood Glucose; Glycemic Control; Humans; Hyperglycemia; Insulin Resistance; Obesity, Morbid
PubMed: 32205577
DOI: 10.1097/MCO.0000000000000657 -
Obesity Surgery Sep 2019A peculiar category of persons with obesity lacking common metabolic disturbances has been depicted and termed as metabolically healthy obesity (MHO). Yet, although MHO... (Review)
Review
A peculiar category of persons with obesity lacking common metabolic disturbances has been depicted and termed as metabolically healthy obesity (MHO). Yet, although MHO patients are free of obesity-associated complications, they might not be entirely precluded from developing cardio-metabolic disorders. Among patients with morbid obesity (MO) who are referred to bariatric surgery, a subset of metabolically healthy MO (MHMO) has been identified and the question arises if these patients would benefit from surgery in terms of mitigating the peril of cardio-metabolic complications. We revisited the pathophysiological mechanisms that define MHO, the currently available data on the cardio-metabolic risk of these patients and finally we reviewed the benefits of bariatric surgery and the urge to better characterize MHMO before submission to surgery.
Topics: Bariatric Surgery; Cardiovascular Diseases; Humans; Metabolic Diseases; Obesity, Metabolically Benign; Obesity, Morbid; Patient Selection; Risk Factors
PubMed: 31273650
DOI: 10.1007/s11695-019-03964-8 -
Current Hypertension Reports Jun 2020Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the... (Review)
Review
PURPOSE OF REVIEW
Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the mechanisms of the temporal dissociation between blood pressure and body weight after bariatric surgery.
RECENT FINDINGS
Restrictive and bypass bariatric surgery lower blood pressure and plasma leptin levels within days of the procedure in both hypertensive and normotensive morbidly obese patients. Rapidly decreasing plasma leptin levels and minimal loss of body weight point to reduced sympathetic nervous system activity as the underlying mechanism of rapid blood pressure decline after bariatric surgery. After the early rapid decline, blood pressure does not decrease further in patients who, while still obese, experience a steady loss of body weight for the subsequent 12 months. The divergent effects of bariatric surgery on blood pressure and body weight query the role of excess body weight in the pathobiology of the obesity phenotype of hypertension. The decrease in blood pressure after bariatric surgery is moderate and independent of body weight. The lack of temporal relationship between blood pressure reduction and loss of body weight for 12 months after sleeve gastrectomy questions the nature of the mechanisms underlying obesity-associated hypertension.
Topics: Bariatric Surgery; Body Mass Index; Humans; Hypertension; Obesity, Morbid; Treatment Outcome; Weight Loss
PubMed: 32591918
DOI: 10.1007/s11906-020-01049-x -
Best Practice & Research. Clinical... Aug 2023Obesity is currently a global pandemic, with increasing trends worldwide. Data from the WHO, US CDC, and the UK show an increasing trend, with 50% and 25% of the US... (Review)
Review
Obesity is currently a global pandemic, with increasing trends worldwide. Data from the WHO, US CDC, and the UK show an increasing trend, with 50% and 25% of the US population expected to be obese and morbidly obese by 2030. Obesity affects several aspects of health, with increased risks of cardiovascular disease, diabetes, metabolic syndrome, and several malignancies. Morbid obesity significantly impacts several aspects of female life and health, from adolescence, through the reproductive years, to the postmenopausal age group. In gynecology, there is a higher prevalence of menstrual disorders and infertility and reduced success rates of assisted reproduction; increased risk of miscarriage; pelvic organ prolapse; and endometrial, ovarian, and breast cancers. Surgery in the patient with morbid obesity is associated with several logistical challenges as well as increased surgical and peri-operative risks and increased cost. In this review, we provide an overview of the current literature, with a focus on challenges of morbid obesity in gynecological practice.
Topics: Humans; Female; Gynecology; Obesity, Morbid; Prevalence; Reproduction; Infertility
PubMed: 37473647
DOI: 10.1016/j.bpobgyn.2023.102379 -
The Surgical Clinics of North America Apr 2021Revisional bariatric surgery is a growing subset of all bariatric procedures. Although revisions can be associated with higher morbidity rates and less optimal outcomes... (Review)
Review
Revisional bariatric surgery is a growing subset of all bariatric procedures. Although revisions can be associated with higher morbidity rates and less optimal outcomes than those seen with primary procedures, they can be safely performed, with excellent outcomes and improved quality of life for patients. Facility and familiarity with revisional principles and techniques are necessary components of bariatric surgical practice.
Topics: Bariatric Surgery; Humans; Laparoscopy; Obesity, Morbid; Reoperation; Weight Loss
PubMed: 33743965
DOI: 10.1016/j.suc.2020.12.008 -
Transplantation Proceedings 2022Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant....
Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.
Topics: Bariatric Surgery; Gastrectomy; Humans; Non-alcoholic Fatty Liver Disease; Obesity, Morbid; Organ Transplantation; Treatment Outcome; Weight Loss
PubMed: 34973842
DOI: 10.1016/j.transproceed.2021.11.008 -
Current Psychiatry Reports Aug 2019Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on... (Review)
Review
PURPOSE OF REVIEW
Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on psychosocial outcomes and provides a narrative review of recent meta-analyses and controlled studies concerning postoperative depression and suicide.
RECENT FINDINGS
Considerable evidence shows short- and medium-term improvement in depressive symptoms after surgery. However, a subgroup of patients exhibits erosion of these improvements or new onset of depression in the long run. Some studies have found an increased risk for suicide among postoperative patients. Prospective longitudinal examinations of factors contributing to the increased risk for postoperative depression and suicide and the interaction between these factors are warranted. The inclusion of mental health professionals in bariatric teams would help to monitor patients for negative psychosocial outcomes and to identify those patients who are vulnerable to depression, suicide, and any other forms of deliberated self-harm following surgery.
Topics: Bariatric Surgery; Depression; Humans; Obesity, Morbid; Prospective Studies; Suicide
PubMed: 31410656
DOI: 10.1007/s11920-019-1069-1 -
Appetite Mar 2020Flavor-consequence learning refers to learned associations between flavor stimuli and post-oral consequences of food that affect food selection, amount eaten and affect.... (Review)
Review
Flavor-consequence learning refers to learned associations between flavor stimuli and post-oral consequences of food that affect food selection, amount eaten and affect. Forms of flavor-consequence learning include flavor aversions, flavor avoidance, conditioned satiety, expected satiety and appetition. Roux-en-Y gastric bypass surgery (RYGB) and other bariatric procedures alter gastrointestinal processing of food in a number of ways. Thus, it is plausible that these procedures alter post-oral unconditioned stimuli that support flavor-consequence learning, leading to altered food selection, amount eaten, and affect. Surprisingly, however, there is almost no research on the role of flavor-consequence learning in the effects of bariatric surgery on appetite. This issue urgently warrants investigation.
Topics: Appetite; Association Learning; Bariatric Surgery; Flavoring Agents; Food Preferences; Gastric Bypass; Humans; Obesity, Morbid; Postoperative Period
PubMed: 31557496
DOI: 10.1016/j.appet.2019.104467 -
Zentralblatt Fur Chirurgie Feb 2021
Topics: Endoscopy; Gastrectomy; Humans; Obesity, Morbid; Stomach
PubMed: 33588503
DOI: 10.1055/a-1200-6300