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Nature Reviews. Endocrinology Mar 2023Although promising therapeutics are in the pipeline, bariatric surgery (also known as metabolic surgery) remains our most effective strategy for the treatment of obesity... (Review)
Review
Although promising therapeutics are in the pipeline, bariatric surgery (also known as metabolic surgery) remains our most effective strategy for the treatment of obesity and type 2 diabetes mellitus (T2DM). Of the many available options, Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are currently the most widely used procedures. RYGB and VSG have very different anatomical restructuring but both surgeries are effective, to varying degrees, at inducing weight loss and T2DM remission. Both weight loss-dependent and weight loss-independent alterations in multiple tissues (such as the intestine, liver, pancreas, adipose tissue and skeletal muscle) yield net improvements in insulin resistance, insulin secretion and insulin-independent glucose metabolism. In a subset of patients, post-bariatric hypoglycaemia can develop months to years after surgery, potentially reflecting the extreme effects of potent glucose reduction after surgery. This Review addresses the effects of bariatric surgery on glucose regulation and the potential mechanisms responsible for both the resolution of T2DM and the induction of hypoglycaemia.
Topics: Humans; Diabetes Mellitus, Type 2; Bariatric Surgery; Gastric Bypass; Insulin; Weight Loss; Gastrectomy; Hypoglycemia; Glucose
PubMed: 36289368
DOI: 10.1038/s41574-022-00757-5 -
JAMA Jun 2022Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.
IMPORTANCE
Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.
OBJECTIVE
To investigate whether bariatric surgery is associated with lower cancer risk and mortality in patients with obesity.
DESIGN, SETTING, AND PARTICIPANTS
In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) matched cohort study, adult patients with a body mass index of 35 or greater who underwent bariatric surgery at a US health system between 2004 and 2017 were included. Patients who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30 318 patients. Follow-up ended in February 2021.
EXPOSURES
Bariatric surgery (n = 5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care (n = 25 265).
MAIN OUTCOMES AND MEASURES
Multivariable Cox regression analysis estimated time to incident obesity-associated cancer (a composite of 13 cancer types as the primary end point) and cancer-related mortality.
RESULTS
The study included 30 318 patients (median age, 46 years; median body mass index, 45; 77% female; and 73% White) with a median follow-up of 6.1 years (IQR, 3.8-8.9 years). The mean between-group difference in body weight at 10 years was 24.8 kg (95% CI, 24.6-25.1 kg) or a 19.2% (95% CI, 19.1%-19.4%) greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group had an incident obesity-associated cancer (incidence rate of 3.0 events vs 4.6 events, respectively, per 1000 person-years). The cumulative incidence of the primary end point at 10 years was 2.9% (95% CI, 2.2%-3.6%) in the bariatric surgery group and 4.9% (95% CI, 4.5%-5.3%) in the nonsurgical control group (absolute risk difference, 2.0% [95% CI, 1.2%-2.7%]; adjusted hazard ratio, 0.68 [95% CI, 0.53-0.87], P = .002). Cancer-related mortality occurred in 21 patients in the bariatric surgery group and 205 patients in the nonsurgical control group (incidence rate of 0.6 events vs 1.2 events, respectively, per 1000 person-years). The cumulative incidence of cancer-related mortality at 10 years was 0.8% (95% CI, 0.4%-1.2%) in the bariatric surgery group and 1.4% (95% CI, 1.1%-1.6%) in the nonsurgical control group (absolute risk difference, 0.6% [95% CI, 0.1%-1.0%]; adjusted hazard ratio, 0.52 [95% CI, 0.31-0.88], P = .01).
CONCLUSIONS AND RELEVANCE
Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.
Topics: Adult; Bariatric Surgery; Cohort Studies; Female; Gastrectomy; Gastric Bypass; Humans; Male; Middle Aged; Neoplasms; Obesity; Obesity, Morbid; Retrospective Studies; Risk; United States; Weight Loss
PubMed: 35657620
DOI: 10.1001/jama.2022.9009 -
Current Diabetes Reports Mar 2023Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further... (Review)
Review
PURPOSE OF REVIEW
Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain.
RECENT FINDINGS
Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
Topics: Humans; Weight Gain; Retrospective Studies; Bariatric Surgery; Obesity; Obesity, Morbid; Gastric Bypass
PubMed: 36752995
DOI: 10.1007/s11892-023-01498-z -
Biomolecules Oct 2021Obesity is a highly prevalent public health concern, attributed to multifactorial causes and limited in treatment options. Several comorbidities are closely associated... (Review)
Review
Obesity is a highly prevalent public health concern, attributed to multifactorial causes and limited in treatment options. Several comorbidities are closely associated with obesity such as the development of type 2 diabetes mellitus (T2DM), cardiovascular and cerebrovascular diseases, and nonalcoholic fatty liver disease (NAFLD). Bariatric surgery, which can be delivered in multiple forms, has been remarked as an effective treatment to decrease the prevalence of obesity and its associated comorbidities. The different types of bariatric surgery create a variety of new pathways for food to metabolize in the body and truncate the stomach's caliber. As a result, only a small quantity of food is tolerated, and the body mass index noticeably decreases. This review describes the improvements of obesity and its comorbidities following bariatric surgery and their mechanism of improvement. Additionally, endocrine function improvements after bariatric surgery, which contributes to the patients' health improvement, are described, including the role of glucagon-like peptide-1 (GLP-1), fibroblast growth factors 19 and 21 (FGF-19, FGF-21), and pancreatic peptide YY (PYY). Lastly, some of the complications of bariatric surgery, including osteoporosis, iron deficiency/anemia, and diarrhea, as well as their potential mechanisms, are described.
Topics: Bariatric Surgery; Diabetes Mellitus, Type 2; Humans; Iron Deficiencies
PubMed: 34827579
DOI: 10.3390/biom11111582 -
Obesity Surgery Apr 2022Obesity in childbearing women leads to pregnancy-related complications such as gestational diabetes mellitus, pregnancy-associated hypertensive disorders, and... (Review)
Review
Obesity in childbearing women leads to pregnancy-related complications such as gestational diabetes mellitus, pregnancy-associated hypertensive disorders, and macrosomia. Weight loss helps reduce these complications. Studies show bariatric surgery reduces obesity-related complications during and after pregnancy. However, bariatric surgery might be associated with adverse outcomes, such as low birth weight and small-for-gestational-age infants. In addition, several studies suggest pregnancy occurring less than a year post-bariatric surgery adversely affects pregnancy outcomes and causes micronutrients deficiency since the dramatic weight loss occurs in the first year. These adverse outcomes may lead to nutritional malabsorption, such as anemia and low vitamin B12 and folic acid levels. The review aims to overview obesity-related complications during pregnancy and the benefits and risks of bariatric surgery on pregnancy outcomes and maternal nutrition status.
Topics: Bariatric Surgery; Female; Humans; Nutritional Status; Obesity, Morbid; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 35165854
DOI: 10.1007/s11695-021-05822-y -
Canadian Family Physician Medecin de... Jun 2020To identify expected pharmacokinetic changes and provide practical recommendations for the medication management of chronic disease states after bariatric surgery. (Review)
Review
OBJECTIVE
To identify expected pharmacokinetic changes and provide practical recommendations for the medication management of chronic disease states after bariatric surgery.
SOURCES OF INFORMATION
MEDLINE, EMBASE, PubMed, Scopus, and the Cochrane Library were searched. The search was limited to studies in human adults. Search terms included and . Reference lists of original studies and reviews were also hand searched. Included studies were entered into PubMed and articles under the "Similar articles" heading were also reviewed. Only studies relevant to bariatric surgery types currently available in Canada (ie, Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric banding) were included.
MAIN MESSAGE
Pharmacokinetic changes anticipated after bariatric surgery vary by surgery type. There are several guiding principles that might be applied to medication management regimens after bariatric surgery. Practice tips are also presented for medication management of specific chronic disease states.
CONCLUSION
Changes to long-term medication regimens after bariatric surgery should be anticipated and managed in an appropriate and timely manner. The provided clinical practice recommendations might be used in conjunction with a patient's clinical picture to adjust chronic medication regimens in an appropriate and evidence-based manner after bariatric surgery.
Topics: Adult; Bariatric Surgery; Canada; Gastric Bypass; Humans; Medication Therapy Management; Obesity, Morbid
PubMed: 32532720
DOI: No ID Found -
International Journal of Environmental... Jul 2022Most studies analyzing the health-related quality of life (HRQOL) after bariatric treatment ceased at five years post-surgery or even earlier, and it is unclear whether... (Review)
Review
BACKGROUND
Most studies analyzing the health-related quality of life (HRQOL) after bariatric treatment ceased at five years post-surgery or even earlier, and it is unclear whether the HRQOL benefit persists for a longer time. This paper reviews sparse evidence regarding HRQOL in patients who underwent bariatric surgery at least nine years prior.
MATERIALS AND METHODS
A of PubMed, Scopus and Google Scholar between 2007-2021 was carried out for the studies investigating HRQOL as an outcome measure in patients after bariatric surgery of any type and having at least a 9-year follow-up. Inconsistent reporting of weight loss or postgraduate study results unrelated to QoL were not included in the study. The study used the PICO procedure.
RESULTS
The review of 18 identified publications demonstrated that bariatric treatment seems to provide a persistent benefit in terms of HRQOL, especially its physical component score. Due to psychological predispositions, some patients appear to be less likely to benefit from bariatric treatment, whether in terms of HRQOL or bodyweight reduction. Inconsistent and imprecise studies may limit the evidence included in a review.
CONCLUSIONS
The early identification of such patients and providing them with holistic care, including psychological intervention, would likely further improve the outcomes of bariatric treatment.
Topics: Bariatric Surgery; Humans; Obesity, Morbid; Outcome Assessment, Health Care; Quality of Life; Weight Loss
PubMed: 35897447
DOI: 10.3390/ijerph19159078 -
British Journal of Clinical Pharmacology Dec 2021Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume... (Review)
Review
Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended-release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advice for oral drug therapy after bariatric surgery, implying that a risk assessment on a case-by-case basis is required for each drug.
Topics: Administration, Oral; Bariatric Surgery; Drug-Related Side Effects and Adverse Reactions; Enterohepatic Circulation; Humans; Pharmaceutical Preparations; Pharmacology; Weight Loss
PubMed: 33990981
DOI: 10.1111/bcp.14913 -
Surgical Endoscopy Jun 2020Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an...
BACKGROUND
Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery.
METHODS
A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards.
RESULTS
Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-to-decision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure.
CONCLUSION
This document summarizes the latest evidence on bariatric surgery through state-of-the art guideline development, aiming to facilitate evidence-based clinical decisions.
Topics: Bariatric Surgery; Endoscopy; Europe; Humans; Obesity, Morbid; Practice Guidelines as Topic; Societies, Medical
PubMed: 32328827
DOI: 10.1007/s00464-020-07555-y -
Chirurgie (Heidelberg, Germany) Jun 2023
Topics: Humans; Bariatric Surgery; Obesity, Morbid
PubMed: 37212897
DOI: 10.1007/s00104-023-01839-4