Saliva was used as non-invasive alternative to blood for diagnosing pathophysiological conditions. This study aimed to assess changes in protein profile in people with obesity after bariatric surgery and to assess the impact of exercise on these changes. The saliva proteome was determined from two-dimensional gels of twenty adults (ten people with normal weight and ten people with obesity). The effects of bariatric surgery and exercise were assessed. A decrease in body weight, body mass index, and waist-to-height ratio was observed after bariatric surgery. Low levels of carbonic anhydrase VI (CA-VI), short palate, lung, and nasal epithelium clone 2 (SPLUNC2), and haptoglobin were observed. One month after bariatric surgery, spots of haptoglobin and SPLUNC2 increased, although one CA-VI spot decreased. Zn-alpha-2 glycoprotein, immunoglobulin chains, and actin-related protein-3, which are high in people with obesity, decreased 1 month after bariatric surgery. Five months after bariatric surgery, the most significant change was the amylase decrease. The exercise-induced changes in salivary proteins increased SPLUNC, CA-VI, type S cystatins, actin cytoplasmic 1, and zinc alpha-2 glycoprotein levels and decrease Ig kappa chain C region and Rab GDP dissociation inhibitor beta. It can be concluded that the salivary proteins change between people with normal weight vs. patients with obesity, as well as after bariatric surgery and exercise programmes. Salivary proteins may be useful biomarkers in non-invasive samples for monitoring and assessing the impact of interventions on people with obesity.

It is important to know what individuals experience in the complex long-term process after bariatric and metabolic surgery, this information is now more sought after. It can be used to improve patient care management by better understanding individuals' long-term life experiences after bariatric and metabolic surgery.

This qualitative study aimed to determine the long-term experiences of patients who underwent bariatric and metabolic surgery using a phenomenological design.

The study was conducted as qualitative research. It included 16 volunteers who underwent bariatric and metabolic surgery at least 5 years ago. Its data was collected using a semi-structured in-depth interview method. The collected data were analysed through a content, descriptive, and thematic analysis process and supported by the participants' metaphors.

In the study, 10 of the participants were female and six were male. Only one of the participants underwent adjustable gastric band surgery, the others underwent sleeve gastrectomy. Content analysis of the data revealed four main themes. These were: 'emotions and thoughts created by bariatric surgery', 'gains brought by the new body', 'difficulties brought by the new body', 'the point reached in the journey of process'.

Long Term Patient Experiences after Bariatric and Metabolic Surgery, which were both positive and negative, provide information about the participant's postsurgical process and what can be done to improve it and help patients in their recovery.

Endoscopic gastroplasty (EG) is a less invasive method for managing obesity compared with bariatric surgery. However, evidence on the use of EG is still scarce. This study aims to review existing evidence comparing EG with lifestyle modifications (LM) in terms of weight loss and improvement in metabolic syndrome.

A systematic search was performed on PubMed, Embase, and the Cochrane Library from inception to August 2023. Exclusion criteria were patients who received concomitant pharmacological therapy for weight loss, the use of other endoscopic interventions apart from EG, and patients with prior bariatric surgery. Based on the heterogeneity of included studies, meta-analysis was performed using either a fixed-effect model or a random-effect model.

There were 5 studies (4 RCTs and 1 retrospective study) with 1007 patients included in the pooled analysis. Only a minority were males (n=199, 19.8%), and only 1 study included a Sham procedure in the LM group. Six-month percentage total body weight loss (%TBWL) (n=3 studies, MD: 6.34, 95% CI: 2.89, 9.78, P <0.01) and 12-month %TBWL (n=4 studies, MD: 6.43, 95% CI: 2.62, 10.25, P <0.01) were significantly higher in EG compared with LM. Patients in the EG group also had significant improvement in control of diabetes mellitus (n=2 studies, OR: 29.10, 95% CI: 5.84, 145.08) and hypertension (n=2 studies, OR: 2.35, 95% CI: 1.18, 4.70) compared with LM. Incidence of serious adverse events ranged from 2% to 5%.

EG is effective for weight loss and improvement in metabolic comorbidities compared with LM alone but is suboptimal based on the Food and Drug Administration thresholds.

Bariatric surgery (BS) leads to a durable weight loss and remission of diabetes, but the long-term impact on hypertension and lipid disorders is not unequivocal. The aim of the study was to assess the impact of BS on the level of cardiovascular (CV) risk factors and estimate CV risk 10 years following BS.

The study included patients who underwent BS in 2010-2015, re-evaluated in 2023-2024. The CV risk was estimated using the Pooled Cohort Equations calculator.

The analysis included 188 patients (76 % women), with a mean age of 43.3 ± 9.8 years, who underwent sleeve gastrectomy (73.4 %) and gastric bypass (26.6 %). The observation period lasted 10 (9-11) years, and BMI decreased from 41.7 (38.2-46.0) kg/m2 to 33.9 (29.4-38.8) kg/m2 (p < 0.001). The prevalence of hypertension decreased from 76.6 % to 67.0 % (p < 0.05), while the prevalence of diabetes (31.9 % vs. 23.9 %; p = 0.08), hypercholesterolemia (77.1 % vs. 70.7 %; p = 0.16), and smoking (from 35.6 % to 31.4 %; p = 0.39) did not change significantly. CV risk increased from 1.6 % (0.6-4.2 %) to 2.6 % (1.0-6.7 %) (p < 0.001). Since patients examined during the follow-up examination were 10 years older and since age is a main driver of CV risk, we also calculated CV risk using the baseline age, which was significantly lower, 1.1 % (0.4-3.0 %; p < 0.001 vs baseline).

Long-term weight reduction following BS is related to the decrease in the estimated CV risk.

Obesity adversely impacts musculoskeletal health, contributing to functional limitations and an increased risk for falls, fractures and disability. Weight loss can mitigate these effects, but strategies that neglect to incorporate evidence-based dietary and/or exercise approaches can exacerbate musculoskeletal and functional declines. Sustainable weight loss requires a personalised approach that prioritises adequate protein intake and essential nutrients to preserve musculoskeletal health. To enhance adherence and long-term success, dietary strategies should be practical, nutritionally balanced and cost-effective. Similarly, exercise programmes should be individually tailored and progressive, with resistance training central to any program prescribed in the context of weight loss, due to its critical role in maintaining muscle and bone mass and strength. When prescribing weight loss strategies involving lifestyle behaviour changes, clinicians must consider their patient's readiness to change. We have used the transtheoretical model of change framework as an example to identify a patient's level of readiness and provided associated motivational interviewing-based strategies to enhance adherence and engagement. This review outlines evidence-based, practical diet and exercise recommendations and behavioural strategies that can facilitate effective and sustainable weight loss, which is particularly important for at-risk populations such as older adults.

Objectives: The primary objective of this review is to analyze the effects on body weight of discontinuing therapy with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or tirzepatide in patients treated for obesity. In recent months, there has been a considerable increase in the utilization of GLP-1 RAs and GIP/GLP-1 RAs. However, the paucity of available data regarding their medium- to long-term safety remains a salient concern. Of particular significance is the observation of the weight curve following their suspension, a subject that has received scant attention to date. Methods: For this, a bibliographic search was carried out in three electronic databases: PubMed, Cochrane Library and Google Scholar. The following filters were applied: in the last 10 years, Randomized Controlled Trial, Adult: 19+ years. The review was restricted to randomized controlled trials to reduce bias and ensure the high quality of the studies examined. A total of 427 references were identified, 178 articles were read in full, and 13 articles were included in the analysis. Results and Conclusions: The analysis showed a rapid regain of weight after cessation of therapy, regardless of the duration of the treatment with GLP-1 RA or GIP/GLP-1 RA. This rebound is likely to substantially mitigate the metabolic benefits attained through weight loss. Given the efficacy of these drugs, it is essential for future research to focus on elucidating the optimal duration of these treatments or identifying techniques or schemes that involve a reduction in dosages to prevent weight regain.

Osteochondral allograft transplantation (OCAT) is an effective treatment option for young, active patients with full-thickness articular cartilage defects, but long-term success is limited by treatment failures often linked to nonadherence to postoperative protocols. Validated methods for preoperative identification of patients at risk for nonadherence and/or poor outcomes following OCAT are limited. This study aimed to characterize the ability of a health behavior psychologist (HBP) to preoperatively delineate patient-specific barriers associated with nonadherence and failure following OCAT. Patients were prospectively enrolled in a lifelong, institutionally approved registry. Patients were eligible for inclusion if they had a preoperative evaluation with an HBP. Demographic, biopsychosocial, patient-reported outcomes surveys, and adherence status were collected. Risk domains (low, medium, high) were assigned by the HBP based on the presence and severity of barriers identified during HBP evaluations. OCAT patients (n = 99) were evaluated and assigned a risk domain: (low-risk [n = 41], medium-risk [n = 44], high-risk [n = 14]). Patients in medium- and high-risk cohorts reported significantly more barriers, including mental health issues, limited social support, and high-demand occupations, compared with low-risk patients. Nonadherence rates were significantly higher in medium- and high-risk cohorts; however, nonadherence was not significantly associated with treatment failure. The low-risk cohort reported better mental health and satisfaction outcomes, whereas medium- and high-risk patients had worse physical health outcomes. Preoperative HBP evaluations effectively identified patient-specific barriers to adherence, enabling targeted interventions to improve OCAT surgery outcomes. Integrating behavioral health support into orthopaedic care may improve adherence, highlighting the need for broader implementation and further studies.Level of Evidence 2, prospective cohort study.

We aimed to summarize research on disparities in obesity treatment outcomes, access, and utilization.

We identified disparities in treatment effectiveness by race/ethnicity, sex/gender, and disability status. There were equivocal results regarding whether outcomes varied by socioeconomic status (SES) and there was no evidence for a rural/urban disparity. A different pattern emerged for treatment access/utilization; disparities were identified across all groups, including race/ethnicity, SES, rurality, sex/gender/sexual and gender minority (SGM) status, and disability status. Little is known regarding how multiple marginalized identities may interact in relation to treatment outcomes or access/utilization. Future research should adopt an intersectional framework to understand the complex interactions between an individual's identities and obesity treatment effectiveness, access, and utilization. Moreover, the field should look beyond the individual-level, using a multi-level approach to identify barriers and strategies to promoting access to effective treatment across system/organizational and policy levels.

BMI is widely used as a primary criterion for prioritizing candidates for metabolic surgery. However, it may not fully capture disease severity or mortality risks associated with comorbidities such as type 2 diabetes (T2D) and cardiovascular disease (CVD). This study aimed to assess whether BMI accurately reflects disease burden and risk in patients undergoing metabolic surgery.

A retrospective audit included 723 adult candidates for primary metabolic surgery at a tertiary care center between January 2014 and December 2022. Patients undergoing revisional surgeries were excluded. Clinical data, including demographics, comorbidities, and disease severity indicators (e.g., ASA score, Charlson Comorbidity Index [CCI], medication usage, and estimated 10-year survival), were analyzed. Patients were grouped by BMI (< or ≥ 50 kg/m2), T2D, and CVD status for comparison.

Prevalence rates for T2D, BMI ≥ 50 kg/m2, and CVD were 41.6%, 37.3%, and 16.2%, respectively. Patients with BMI ≥ 50 kg/m2 were generally younger, had fewer comorbidities, lower CVD prevalence, and better estimated 10-year survival than those with BMI < 50 kg/m2. In contrast, patients with T2D and CVD had significantly higher ASA and CCI scores, greater medication usage, and reduced 10-year survival (p < 0.001 for T2D; p < 0.01 for CVD).

Higher BMI levels do not reflect greater disease burden and mortality risk among candidates for bariatric/metabolic surgery. These findings do not support the use of high BMI-based thresholds (e.g., ≥ 50 kg/m2) as criteria for expedited access. Clinically relevant measures of baseline disease burden should be used to determine the urgency of access to surgical treatment of obesity and T2D.

Bariatric surgery is an effective approach to management of morbid obesity. Given its increasing popularity worldwide, post-operative imaging of patients following bariatric surgery is frequently encountered in clinical practice. In this article we review the physiological principles, normal post-operative anatomy, and imaging appearance of common bariatric procedures (Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and laparoscopic adjustable gastric banding) as well as less common bariatric procedures (including intragastric balloon and biliopancreatic diversion with duodenal switch). Technical considerations and imaging pearls for identifying perioperative and late complications following bariatric procedures will be illustrated through fluoroscopic upper GI studies and computed tomography case examples. Familiarity with expected anatomy and imaging appearances following bariatric procedures allows the radiologist to play a key role in early identification and management of postoperative complications.

For individuals with obesity and type 2 diabetes, weight loss improves insulin sensitivity and β-cell function and can induce remission of diabetes. However, the long-term comparative effectiveness of standard gastric bypass and sleeve gastrectomy on remission of type 2 diabetes remains unclear. We aimed to compare the effects of gastric bypass and sleeve gastrectomy on type 2 diabetes remission, weight loss, and cardiovascular risk factors 5 years after surgery.

We present a secondary analysis of a two-armed, single-centre, triple-blind, randomised controlled trial conducted at a public tertiary obesity centre in Norway. Adults (ie, age ≥18 years) with type 2 diabetes and obesity were randomly assigned (1:1) by a computerised random number generator to laparoscopic gastric bypass or sleeve gastrectomy, with balanced block sizes of ten. Study personnel, participants, and the primary-outcome assessor were all masked to the allocation until 1 year after surgery, after which further follow-up was open label. Changes in key secondary outcomes, including type 2 diabetes remission, weight loss, and cardiovascular risk factors, were assessed 5 years after surgery. The trial procedure estimand assessed treatment effects in all randomised participants, with data collected after conversional surgery removed from analyses. The trial was registered with ClinicalTrials.gov (NCT01778738) and was completed in December, 2022.

Between Oct 15, 2012, and Sept 1, 2017, 319 patients were assessed for eligibility, resulting in 109 participants who were randomly assigned to gastric bypass (n=54) or sleeve gastrectomy (n=55). The baseline mean age was 47·7 years (SD 9·6), mean BMI 42·3 kg/m2 (SD 5·3), 72 (66%) were women, and 37 (34%) were men. 93 (85%) participants completed 5-year follow-up (47 [85%] in the sleeve gastrectomy group and 46 [85%] in the gastric bypass group). The proportions with remission of type 2 diabetes were higher after gastric bypass than after sleeve gastrectomy (HbA1c ≤6·0% 23 [50%] of 46 vs nine [20%] of 44, risk difference 29·5% [95% CI 10·8 to 48·3]; HbA1c <6·5% 29 [63%] vs 13 [30%], risk difference 33·5% [14·1 to 52·9]). Gastric bypass provided greater loss in bodyweight (mean 22·2% [95% CI 20·3 to 24·1] vs 17·2% [15·3 to 19·1], treatment difference 5·0% [2·4 to 7·7]) and lower LDL-cholesterol (treatment difference -0·5 mmol/L [-0·8 to -0·1]). The prevalence of erosive oesophagitis and Barrett's oesophagus was similar between groups, whereas pathological acid reflux occurred more frequently after sleeve gastrectomy (risk difference 51·1% [28·0 to 74·2]). More participants had symptomatic postprandial hypoglycaemia after gastric bypass than after sleeve gastrectomy (15 [28%] vs one [2%]).

Gastric bypass was superior to sleeve gastrectomy regarding long-term remission of type 2 diabetes, weight loss, and LDL cholesterol concentrations, at the expense of a higher frequency of symptomatic postprandial hypoglycaemia. These findings could inform clinical practice and future guidelines regarding the preferred surgical procedure in patients with type 2 diabetes.

Vestfold Hospital Trust.

For the Norwegian translation of the abstract see Supplementary Materials section.

Bariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies.

This study aimed to describe the type of prepregnancy bariatric surgery, analyze maternal, pregnancy, and offspring outcomes relative to matched women, and assess the impact of prepregnancy bariatric surgery on fetal growth, particularly the proportions of small for gestational age and large for gestational age infants.

A cross-sectional, matched study was performed using a statewide hospital and perinatal data register. A total of 2018 births of 1677 women with prepregnancy bariatric surgery were registered between 2013 and 2018. Of those, 1282 were included and analyzed, matched in a 1:10 ratio for age, parity, smoking status, and body mass index to women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and neonatal birth records were analyzed. Multivariable logistic regression was used to estimate the association between small for gestational age and large for gestational age infants and prepregnancy bariatric surgery.

Of the 1282 women, 93% had undergone laparoscopic sleeve gastrectomy. Among women with prepregnancy bariatric surgery compared with matched women, offspring had lower absolute birthweight (3223±605 vs 3418±595 g; P<.001), and a lower rate of large for gestational age infants (8.6% vs 14.1%; P<.001) and a higher rate of small for gestational age infants (10.7% vs 7.3%; P<.001) were found. Offspring of mothers with prepregnancy bariatric surgery were more likely to be born preterm (10.5% vs 7.8%; P=.007). Fewer women with previous bariatric surgery were diagnosed with gestational diabetes mellitus (15% vs 20%; P<.001) or pregnancy-induced hypertension (3.7% vs 5.4%; P=.01). In the adjusted model, prepregnancy bariatric surgery was associated with lower risk of large for gestational age (odds ratio, 0.54; 95% confidence interval, 0.44-0.66) and higher risk of small for gestational age infants (odds ratio, 1.78, 95% confidence interval, 1.46-2.17).

These data suggest that prepregnancy bariatric surgery was associated with a reduction in several obesity-related pregnancy complications at the expense of more preterm births and small for gestational age offspring.

Obesity, a chronic and progressive disease with a complex etiology, remains a significant global health challenge. Despite advancements in lifestyle interventions, pharmacological therapies, and bariatric surgery, substantial barriers to effective and sustained obesity management persist. Resistance to weight loss and gradual weight regain are commonly reported, limiting the long-term success of both non-pharmacological and pharmacological strategies. A possible contributor is metabolic adaptation, a phenomenon characterized by reduced metabolic rate and energy expenditure following weight loss, which hinders therapeutic efficacy. To address these challenges, increasing attention has been directed toward strategies that counteract maladaptive mechanisms by modulating metabolic rate and enhancing energy expenditure. One promising approach involves mitochondrial uncoupling, where electron transport and oxygen consumption are disconnected from ATP synthesis, promoting energy dissipation. Preclinical studies have demonstrated the potential of various chemical compounds with uncoupling activity as anti-obesity agents. Additionally, carbon monoxide (CO) has emerged as a significant gaseous signaling molecule in human physiology, with anti-inflammatory, antioxidative, and cytoprotective properties. Advances in CO-based pharmacology have led to the development of controlled-release CO donors, enabling precise therapeutic application. Experimental studies suggest that CO modulates mitochondrial bioenergetics, induces mild mitochondrial uncoupling, and regulates mitochondrial biogenesis. By integrating these findings, this review uniquely connects scientific threads, offering a comprehensive synthesis of current knowledge while proposing innovative directions in mitochondrial, metabolic and CO-based pharmacological research. It highlights the potential of CO-based pharmacology to regulate metabolic rate, support weight loss, and address obesity-related dysfunctions, thus suggesting novel pathways for advancing obesity treatment.

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24 months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses.

Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24 months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression.

BMI and HR-QoL improved significantly for all patients from pre-surgery to 24 months post-operation, though some patients deteriorated in their outcomes after 12 months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories.

Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

In patients with osteoarthritis, bariatric surgery is associated with diminished joint pain and improved functionality.

To evaluate the relationship between the risk of total joint replacement (TJR) and the fact of having undergone bariatric surgery (yes or no) in people living with obesity.

Data from the French National Hospitals Database.

This case-control study was conducted to identify hospitalizations for TJR. The main exposure of interest was having undergone (or not) a bariatric surgery procedure between January 2017 and December 2021. After a 6-month run-in phase, data on hospitalizations for the first TJR (i.e., hip or knee) from July 2017 to December 2023 were classified by obesity class and surgical type.

One hundred sixty thousand seven hundred seventy-three patients who had undergone bariatric surgery (mean age: 40.8 years, 79.5% females) and 160,773 matched controls were identified. The most frequent surgical technique was sleeve gastrectomy (72.2%), followed by gastric bypass (27.8%). The average follow-up was 4.7 years. An increase in the overall risk of TJR, with a hazard ratio (HR) of 1.09 (95% confidence interval [CI], 1.03-1.15), was observed. Depending on obesity class, patients with body mass index (BMI) < 40 kg/m2 had a lower risk of TJR (HR: 5.85; 95% CI: .78-.93), whereas a higher risk was observed in patients with BMI ≥40 kg/m2 (HR: 5 1.25; 95% CI: 1.16-1.34).

In France, hospitalizations for TJR following bariatric surgery were associated with an increase of 25% in patients with BMI ≥ 40 kg/m2, whereas it was associated with a decrease of 15% in patients with BMI < 40 kg/m2.

Bariatric surgery is the most effective treatment for patients with obesity. After surgery, lifelong follow-up care is recommended to improve weight-loss outcomes. However, follow-up attendance is low, and the reasons have yet to be determined. Therefore, the present study aimed to identify patients' expectations and perspectives on follow-up care after bariatric surgery to identify current unmet needs and ways to increase follow-up attendance.

Patients who underwent bariatric surgery at a university medical center and attended at least one follow-up appointment completed an online questionnaire. The questionnaire consisted of open-ended questions regarding follow-up care. Content analysis was applied to qualitatively analyze the results.

In total, 164 patients responded to at least one question (participation rate 50.1%). On average, patients had attended three follow-up appointments at the time of the study. Expectations concerning the content of follow-up care included regular examinations, blood tests, and psychological and nutritional counseling and support. Notably, the follow-up care was most criticized for its lack of regular psychological and nutritional support, with many suggesting that these services be incorporated. Interestingly, follow-up care appointment attendance was rarely connected with expectations of better outcomes. Regular appointments and laboratory results were among the positive aspects of the current follow-up care.

Expectations were mostly related to the content of follow-up care. However, few patients seemed to recognize the importance of follow-up care for improved outcomes. Therefore, educating patients about the critical role of follow-up care might improve attendance and also lead to more successful long-term bariatric surgery outcomes.

Data on the preoperative factors for bariatric surgery response in patients with morbid obesity are limited, and there are no studies on the relationship between myosteatosis and surgery response.

We investigated the preoperative factors determining bariatric surgery response and the impact of preoperative muscle fat infiltration on bariatric surgery response.

This retrospective longitudinal cohort study included 125 individuals (37 men, 88 women) with morbid obesity who underwent bariatric surgery. Muscle fat infiltration [skeletal muscle fat index (SMFI)] was evaluated using computed tomography-based psoas muscle mass and density at the fourth lumbar level. A bariatric surgery response was defined as ≥50% excessive weight loss at 1 year postoperatively.

Before bariatric surgery, the patient's mean body weight and body mass index (BMI) were 107.0 kg and 39.0 kg/m2, respectively. After 1 year, the mean body weight was 79.6 kg. The mean excessive weight loss at 1 year was 75.6%, and 102 (81.6%) patients were categorized as responders. There were no statistically significant differences in initial BMI, age, sex, or proportion of diabetes between responders and nonresponders. Responders were more likely to have lower SMFI and triglyceride and glycated hemoglobin A1c levels than nonresponders at baseline (P < .05). Multiple logistic regression analysis showed that a lower baseline SMFI was associated with bariatric surgery response (odds ratio = 0.31, 95% confidence interval = 0.14-0.69, P = .004).

Preoperative myosteatosis may determine the response to bariatric surgery.

Bariatric surgery is widely recognized as a mainstay in the treatment of obesity; however, there is limited information regarding its success and the factors that influence outcomes within the Mexican population. This study provides an analysis of bariatric surgery outcomes at the "Hospital de Especialidades" of the "Centro Médico Nacional Siglo XXI," with a particular focus on the prevalence of suboptimal initial clinical response, weight regain, and the identification of predictive factors.

A retrospective cohort study involving 132 patients who underwent bariatric surgery between January 2018 and March 2023 was conducted. The prevalence of suboptimal initial clinical response was determined, and a binary logistic regression was applied to identify potential risk factors.

The study found that 21.97% of patients experienced suboptimal initial clinical response, a rate lower than reported in global literature. The population exhibited a significant prevalence of comorbidities, including type 2 diabetes mellitus (63.64%), hypertension (55.3%), and obstructive sleep apnea (60.61%), reflecting Mexico's high obesity rates. Additionally, male sex was identified as a significant predictor of suboptimal initial clinical response, while glycated hemoglobin and serum albumin emerged as relevant biochemical predictors, underscoring the importance of preoperative glycemic control.

These findings offer valuable insights into bariatric surgery outcomes and identifies adequate preoperative glycemic control as an important modifiable factor that can inform future policies aimed at enhancing patient care and surgical success in bariatric procedures.

Obesity is a growing global health challenge, necessitating effective treatment options beyond lifestyle interventions. This narrative review explores established and emerging pharmacotherapies for weight management, including parenteral agents like Liraglutide, Semaglutide, Setmelanotide, and Tirzepatide, as well as peroral medications such as Phentermine, Phentermine/Topiramate, Bupropion/Naltrexone, Orlistat, and Metformin. Newer treatments like Cagrilintide and Bimagrumab show promise for enhancing weight loss outcomes. Parenteral GLP-1 receptor agonists demonstrate superior efficacy compared to traditional peroral medications, with gastrointestinal side effects being the most common. Artificial intelligence presents intriguing opportunities to enhance weight loss strategies; however, its integration into clinical practice remains investigational and requires rigorous clinical validation. While current anti-obesity medications deliver significant benefits, future research must determine the efficacy, safety, and cost-effectiveness of AI-driven approaches. This includes exploring how AI can complement combination therapies and tailor personalized interventions, thereby grounding its potential benefits in robust clinical evidence. Future directions will focus on integrating AI into clinical trials to refine and personalize obesity management strategies.

Untreated obesity in pregnancy is associated with adverse fetal and neonatal outcomes that influence the long-term offspring health trajectory, propagating obesity and cardiometabolic disease from one generation to the next. The current efforts to reduce the risk of these negative outcomes through preconception weight loss remain largely ineffective. Anti-obesity medications (AOMs) are an understudied option for this indication, likely due to the potential for teratogenicity with accidental exposure during pregnancy. However, the current recommendation to discontinue all AOMs prior to conception fails to frame obesity within the chronic disease paradigm typically used for preconception counseling. Evolving evidence suggests that glucagon-like peptide 1 receptor agonists (GLP-1 RAs), the newest and most effective AOM class, may be safe in early pregnancy. Although further research is needed, counseling about GLP-1 RAs during pregnancy should include the potential for both risk and benefit. This review summarizes the known risks that obesity in pregnancy poses to the offspring and discusses the benefits and limitations of current treatment strategies. While there remain several barriers to optimal preconception and prenatal care for people with obesity, this review aims to arm providers with the knowledge needed for patient-centered counseling prior to and during pregnancy.

Bone fractures and vitamin deficiencies are potential long-term risks after metabolic/bariatric surgery (MBS). This study aimed to evaluate the health status of patients with an average follow-up of 15 years after MBS, focusing on vitamin deficiencies, patients' satisfaction, and bone fractures.

A questionnaire-based cross-sectional study was performed. In total, 844 patients, with a history of MBS before March 2010, were eligible and contacted by mail. Overall, 263 patients returned the questionnaire.

Roux-en-Y gastric bypass (RYGB) was the most common bariatric procedure (69%), followed by adjustable gastric banding (AGB) in 23% and sleeve gastrectomy (SG) in 8%, respectively. A total of 14% reported bone fractures after MBS. However, the prevalence of bone fractures was similar after RYGB and after restrictive procedures (RYGB: 17% vs. AGB+SG: 11%; p > 0.05). Moreover, no association between the occurrence of bone fractures and the follow-up time was found. Patients with mixed (RYGB) procedures had more vitamin deficiencies compared to patients with dominantly restrictive (AGB+SG) procedures (RYGB: 76% vs. AGB+SG: 54%; p < 0.05). The self-reported health status (RYGB: 64% good-excellent, 36% fair-poor vs. AGB+SG: 53% good-excellent, 46% fair-poor; p > 0.05) was not different between the procedures. However, more patients after RYGB answered that "they would undergo the procedure again" compared to patients after SG or AGB (RYGB: 84% vs. AGB+SG: 61%; p < 0.001).

Even though a higher prevalence of vitamin deficiencies following RYGB was found, the number of patients who were satisfied with the decision made at the time of the initial operation was higher among patients with RYGB compared to SG and AGB.

Obesity has become major public health problem around the world. Lifestyle interventions, Pharmacotherapy and bariatric surgery are the common intervention to reduce weight in clinical practice. This study aims to conduct an economic evaluation of Duodenal-Jejunal Bypass Sleeve (DJBS) plus Intensive Lifestyle Intervention (ILI) compared with ILI only in people with obesity in China.

A hybrid model using a Decision Tree and Markov model was used to compare 9-month and lifetime horizon cost-effectiveness between DJBS plus ILI and ILI only. The data on clinical effectiveness were based on a prospective, open-label, and randomized trial (NCT05938231). This study employed 1-3 times the Gross Domestic Product (GDP) per capita (¥85,498, exchange rate: $1 US dollar = ¥6.73, 2022) and disposable income per capita (¥36,883, 2022) as the Willingness-To-Pay (WTP) thresholds. One-way, probabilistic sensitivity and scenario analysis were performed to test the robustness of the results.

The results of the 9-month decision tree model showed that compared to ILI only, DJBS plus ILI decreased body mass index (BMI) by 1.69 kg/m2 (1.41 vs. 3.10), with an increasing cost of ¥28,963.98 yuan (¥29,111.06 vs.¥147.08). The incremental cost-effectiveness ratio (ICER) was ¥17,138.45 per unit decrease of BMI. The lifetime horizon model showed that compared to ILI only, DJBS plus ILI had a higher cost of ¥13261.94 yuan (¥31,688.98 vs. ¥18,427.04), while with a life-year increase of 0.02 (9.43 vs. 9.41) and quality-adjusted life years (QALYs) increase of 0.15 (7.82 vs. 7.67) per people with obesity. The ICER was ¥88,412.93 per QALY gained. Probability sensitivity analysis showed the robustness of the economic evaluation results.

The findings suggested that DJBS plus ILI was not a cost-effective strategy over a lifetime horizon when the WTP threshold was set at GDP per capita and disposable income per capita. However, it was considered cost-effective when the threshold was set at 1.03 times GDP per capita.

Bariatric surgery is highly effective for the management of severe obesity, but its safety profile is not completely understood. This review aimed to synthesise evidence linking demographic factors to postoperative complications and mortality following primary bariatric surgery.

We searched Medline for observational studies of adult patients linking demographic factors to postoperative complications of primary bariatric surgery published from 2017 to 2022. Risk ratios (RR) with 95% confidence intervals (95% CI) were calculated and pooled using random effect meta-analysis. Heterogeneity was quantified using the I2 statistic and tested for statistical significance using the Q-statistic. Sensitivity analyses were used to explore potential sources of heterogeneity.

A total of 71 observational studies (69 cohort, 2 case-control) were reviewed and appraised. Older age was consistently associated with increased risks of postoperative mortality (RR = 2.62, 95% CI 1.63-4.23, I2 = 42.04%), serious complications (RR = 1.76, 95% CI 1.09-2.82, I2 = 93.24%), anastomotic leak (RR = 1.64, 95% CI 1.04-2.58, I2 = 61.09%), and haemorrhage (RR = 1.44, 95% CI 1.07-1.94, I2 = 45.25%). Male sex was associated with increased anastomotic leak (RR = 1.39, 95% CI 1.04-1.87, I2 = 72.36%). Sensitivity analyses did not identify sources of bias. Socioeconomic factors, including Black/African American race, low financial status, and marital status (mixed results), were linked to higher complication risks in some studies.

Older age and certain demographic factors (male sex, Black/African American race, low financial status, marital status) were associated with increased risks of postoperative complications following primary bariatric surgery.

Bariatric surgery (BS) is an effective intervention for obesity, inducing significant neurobiological and gut microbiota changes that influence hunger, appetite, taste perception, and long-term metabolic health. This narrative review examines these alterations by analyzing recent findings from clinical and preclinical studies, including neuroimaging, microbiome sequencing, and hormonal assessments. BS modulates appetite-regulating hormones, reducing ghrelin while increasing glucagon-like peptide-1 (GLP-1) and peptide tyrosine-tyrosine (PYY), leading to enhanced satiety and decreased caloric intake. Neuroimaging studies reveal structural and functional changes in brain regions involved in reward processing and cognitive control, contributing to reduced cravings and altered food choices. Additionally, BS reshapes the gut microbiota, increasing beneficial species such as Akkermansia muciniphila, which influence metabolic pathways through short-chain fatty acid production and bile acid metabolism. These findings highlight the complex interplay between the gut and the brain in post-surgical metabolic regulation. Understanding these mechanisms is essential for optimizing post-operative care, including nutritional strategies and behavioral interventions. Future research should explore how these changes impact long-term outcomes, guiding the development of targeted therapies to enhance the recovery and quality of life for BS patients.

It is unclear how bariatric surgery for the treatment of obesity may affect outcomes of surgical treatment for ankle conditions. The purpose of this study was to compare rates of revision surgery after primary ankle arthrodesis ("arthrodesis") and total ankle arthroplasty ("arthroplasty") for patients who had undergone bariatric surgery and those who had not ("control group").

In this retrospective study, we used data from the PearlDiver database to compare 5-year revision surgery rates after arthroplasty and arthrodesis in patients with and without a history of bariatric surgery. Cohorts were propensity-matched by age, sex, and Charlson Comorbidity Index value in a 1:4 ratio. We explored the following surgical outcomes: arthroplasty revision, joint infection, instrumentation removal, open reduction and internal fixation (ORIF), and adjacent joint fusion. Cumulative incidence was calculated through Kaplan-Meier survival analysis and compared using Cox proportional hazard ratios.

At 5 years after arthrodesis, the likelihood of adjacent joint fusion was higher among patients with a history of bariatric surgery than among control patients (hazard ratio: 1.8, 95% confidence interval, 1.2 to 2.6); however, we found no differences in surgical outcomes for joint infection, instrumentation removal, or ORIF. At 5 years after arthroplasty, surgical outcomes did not differ between those with a history of bariatric surgery versus control patients.

These findings suggest that a history of bariatric surgery is not an important predictor of joint infection, instrumentation removal, or ORIF within 5 years after primary total ankle arthroplasty or arthrodesis. When choosing between arthroplasty or arthrodesis in patients who have undergone bariatric surgery, higher incidence of adjacent joint fusion should be a consideration.

III, Retrospective cohort study.

Worldwide, nearly 40% of adults are overweight and 13% are obese. Health consequences of excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, and increased mortality. Treating obesity is challenging and calorie restriction often leads to rebound weight gain. Treatments such as bariatric surgery create hesitancy among patients due to their invasiveness. GLP-1 medications have revolutionized weight loss and can reduce body weight in obese patients by between 15% and 25% on average after about 1 year. Their mode of action is to mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism and satiety. However, GLP-1 drugs carry known risks and, since their use for weight loss is recent, may carry unforeseen risks as well. They carry a boxed warning for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) are fairly common while pancreatitis and intestinal obstruction are rarer. There may be a loss of lean body mass as well as premature facial aging. A significant disadvantage of using these medications is the high rate of weight regain when they are discontinued. Achieving success with pharmacologic treatment and then weaning to avoid future negative effects would be ideal.

The prevalence of obesity continues to increase worldwide. Obesity is associated with an increased risk of cardiometabolic and other diseases, reduced quality of life and shortened life expectancy. Highly effective therapies are required to achieve meaningful and sustained weight reduction to prevent, slow or reverse disease associated with obesity. Bariatric surgery is a highly effective intervention to induce weight loss, with observational data demonstrating durability of weight loss over 10 or more years. In addition, bariatric surgery improves cardiometabolic risk factors, including hyperglycaemia and type 2 diabetes, hypertension and dyslipidaemia. Observational data have shown a reduction in all-cause mortality, cardiovascular events and mortality and a reduction in cancer risk and mortality in patients who have undergone bariatric surgery compared to matched patients who did not have surgery. The emergence of newer incretin agonists, particularly semaglutide and tirzepatide, have demonstrated remarkable efficacy in inducing and maintaining weight loss with ongoing use. As for bariatric surgery, incretin agonist therapies also improve type 2 diabetes outcomes, cardiovascular mortality and other obesity-related complications, with new evidence emerging and long-term outcome data awaited. This perspective compares bariatric surgery and incretin agonist therapy, assessing their relative efficacies in weight reduction, impact on obesity-related complications, their respective risk profiles and considerations of cost-effectiveness and equity of access. These comparisons seek to evaluate whether these increasingly popular medications could make bariatric surgery a thing of the past.

Hyperuricemia is a metabolic disorder associated with obesity. Many studies have reported the effect of bariatric surgery on the decrease of serum uric acid level in patients with hyperuricemia. However, since the update of diagnostic criteria of hyperuricemia, the correlation between preoperative body mass index, postoperative weight changes, and the remission of hyperuricemia in patients with obesity after sleeve gastrectomy requires consensus.

One hundred and ninety-three patients with obesity and hyperuricemia who underwent laparoscopic sleeve gastrectomy were enrolled. All patients were followed up for 6 months postoperatively. Subgroup analysis was performed using the tertiles of preoperative body mass index, total weight loss, and excess weight loss to investigate the correlation with the remission of hyperuricemia after sleeve gastrectomy.

A total of 193 patients were included in this study. Among them, 123 patients were female and 70 were male. And the mean age was 30.2 ± 7.8 years, preoperative body weight was 116.1 ± 23.3 kg, and the preoperative BMI was 40.5 ± 6.7 kg/m2. 59.1% (114/193) patients achieved remission of hyperuricemia 6 months after sleeve gastrectomy. The TWL% and EWL% were 25.6% ± 5.4% and 75.9% ± 28.2%, respectively. Female patients had a significantly higher remission rate than that of male patients (p < 0.05). Correlations were found between EWL%/preoperative BMI with the remission of hyperuricemia (p < 0.05).

Sleeve gastrectomy had a positive effect on the remission of hyperuricemia in patients with obesity. EWL% may play a significant role in the remission of hyperuricemia.

Bariatric surgery is a cornerstone intervention for individuals with severe obesity, offering substantial and sustainable weight loss.

This retrospective cohort study included 186 patients with obesity and Type2 diabetes who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2009 and 2020 ​at University Hospital Ayr. Optimal clinical response weight loss was defined as excess weight loss (%EWL) ≥50 ​% or total weight loss (%TWL) ≥20 ​%.

At 2-years post-surgery, 43.6 ​% achieved ≥50 %EWL, and 44.1 ​% achieved ≥20%TWL, with 31.8 ​% maintaining this at 5-years. Depending on the definition used, between 11.2 ​% and 45.9 ​% of patients experienced recurrent weight gain. BMI had significant positive association with %TWL but negative with %EWL (p ​< ​0.05). RYGB had significantly higher %TWL compared to SG (p ​< ​0.05).

Most patients experienced weight loss which was maintained over time, however recurrent weight gain was noted. Pre-surgery BMI was significantly associated with weight changes.

As the prevalence of obesity increases worldwide, and lifestyle modification or pharmaceutical treatment yields insufficient results for patients with severe obesity, an increasing number of patients opt for metabolic bariatric surgery as an effective and durable treatment of this disease. Seeing as 80% of these patients are women, many of whom are of reproductive age, pregnancies after metabolic bariatric surgery become increasingly common. Metabolic bariatric surgery has many benefits for overall health and pregnancy outcomes, but certain risks are also reported. This leads to the rise of a new population of patients with their own specific needs regarding follow-up. This review discusses the various benefits and risks of these types of surgery for pregnancy. We provide an overview of the current state of the evidence and look into future research goals.

Hypertension is a frequent comorbidity of obesity that significantly and independently increases the risk of cardiovascular and renal events. Obesity-related hypertension is a major challenge to the healthcare system because of the rapid increase in obesity prevalence worldwide. However, its treatment is still not specifically addressed by current guidelines. Weight loss (WL) per se reduces blood pressure (BP) and increases patient responsiveness to BP-lowering medications. Thus, a weight-centric approach is essential for the treatment of obesity-related hypertension. Diet and physical activity are key components of lifestyle interventions for obesity-related hypertension, but, in real life, their efficacy is limited by poor long-term patient adherence and frequently require pharmacotherapy implementation to achieve target BP. In this context, first-generation anti-obesity drugs such as orlistat, phentermine/topiramate, and naltrexone/bupropion are poorly effective, whereas second-generation incretin receptor agonists, including the GLP-1 receptor agonists liraglutide and semaglutide, and in particular the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) co-agonist tirzepatide, substantially contribute to effective WL and BP control in obesity. SGLT2 inhibitors are weak body weight and BP-lowering medications, but clearly synergize the benefits of these medications. Bariatric surgery remains the gold standard treatment for severe "pathological" obesity and related life-threatening complications. Renal denervation is a valuable rescue treatment for drug-resistant hypertension, commonly related to obesity. Integrating a multifaceted weight-based approach with other strategies, such as antihypertensive drugs and renal denervation, could specifically target the main neuro-hormonal and renal pathophysiological mechanisms of obesity-related hypertension, including sympathetic-nervous and renin-angiotensin-aldosterone systems overactivity, salt retention, and volume expansion. This comprehensive strategy can provide a personalized algorithm for managing hypertension in obesity within the context of "precision medicine" principles.

Type 2 diabetes and obesity have some overlapping pathophysiology. This has allowed for the creation of therapies which are highly effective in treating both conditions. Weekly subcutaneous incretin agonists are preferred agents as they provide significant improvement in glycemic parameters, weight, and other comorbidities, like heart failure and reduce major adverse cardiovascular event. Bariatric surgery continues to show the most durable benefits for patients with both type 2 diabetes mellitus and obesity and should be considered in patients who are unable to meet goals with pharmacotherapy and lifestyle.

Previous studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations.

This study aims to compare OAGB and RYGB during 5years of follow-up in terms of weight loss, remission of comorbidities, and complications.

This longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity.

A 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB.

After 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; P = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; P < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5years (30.0% after OAGB and 28.8% after RYGB; P = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (P = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; P = .015).

OAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.

The evidence supporting the benefits of early exercise in post-bariatric patients is growing. This study analyzed the effects of early exercise (1-week post-bariatric surgery) on body composition in patients with overweight and obesity 1 month after surgery.

Thirty patients (age 36.5 ± 12.3 [range, 18-65] years; body mass index [BMI], 36.2 ± 12.3 kg/m2, range, 29-48) who underwent laparoscopic sleeve gastrectomy for bariatric surgery were instructed to participate in an exercise training program initiated on day 3 post-surgery and to follow a recommended protein intake of 60 g/day. After 1-month post-surgery, patients were stratified into those who adhered to exercise recommendations and those who did not. Pre- and post-differences in total weight loss (TWL), skeletal muscle mass (SMM), fat mass (FM), and visceral fat mass (VFM) were compared.

TWL, SMM, and FM loss were similar between non-adherent and adherent subjects (10.2 ± 3.5 kg and 11.9 ± 3.6 kg; p = 0.2; 2.9 ± 1.0 kg and 3.2 ± 1.2; p = 0.2; 6.2 ± 2.1 kg and 7.5 ± 3.6 kg; p = 0.2, respectively), whereas VFM was markedly reduced in the adherent group (29.9 ± 18.2 cm2 vs 14.6 ± 9.4 cm2; p = 0.01) compared to the non-adherent group. When the group was divided according to adherence to exercise and protein intake or non-adherence to both conditions, there was a significant difference in TWL, FM, and VFM losses (p < 0.05). In contrast, no differences in SMM were found.

Early exercise training accelerated visceral fat mass loss during the initial recovery period in patients after bariatric surgery. Additionally, adherence to daily protein intake recommendations can increase total body weight and fat mass loss.

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Obesity is associated with multiple comorbidities that contribute to increased mortality among affected individuals. There are multiple treatments for this condition, including nutritional interventions, pharmacological therapies, and surgical procedures. Within these, bariatric surgery is an effective treatment option that requires a multidisciplinary approach, both before and after surgery. Nutritional management prior to surgery aims to achieve metabolic control and reduce comorbidities associated with the procedure. Postoperative nutritional management focuses on preventing complications, ensuring adequate nourishment, and providing necessary supplementation for optimal recovery and long-term success. This narrative review examines all these critical aspects of nutritional management in bariatric surgery, including preoperative nutrition, postoperative nutrition and physical activity recommendation, different nutritional aspects according to the type of bariatric surgery, and future directions for investigation.

To assess the efficacy and safety of the Qingyanyin formulated granules (, QYY), press needles (PN), and their combined application in addressing abdominal obesity (AO). This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.

From March 2021 to July 2021, a multicenter, triple －blind, randomized 2 × 2 factorial design clinical trial was conducted across 7 centers in 4 major cities within mainland China. The trial participants were patients diagnosed with AO. The trial followed a 1∶1∶1∶1 random allocation ratio, assigning participants to one of four groups: QYY placebo plus simulated press needles (SPN) (placebo + SPN), QYY plus SPN (QYY + SPN), QYY placebo plus PN (placebo + PN), and QYY plus PN (QYY + PN). The trial participants received treatment for 12 weeks. Observe the changes in waist circumference, body weight, body mass index (BMI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) scores, and Pittsburgh Sleep Quality Index (PSQI) before and after treatment.

The QYY + PN group exhibited significant improvements in waist circumference compared to placebo + PN [Difference = －1.59, 95% CI (－3.03, －0.16)] and placebo + SPN groups [Difference = －2.01, 95% CI (－3.46, －0.57)]. QYY + PN demonstrated a significant advantage over placebo + SPN [Difference = －2.01, 95% CI (－3.46, －0.57)], and no statistically significant interaction was observed between the two interventions (P > 0.05). In terms of weight and BMI improvements, the QYY + PN, QYY + SPN, and the PN + placebo groups all experienced trending greater reductions in weight compared to the placebo group. In terms of the total scores of PSQI, BAI, and BDI, all four groups exhibited improvements compared to the baseline. Specifically, concerning the change in total PSQI scores, the QYY + PN group exhibited a greater reduction; Regarding the change in total BAI scores, the PN + placebo group demonstrated a greater decrease;As for the change in total BDI scores, the QYY + SPN group displayed a greater reduction.

This study confirmed that QYY + PN can effectively reduce the waist circumference of patients with AO. Furthermore, the combined approach offers greater benefits than either treatment alone, all without any reported serious adverse events.

Currently, there is no consensus on the best bariatric surgery type for patients with body mass index (BMI) ≥50 kg/m2. This systematic review and meta-analysis aimed to compare outcomes of duodenal switch (DS) and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, resolution of obesity-related comorbidities, and complications among patients with a BMI ≥50 kg/m2. A systematic search was conducted across databases including PubMed, Embase, Scopus, and Web of Science to include studies that compared outcomes of DS and RYGB in patients with BMI ≥50 kg/m2. A meta-analysis was carried out, alongside subgroup analyses based on the type of study and duration of follow-up. Twelve articles were included in this study (2678 patients, follow-up: 1-15 years). Patients with DS had 7.31 kg/m2 higher BMI loss (95% CI: 5.59-9.03, P < .001) and 9.9% more total weight loss (95% CI: 4.47-15.28%, P < .001) compared with RYGB. The rate of complications, reoperation, mortality, and remission of comorbidities including diabetes, hypertension, dyslipidemia, and obstructive sleep apnea was not significantly different between DS and RYGB. Rate of malnutrition was 8.3% in the DS group compared with 1.2% in RYGB (OR: 5.53, 95% CI: 1.35-22.44, P = .02). In addition, 5.4% DS patients needed revisional surgery for malnutrition versus none in RYGB (OR: 6.1, 95% CI: 1.03-36.33, P = .05), and 24.6% of DS patients developed gallbladder disease needed cholecystectomy versus 4.5% after RYGB (OR: 6.36, 95% CI: 1.70-23.82, P = .01). DS leads to significantly higher BMI and total weight loss in patients with BMI ≥50 kg/m2 but may be associated with a higher rate of major malnutrition and needed revisional surgery. These should be considered in surgical planning.

Obesity is one of the most important health problems in the world. It affects all systems, especially the respiratory and cardiovascular systems. Laparoscopic sleeve gastrectomy is an effective method in the treatment of obesity and can improve respiratory functions. We aimed to evaluate the effects of surgery on pulmonary function in patients with obesity.

A retrospective analysis was conducted on a group of patients who underwent sleeve gastrectomy. This study assessed pre-operative and long-term pulmonary function in patients who underwent laparoscopic sleeve gastrectomy between 2009 and 2015, with a minimum follow-up of 10 years. Patients were stratified based on smoking status and presence of comorbidities.

The study included 51 patients (82.4% female) with a mean age of 51.90 ± 11.57 years. Significant weight loss and reductions in BMI were observed postoperatively. Mean pre-operative BMI was 47.53 ± 6.95 and significantly decreased to 37.75 ± 6.02 post-operatively, BMI reduction rate was %22 (p < 0.001). Pulmonary function tests demonstrated significant improvements in FEV1 (2.65 ± 0.69 to 2.76 ± 0.67, p = 0.044), FEV1% (92.07 ± 15.31 to 97.98 ± 14.45, p = 0.001), PEF (74.01 ± 18.12 to 91.53 ± 24.16, p < 0.001), and MEF25-75 (77.17 ± 22.07 to 108.57 ± 28.11 p < 0.001) after surgery. These improvements were consistent across different subgroups, including smokers, non-smokers, and patients with and without comorbidities. Non-smokers exhibited a greater percentage increase in FEV1 compared to smokers. While there was an increase in FEV1 among patients with comorbidities, this difference was not statistically significant. Conversely, patients without comorbidities demonstrated a significant improvement in FEV1.

Bariatric surgery is associated with significant improvements in pulmonary function in obese patients, regardless of smoking status or comorbidities.

Individuals with excess weight are at a higher risk for various physical and mental health conditions. Interventions targeting weight loss can improve health, with modest weight loss of five to ten percent of body weight often considered clinically meaningful for enhancing health outcomes. However, the benefits of achieving low-level weight loss ( < 5% body weight) are poorly understood. We aimed to systematically review relevant literature and synthesise the evidence that assessed the potential health benefits of losing less than five percent body weight. We searched seven academic databases and included studies in any language, from any country, with no time constraints. We included any intervention studies that assessed the impact of less than five percent weight loss on any measured physical or mental health markers or indices. 70 studies from 68 articles were included, with study participants ranging from 14 to 10,742. In total, 137 health markers were assessed, categorised into metabolic markers (n = 42), cardiovascular markers (n = 32), anthropometric measures (n = 19), quality of life indices (n = 10), inflammatory biomarkers (n = 10), renal and hepatic markers (n = 9), psychosocial and behavioural measures (n = 8), pulmonary function (n = 3), total mortality (n = 2), ovulatory function (n = 1), and muscle strength (n = 1). Overall, 60% of studies reported improvements, 37% found no change or mixed results, and 3% observed a worsening of health markers or indices. Based on the available data, 87% of participants (n = 15,839) in the studies reported improvements in health markers or indices as a result of low-level weight loss. Our findings suggest that low-level weight loss can lead to various health benefits and challenges the conventional threshold for effective weight loss.Preregistration The review protocol was pre-registered with PROSPERO (CRD42023406342).

Underutilization of bariatric surgery is multifactorial. This study aimed to understand the association of SDOH on not achieving surgery.

1081 applications for primary MBS from January-December 2021 were stratified into those that completed surgery (COM; n = 415), in progress > 1-year (IP; n = 107), dropped out (DO; n = 379), and never started (NS; n = 180). Using the American-Community-Survey results (2015-2020) and patient zip-codes, population differences in 4-domains of SDOH (demographic/social/housing/economic) were examined between COM versus the other groups. Additionally, using institutional MBSAQIP and EMR data, patient-specific differences in comorbidities were evaluated for COM versus IP/DO. Univariate analysis using Kruskal-Wallis, chi-squared/Fisher's exact tests were used for continuous and/or categorical variables. For patient-level analysis multinomial logistic regression was used to determine predictors of not achieving surgery. Hypothesis testing was conducted at an overall 5 percent type-I error rate (alpha = 0.05) and Bonferroni's method was used to adjust for multiple comparisons.

Compared to COM, IP-patients resided in zip-codes characterized by fewer married people (43% vs 46%; p = 0.019), lower education levels (49% vs 43%; p = 0.048), more households where rent was > 50% of household income (10% vs 8%, p = 0.002), and households below the poverty line (17.6% vs 14.5%, p = 0.017). At the patient-level, IP were more likely to be male (27.9% vs 14.9%; p = 0.014), publicly insured (44.9% vs 28.4%; p = 0.004), Black (35.5% vs 22.2%; p = 0.006), an active smoker (8.9% vs 2.2%; p = 0.018), have a higher BMI (49.6 vs 47.6; p = 0.01), and coronary intervention (5.8% vs 1.7%, p = 0.034). Comparison of COM vs DO was similar for both phases. Multinomial multivariable logistic regression demonstrated higher BMI (OR = 1.03,[CI]:1.01-1.05, p = 0.001), males (OR = 1.9,[CI]:1.09-3.32, p = 0.024), smoking (OR = 4.58,[CI]:1.74-12.02, p = 0.002), and Medicaid (OR = 2.16,[CI]:1.33-3.49, p = 0.002) independently predicted not achieving surgery.

Patient-level data demonstrated social not clinical factors predicted surgery completion. Given zip-codes characterizing the IP/DO groups had a greater prevalence of social risk, more attention needs to be directed patient-level social risks.