There is a paucity of literature on the impact for bariatric surgery on the progression from prediabetes (PDM) to type II diabetes mellitus (T2DM).

To evaluate the progression from PDM to T2DM in bariatric surgery compared with a nonsurgical cohort.

Single academic institution, Center of Bariatric Excellence.

This retrospective study of patients with morbid obesity with patients with PDM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2001 and 2022. Nonsurgical controls from a primary care cohort were directly matched by hemoglobin A1c, age, sex, and body mass index. DM was defined as a clinical diagnosis of type II diabetes or hemoglobin A1c ≥6.5%. Kaplan-Meier analysis was used to estimate time until T2DM. Cox regression was used to compare time until T2DM in RYGB versus sleeve gastrectomy and in bariatric surgery versus nonsurgical controls.

A total of 1326 bariatric cases with PDM (n = 1154 RYGB, n = 172 SG) were identified. The cohort was 83% female, mean age = 45.3 years, mean body mass index 46.9 kg/m2, and follow-up was 65% over 15 years. In bariatric cases, PDM progression to T2DM at 5, 10, and 15 years after surgery was 1.8%, 3.3%, and 6.7%, respectively. PDM progression to T2DM was almost 20 times greater in matched nonsurgical controls at 5, 10, and 15 years 31.1%, 51.4%, and 68.7%, respectively (hazard ratio 19.8, 95% confidence interval 13.9-28.4, P < .0001). When stratifying by bariatric surgery type, those with SG were 4 times more likely to progress to T2DM versus RYGB (hazard ratio 4.01, 95% confidence interval 1.71-9.39, P = .0014).

Bariatric surgery significantly decreases the conversion from PDM to T2DM. The impact was significantly greater for RYGB compared with SG.

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.

In recent decades, the prevalence of obesity has escalated markedly, becoming a serious epidemic and public health crisis requiring urgent and sustained attention. Obesity is associated with a large number of health conditions, including cardiovascular diseases (CVDs), which contribute to an increase in mortality and overall global health challenge. Despite its high morbidity and mortality, most healthcare practitioners perceive obesity as an outcome of unhealthy lifestyle rather than a disease by itself. As such, obesity is either overlooked or considered a minor risk factor for CVD in clinical practice, among others. Since cardiovascular (CV) causes remain the leading cause of death in patients with obesity, cardiologists are among the most frequently visited healthcare professionals and can play an essential role in addressing this disease. Obesity is a complex, chronic, relapsing yet treatable disease that stems from the disruption in the body's homeostatic, hedonic, and cognitive systems, as a result of an interplay between genetic, metabolic, inflammatory, vascular, environmental and behavioral, and pharmacological factors. With early recognition and assessment, management of this disease can successfully improve life expectancy and reduce CV risk. In this review, a concise overview of obesity was provided, focusing on its pathophysiology, diagnosis, and management. The correlation between obesity and CVDs was further discussed, highlighting the significance of obesity education and management among cardiologists to improve patient outcomes and prevent the progression of obesity and its related comorbidities.

Obesity and accompanying comorbidities are serious diseases that impair the quality of life and even threaten human life. Today, the most effective method for providing sustainable weight loss in the treatment of obesity is Bariatric and Metabolic Surgery procedures. In our study, we aimed to compare the therapeutic effects of Laparoscopic Sleeve Gastrectomy (LSG) and One Anastomosis Gastric Bypass (OAGB) on metabolic syndrome components. We also planned to investigate the complications after bariatric and metabolic surgery, whether the patients had recurrent weight gain, and the short, medium and long-term effects.

Patients who underwent bariatric and metabolic surgery with the diagnosis of obesity between December 2012-January 2020 were retrospectively analyzed. 561 patients who were followed up at 3, 6 months, 1, 2 and 3 years after the operation were included in the study. The effects of bariatric and metabolic surgery on metabolic syndrome components were evaluated as partial and complete remission according to the status at the last follow-up. Statistical analysis were performed by SPSS 18. Results were reported as mean ± standard deviation. P < 0.05 was accepted as statistical significance.

In 516 patients who underwent LSG and 45 patients who underwent OAGB, a decrease in BMI and an increase in EWL(%) values were observed at the 3rd month, 6th month, 1st year and 2nd year controls. In the 3rd year controls of patients who underwent LSG, recurrent weight gain was observed, therefore there was an increase in BMI and a decrease in EWL(%) values compared to the 2nd year. In patients who underwent OAGB, a decrease in BMI continued at the 3rd year, while an increase in EWL(%) values was observed. Thanks to both LSG and OAGB; a remission was achieved at the rates of DM, HT, HL/DL, OSAS, hypothyroidism in the early period. As the follow-up period extended, the rate of patients showing complete recovery decreased for DM(p = 0.0001). No change was observed during the follow-up period for other parameters. CONCLUSıON: Therapeutic effects of LSG and OAGB on metabolic syndrome components have been demonstrated in our study. However, when DM remission and sustainable weight loss are evaluated, OAGB is more effective in the long term.

Opioid-free anaesthesia (OFA) may enhance postoperative recovery after bariatric surgery, but its combined effect with opioid-free interventions has not been studied.

To compare postoperative pain and recovery after laparoscopic bariatric surgery with a total opioid-free care pathway and conventional opioid-based treatment.

A multicentre nonblinded controlled trial.

Two university hospitals in Sweden.

Adult patients scheduled for laparoscopic bariatric surgery were enrolled between May 2019 and November 2023. Of 837 patients screened, 112 were randomised, and 110 were included in the analysis: 55 in the intervention and 55 in the control group.

Patients were randomised to an opioid-based standard care (control group) or to an opioid-free care pathway (intervention group), including intraoperative OFA and postoperative first-line transcutaneous electrical nerve stimulation (TENS) treatment.

The primary outcome was the change in patient-reported postoperative pain intensity on a numerical rating scale (NRS) from arrival in the postanaesthesia care unit (PACU) until discharge to the surgical ward. Key secondary outcomes were postoperative pain intensity, in-hospital opioid consumption, and postoperative quality of recovery scale (PQRS) scores.

There was no difference between the groups regarding the changes in pain intensity from arrival in PACU until discharge to the ward, with mean ± SD changes in NRS of 3.20 ± 3.01 (intervention) vs. 3.15 ± 2.25 (control); mean difference (MD) 0.04 [(95% confidence interval (CI), -1.00 to 1.08); P = 0.97], and pain intensity at 24 h (P = 0.078), 72 h (P = 0.060), and 3 months (P = 0.30) postoperatively. The intervention group had a significantly lower opioid consumption in the PACU; mean morphine equivalents 6.08 ± 12.31 vs. 51.1 ± 14.9 mg; MD -45.0 (95% CI, -50.1 to -39.8) mg; P < 0.0001; and during the hospital stay MD -40.3 (95% CI, -54.4 to -25.9) mg; P < 0.0001. Total PQRS scores did not differ significantly over the 3-month follow-up.

The opioid-free care pathway offers patients pain relief and recovery outcomes comparable to conventional opioid-based care and reduces opioid use after laparoscopic bariatric surgery.

ClinicalTrials.gov NCT03756961.

Obesity is associated with an increased cardiovascular risk. Drugs with glucagon-like peptide-1 receptor agonist (arGLP-1) action for overweight/obesity, such as liraglutide, semaglutide, and tirzepatide, have shown improvements in weight and body composition, as well as in parameters related to glucose metabolism, hypertension, dyslipidemia (reduction of triglycerides and increase in HDL cholesterol), and metabolic dysfunction-associated steatotic liver disease. Additionally, semaglutide 2.4mg sc has shown a reduction in cardiovascular mortality, non-fatal myocardial infarction or stroke, and symptoms of heart failure, while tirzepatide has demonstrated a reduction in cardiovascular mortality and heart failure symptoms in patients with obesity and heart failure. The availability of these new drugs with arGLP-1 action represents a paradigm shift in the treatment of obesity, as they achieve greater weight loss and improvements in cardiometabolic comorbidities.

Some studies of obesity treatments use control groups identified from real-world registers, which may differ from people with obesity in the general population. We evaluated whether such control groups affect the results. The SOS study examines long-term mortality post-bariatric surgery. Among volunteers with obesity, 2,007 individuals underwent surgery, while a control group of 2,040 individuals was matched using 18 variables. Age was 37-60 years and BMI was ≥ 34/≥38 kg/m2 for men and women, respectively. We subdivided the control group into those with an obesity diagnosis (n = 177) and those without an obesity diagnosis (n = 1,863) in the Swedish National Patient Register prior to study inclusion. Mortality was determined over a median follow-up period of 26 years. The controls with a prior obesity diagnosis had a higher mortality rate than the controls without a prior obesity diagnosis, with 19.7 (95% CI, 15.5-25.1) and 14.4 (95% CI, 13.3-15.7) deaths per 1000 person-years, respectively. This corresponds to a hazard ratio of 1.45 (95% CI, 1.12-1.89; p = 0.005) and a 3.4-year shorter life expectancy. These results were confirmed in another cohort (n = 2,759, HR = 1.82 [95% CI, 1.47-2.25; p<0.001] and a 6.1-year shorter life expectancy). Controls with obesity identified from real-world datasets may be in poorer health than those who voluntarily participate in clinical studies. Consequently, selection bias could lead to an overestimation of the survival benefits of obesity treatments in research using controls identified by prior obesity diagnosis.

Bariatric surgery is an effective treatment for obesity, promoting significant and lasting weight loss while improving health and quality of life. The study examines the clinical and organizational pathway of patients undergoing it, assessing the impact of health services on their well-being through health status analysis. It also seeks to understand whether patient satisfaction during the care process correlates with improved quality of life. A total of 50 patients with severe obesity were included between July 2020 and October 2022. The evaluation was conducted using the Short Form Health Survey 36 and an ad hoc questionnaire at three stages: before the intervention (T0), at six months (T1) and at 12 months (T2). ANOVA analysis showed significant differences between T0, T1 and T2 for most variables except for the number of health professionals consulted (p = 0.09). The Tukey post-hoc test confirmed these differences for several variables, with some exceptions, including medication use (T0-T1: p = 0.14), number of health professionals consulted (T0-T1: p = 0.68; T0-T2: p = 0.08; T1-T2: p = 0.37), and patient-care team relationship between T1 and T2 (p = 0.08). The study confirms the effectiveness of bariatric surgery and emphasizes the importance of a multidisciplinary approach to patient management.

Background/Objectives: The percentage of the world's population with Class II obesity (body mass index (BMI) ≥ 35) and above is increasing annually. Bariatric (elective weight-loss) surgery is performed for less than one percent of eligible patients. A recent Delphi was unable to reach a consensus recommendation for or against mandated weight loss targets prior to bariatric surgery. This systematic review, performed according to the PRISMA 2020 guidelines, looks at the literature to determine whether there is evidence that pre-operative weight loss affects long-term (≥5 years) outcomes of bariatric surgery (weight loss, co-morbidity resolution). Methods: MEDLINE, EMBASE, CABI Digital Library, and Cochrane Central Register of Controlled Trials (Central) were searched from 1 January 2000 to 1 March 2025. Twenty-one full papers were then assessed, and only three papers met the eligibility criteria for inclusion in this review. Results: 1072 patients were included (age range 26-73 years, sleeve: bypass 60.3%:49.7%, F:M 70.2%:29.8%). The studies differed in their pre-operative preparation and selection criteria for surgery: one paper used an intensive pre-operative information course and mandated 5% weight loss. This study reported a significant association between pre-operative weight loss and long-term outcomes. Two papers had no mandated pre-operative weight-loss target and found there was no association between pre-operative weight loss and long-term outcomes. Conclusions: There is limited and conflicting evidence that pre-operative weight loss percentage affects long-term outcomes of bariatric surgery. Further research looking at five-, ten-, and twenty-year outcomes for bariatric patients is required, particularly randomised controlled trials or tier one evidence.

There is a pressing requirement to formulate innovative approaches for addressing inadequate weight loss or recurrence in individuals following metabolic bariatric surgery (MBS). Glucagon-like peptide- 1 (GLP- 1) analogues such as liraglutide and semaglutide have been formulated for treating type 2 diabetes or managing obesity. In this systematic review and meta-analysis, we aimed to pool the results from all available studies on GLP- 1 agonists to assess the efficacy of these drugs in weight recurrence or suboptimal clinical response of patients who underwent MBS.

We searched PubMed, Scopus, and Web of Science from inception till October 2024 for articles that fulfil our eligibility to be included in the systematic review and meta-analysis investigating the use of GLP- 1 agonists in the management of weight recurrence or suboptimal clinical response in patients who underwent MBS. The search strategy was as follows: "Liraglutide" OR "Semaglutide" OR "Tirzepatide" OR "GLP- 1" OR "Glucagon like peptide" AND "Weight" AND "Bariatric" OR "Sleeve" OR "Banding" OR "Roux-en-Y bypass. We used the mean difference (MD) to compare between continuous variables at a confidence interval (CI) of 95%, and p-value of 0.05.

The use of GLP- 1 agonists (liraglutide, semaglutide, and tirzepatide) was associated with a statistically significant decrease in the weight of the included patients showing an overall MD = 8.07 kg (95%CI: 5.5, 10.64, p < 0.00001) and I2 = 44%, p = 0.04. Moreover, these drugs (liraglutide, and semaglutide) showed significantly reduced body mass index (BMI) after treatment with overall MD = 4.42 kg/m2 (95%CI: 3.42, 5.42, p < 0.00001), and I2 = 67%, p = 0.0005. Compared with control group, the use of GLP- 1 agonists was associated with reduced weight with MD = - 9.19% (95%CI: - 10.81, - 7.58, p < 0.00001) and I2 = 0%. However, no difference was observed between both groups regarding BMI change with MD = - 1.97% (95%CI: - 4.65, 0.71, p = 0.15).

GLP- 1 agonists such as liraglutide and semaglutide effectively lower body weight and BMI in patients who suffer from weight recurrence or suboptimal clinical response after undergoing MBS. However, future studies are still warranted to investigate the most appropriate protocols for management.

Metabolic bariatric surgery (MBS) reduces the risk of new-onset hypertension; however, it is unclear whether this effect varies according to patient sex, age, or socioeconomic background. This study aimed to assess the risk of new-onset arterial hypertension after MBS, with a special focus on these patient characteristics.

This follow-up study with matched controls was nested in a large employee cohort, the Finnish Public Sector study, consisting of individuals with no hypertension at baseline. For each patient who underwent laparoscopic MBS between 2008 and 2016, two propensity-score matched controls were selected from individuals hospitalized with a diagnosis of obesity or individuals with self-reported severe obesity [body mass index (BMI) ≥ 35 kg/m 2 ] but no recorded history of MBS. Cases of new-onset hypertension were identified via linked electronic health records from the national health registries until December 31, 2016.

The study included 912 patients and 1780 matched controls. The rate of new-onset hypertension per 1000 person-years was 2.8 in the surgery group and 9.6 in the control group, with a rate ratio of 0.29 (95% confidence intervals 0.15-0.57) and a rate difference of -6.8 (95% confidence intervals -9.6 to -4.0) per 1000 person-years. No significant differences in rate reduction after MBS were observed to be associated with patient sex, age, or socioeconomic status.

Metabolic bariatric surgery reduces the risk of new-onset arterial hypertension across all age-, sex-, and socioeconomic subgroups.

Bariatric surgery is an effective treatment for obesity and its associated comorbidities. However, the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) for elderly and frail populations remain uncertain.

To validate the efficacy and safety of LSG for elderly and frail patients and to assess its impact on overweight and obesity-related comorbidities.

A retrospective cohort study of patients undergoing LSG at a university-affiliated single center between 2009 and 2022 from a prospectively maintained database. Patients were categorized into two cohorts based on age and frailty index: elderly vs younger patients and frail vs non-frail groups. Preoperative, perioperative, and postoperative data were analyzed.

Frailty was associated with statistically significantly higher perioperative complications (%, Clavien-Dindo of III/IV, 8 vs 3) and lower treatment success rates (% Excess Body Weight Loss, six-month, year, and two-year, 58 vs 64, 73 vs 82, 72 vs 81, and 63 vs 76, respectively). Age was not shown to alter the safety or efficacy of the operation.

While LSG is a viable option for elderly and frail patients, frailty is a significant predictor of treatment outcomes. A comprehensive assessment of individual factors, including frailty status, is essential for informed decision-making before surgery.

Bariatric surgery can lead to significant weight loss and improved physical health. Still, it often also brings about complex psychological effects, including changes in self-esteem, body image and emotional well-being that require careful monitoring and support. This systematic review with meta-analysis aims to analyse the relationship between bariatric surgery and postoperative improvement in psychiatric and eating disorders. MEDLINE, EMBASE, COCHRANE Library and other specialized databases were searched in July 2024. Observational studies included individuals who had undergone any bariatric surgical treatment with a preoperative evaluation of eating disorders, depression and anxiety and at a postoperative measure of the same variables selected. Thirteen studies that met the eligibility criteria were included for qualitative synthesis and eight studies for meta-analysis. Two reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. Bariatric surgery was found to be effective in improving eating disorders (-0.81%, 95% CI -1.61 to -0.05; I2 = 98%, p < .05), depression (-0.56, 95% CI -1.09 to -0.04, I2 = 97%, p < .03) and anxiety (-0.74, 95% CI -1.17 to -0.31, I2 = 94%, p < .00). The literature reveals high heterogeneity between studies, particularly in assessing psychological factors, with a common reliance on self-reported questionnaires rather than gold-standard assessments. Nonetheless, based on the findings of this study, there was a genuine effect on eating disorders, depression and anxiety when those participants underwent bariatric surgery.

The long-term durability of improvements in functional mobility and musculoskeletal pain for adolescents after metabolic and bariatric surgery (MBS) is unknown.

We used the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study to determine the change in mobility and pain among adolescents who underwent MBS. From standardized 400-m walk tests, we analyzed walk time, heart rate (HR) parameters, and musculoskeletal pain.

The mean walk time improved from 383 s (95% CI: 368-399) prior to surgery to 351 s (95% CI: 330-372) by 6 years. The mean resting HR was 90 beats per minute (bpm; 95% CI: 87-93) preoperatively and decreased to 80 bpm (95% CI: 76-84) by 6 years. The risk of any musculoskeletal pain decreased from 37.2% (95% CI: 25.5%-48.9%) to 11.0% (95% CI: 4.3%-17.6%) by 6 years. Mediation analysis revealed that the effect of time since surgery on walk time, resting HR, and HR recovery occurred through a weight-dependent mechanism. For posttest HR and HR difference, there was both a significant weight-dependent and weight-independent mechanism. The effect of surgery on the risk of musculoskeletal pain occurred through a weight-independent mechanism.

Adolescents who underwent MBS experienced significant, durable improvement in mobility and pain, despite weight regain. Our models suggest that improvements may occur through a weight-independent mechanism.

Obesity is a chronic disease with prevalence rates that have risen dramatically over the past four decades. This increase is not due to changes in the human genome but rather to environmental factors that promote maladaptive physiological responses. Emerging evidence suggests that external influences, such as high-fat diets, modify the epigenome-the interface between genes and the environment-leading to persistent alterations in energy homeostasis. This review explores the role of epigenetic mechanisms in obesity, emphasizing insights from transgenic animal models and clinical studies. Additionally, we discuss the evolution of obesity research from homeostatic to allostatic frameworks, highlighting key neuroendocrine regulators of energy balance.

Combined lifestyle interventions (CLI) is a program designed to treat (morbid) obesity and can possibly be an adjunct to bariatric surgery. Bariatric surgery can lead to 25-50% total weight loss (TWL) and up to 71% excess weight loss, yet the longevity of the weight reduction remains variable, primarily attributed to a lack of lifestyle change. This pilot study aims to assess the effect of a 3-year structured CLI program, additional to a 5-year bariatric surgery program in a regional hospital, on the short-term outcome following bariatric surgery.

A single-center prospective cohort study was performed on patients who underwent bariatric surgery between September 2021 and October 2022 (n=28). A structured CLI program was organized and offered by an official out-of-hospital CLI provider. CLI participants were matched with patients following regular follow-up. Primary outcome was quarterly measured excess weight loss (EWL). Secondary outcomes were TWL, fat measurements, sports participation and comorbidities.

There were significant differences in sports participation after 1 year (92.9% vs. 62.5%; P=0.050), EWL at 21 months (18.3 kg; 95% confidence interval [CI], 0.14-36.4; P=0.049), fat mass at 18 months (-8.7 kg; 95% CI, -14.1, -3.3; P=0.008) and fat percentage at 18 months (-10.0%; 95% CI, -17.9, -2.0; P=0.017) in the CLI group compared to the control group.

Preliminary short-term results show that a structured additional CLI program to bariatric surgery could benefit in terms of weight loss, perhaps due to better sports participation, but long-term results have to be awaited for.

Limited literature exists on labor and delivery outcomes after bariatric surgery. This study assesses the impact of prior bariatric surgery on peripartum outcomes.

We queried the National Inpatient Sample (2016-2020) for labor and delivery admissions, categorizing them into three cohorts: prior bariatric surgery (BaS), obesity without prior bariatric surgery, and controls without obesity. We used a multivariate regression model, adjusting for confounders, to compare peripartum outcomes.

We identified 22,685 BaS cases, 2.1 million pregnant controls with obesity, and 16.37 million pregnant controls without obesity. Compared to controls with obesity, the BaS cohort had lower rates of cesarean delivery [43% vs 46.8%, adjusted odds ratio (aOR) 0.72, p < 0.001], fetal distress [aOR 0.79, p < 0.001), post-partum hemorrhage (aOR 0.67, p < 0.001), fetal disproportion (aOR 0.36, p < 0.001), and premature rupture of membranes (aOR 0.88, p = 0.04). Compared to controls without obesity, the BaS group had higher rates of cesarean delivery (43% vs 29.57%, aOR 1.43, p < 0.001), breech presentation (aOR 1.4, p < 0.001), thromboembolic events (aOR 2.47, p = 0.01), and pregnancy termination (aOR 1.59, p = 0.048), but lower rates of assisted delivery (aOR 0.54, p < 0.001), fetal disproportion (aOR 0.56, p = 0.025), PROM (aOR 0.87, p = 0.024), and placenta previa (aOR 0.63, p = 0.019). The BaS group had longer hospitalizations (3.11 vs 2.56 days, p < 0.001) and higher hospitalization charges ($25,941 vs $20,760, p < 0.001) compared to controls without obesity.

Pregnancy after bariatric surgery is associated with lower odds of cesarean delivery and postpartum complications, relative to the general population with obesity. This underscores the positive impact of bariatric surgery on peripartum outcomes.

The prevalence of obesity and related co-morbidities has reached epidemic proportions. Effective evidence-based treatment approaches are therefore important. Lifestyle intervention remains the mainstay of the treatment strategy to manage obesity. Increased evidence has also emerged regarding the efficacy of metabolic bariatric surgery (MBS) to induce significant and sustained weight loss while also reducing the progression of obesity-related co-morbidities for people living with obesity.

This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with overweight or obesity by means of lifestyle and behavioural intervention, as well as by MBS.

Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on MBS will focus on current indications, comparison between different MBS procedures, novel endoscopic techniques, potential complications and pre-operative management.

The number of people living with excess weight and complications associated with being overweight is alarmingly quite high. Effective treatment approaches that are supported by clinical studies are therefore important. Lifestyle changes remain very important to manage excess weight. Increased evidence has also shown the benefits of weight loss surgery to produce significant weight loss which could be sustained, while also reducing the risk of developing medical conditions associated with excess weight. This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with excess weight by means of lifestyle and behavioural changes, as well as by weight loss surgery. Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on weight loss surgery will focus on current criteria for suitability, comparison between different weight loss surgery procedures, new techniques, possible complications and appropriate management prior to weight loss surgery.

Individuals with excessive adipose tissue and type 2 diabetes mellitus (T2DM) face a heightened risk of cardiovascular morbidity and mortality. Metabolic surgery is an effective therapy for people with severe obesity to achieve significant weight loss. Additionally, metabolic surgery improves blood glucose levels and can lead to T2DM remission, reducing major adverse cardiovascular outcomes (MACE). Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are a class of medication that effectively reduce body weight and MACE in patients with T2DM. This review explores the potential mechanisms underlying the cardioprotective benefits of metabolic surgery and GLP-1RA-based therapies and discusses recent evidence and emerging therapies in this dynamic area of research.

Social relationships and support are vital for well-being and health. In the context of metabolic bariatric surgery (MBS), these relationships might influence emotion regulation and health behaviors that affect surgical outcomes. Conversely, the outcomes of MBS can impact an individual's social dynamics due to enhanced social engagement or potential shifts in social structures resulting from changes in self-perception.

This study investigated the bidirectional relationship between social factors and metabolic bariatric surgery (MBS) outcomes, testing if social factors are associated with improved MBS outcomes, and if MBS outcomes are associated with changes in social relationships.

Patients reported about structural and functional aspects of their social relations before surgery and at 1-, 3- and 5-year post-surgery. Physiological and mental health parameters were also collected. The relationship between pre-surgery social factors and MBS outcomes 5 years post-surgery was tested with a path model based on regression analysis. The relationship between MBS outcomes 1-year post-surgery and social relationships 3 years post-surgery was tested with multiple and logistic regressions.

Non-family support predicted higher satisfaction with surgery. Increased family coherence in partnered patients was linked to a greater reduction in blood pressure 5 years post-surgery. However, relationship stability, social competence, relationship satisfaction, and weight-loss specific support were not related to biopsychosocial outcomes.On the other hand, changes in social relationships post-surgery were not related to weight loss or other outcomes. Depression and anxiety symptoms 1 year after surgery were associated with decreased relationship satisfaction 3 years post-surgery.

Overall, social factors had limited and selective predictive value to outcomes, potentially due to the dominant influence of physical changes or generally satisfactory relationships. These findings offer insights for patients and healthcare providers on the nuanced implications of MBS beyond physical health.

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.

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

By 2025, global obesity rates are projected to reach 16% in men and 21% in women, imposing a significant public health burden. Obesity is a major contributor to hypertension (HTN), exacerbating cardiovascular risks. This review and meta-analysis evaluated the effectiveness of non-surgical treatments versus bariatric surgery in managing hypertension among obese individuals.

We searched PubMed, Scopus, Embase, and Cochrane databases up to May 2024. Randomized controlled trials (RCTs) comparing bariatric surgery (e.g., Roux-en-Y Gastric Bypass (RYGB), Sleeve gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Duodenal-jejunal bypass liner/Biliopancreatic diversion (DJBL/BPD)) with non-surgical interventions (e.g., lifestyle modifications, medications) in hypertensive obese patients were included. Primary outcomes were changes in systolic and diastolic blood pressure. Secondary outcomes included changes in fasting blood sugar (FBS), HbA1c, and lipid profiles. Data were synthesized using a random-effects model, with heterogeneity and publication bias assessed.

From 7,187 records, 29 studies involving 2,548 patients met the inclusion criteria. Bariatric surgery resulted in greater reductions in systolic (MD: -4.506 mmHg; 95% CI: -6.999 to -2.013) and diastolic (MD: -3.040 mmHg; 95% CI: -4.765 to -1.314) blood pressure compared to non-surgical interventions. Roux-en-Y gastric bypass had the most significant impact. Bariatric surgery also led to substantial reductions in FBS (MD: -30.444 mg/dl; 95% CI: -41.288 to -19.601), HbA1c (MD: -1.108%; 95% CI: -1.414 to -0.802), and triglycerides (MD: -39.746 mg/dl; 95% CI: -54.458 to -25.034), and increased HDL levels (MD: 7.387 mg/dl; 95% CI: 5.056 to 9.719). The quality of evidence was high for most outcomes, supporting these findings.

Bariatric surgery is superior to non-surgical treatments in managing obesity-related hypertension and metabolic disorders. Reductions in blood pressure, glycemic indexes, and lipid profiles highlight bariatric surgery's critical role in improving cardiovascular health and metabolic outcomes in obese hypertensive patients.

Lifestyle modification is essential to achieve and maintain successful outcomes after metabolic bariatric surgery (MBS). Emotions, physical states, and contextual factors are considered important determinants of maladaptive eating behavior, emphasizing their significance in understanding and addressing weight management. In this context, experience sampling methodology (ESM) offers promise for measuring lifestyle and behavior in the patient's natural environment. Nevertheless, there is limited research on its feasibility and association among emotions and problematic eating behavior within the population after MBS.

This study aimed to examine the feasibility of ESM in the population after MBS regarding emotions, physical states, contextual factors, and problematic eating behavior, and to explore the temporal association among these variables.

An experience sampling study was conducted in which participants rated their current affect (positive and negative), physical states (disgust, boredom, fatigue, and hunger), contextual factors (where, with whom, and doing what), and problematic eating behavior (ie, grazing, dietary relapse, craving, and binge eating) via smartphone-based ESM questionnaires at 6 semirandom times daily for 14 consecutive days. Feasibility was operationalized as the study's participation rate and completion rate, compliance in answering ESM questionnaires, and response rates per day. At the end of the study period, patients reflected on the feasibility of ESM in semistructured interviews. Generalized estimation equations were conducted to examine the temporal association between emotions, physical states, contextual factors, and problematic eating behavior.

In total, 25 out of 242 participants consented to participate, resulting in a study participation rate of 10.3%. The completion rate was 83%. Overall compliance was 57.4% (1072/1868), varying from 13% (11/84) to 89% (75/84) per participant. Total response rates per day decreased from 65% (90/138) to 52% (67/130) over the 14-day study period. According to the interviews, ESM was considered feasible and of added value. Temporal associations were found for hunger and craving (odds ratio 1.04, 95% CI 1.00-1.07; P=.03), and for positive affect and grazing (odds ratio 1.61, 95% CI 1.03-2.51; P=.04).

In this exploratory study, patients after MBS were not amenable to participate. Only a small number of patients were willing to participate. However, those who participated found it feasible and expressed satisfaction with it. Temporal associations were identified between hunger and craving, as well as between positive affect and grazing. However, no clear patterns were observed among emotions, physical states, context, and problematic eating behaviors.

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.

To investigate the effectiveness of different bariatric metabolic surgeries in improving metabolic syndrome indicators in patients.

A retrospective analysis was conducted on obese patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic sleeve gastrectomy + jejunojejunal bypass (LSG + JJB), and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients were categorized into groups based on their surgical procedure: LSG (N = 199), LSG + JJB (N = 242), and LRYGB (N = 288).

Successful laparoscopic bariatric metabolic surgery was achieved in 729 patients. Indicators related to body mass, glucose metabolism, insulin resistance, lipid metabolism, and kidney function showed significant improvement compared to the preoperative period.

LSG, LSG + JJB, and LRYGB all demonstrate significant effectiveness in promoting weight loss and improving glycolipid metabolism in the short term. Post-surgery, symptoms of metabolic syndrome improved compared to the preoperative period, with LRYGB showing superior effectiveness over LSG + JJB and LSG.

Obesity is a relapsing condition and response to anti-obesity therapies appears to be normally distributed. Therefore, some patients undergoing metabolic bariatric surgery (MBS) will demonstrate a partial response to therapy. When prescribing therapies to patients living with obesity (PwO) the median total weight loss (TWL) gives a good indication of the likely utility of prescription for that individual. GLP-1 agonists (GLP1a) offer patients a reasonable prospect of clinically significant weight loss even if they have been previously treated with MBS.

A retrospective review of prospectively collected data in a single bariatric clinic was performed. Patients with insufficient weight loss at any time point were offered semaglutide therapy with doses titrated depending on response to treatment, tolerability, availability and affordability. Duration of therapy, highest dose tolerated, anthropometric measures and reported side effects were recorded. Reasons for discontinuation were noted where possible; however, discontinuation due to medication unavailability was not reliably captured in the dataset.

The median dose tolerated was 1 mg s/c per week, and 78% tolerated ≤ 1 mg as the maximum achieved dose. The median TWL was 7.5% and side effects were uncommon. Most patients took therapy for > 6 months, but continued therapy > 1 year was uncommon.

Overall 'real-world' utility of semaglutide after MBS may potentially be hampered by supply and cost issues more than issues associated with effectiveness or side effect profile.

Suboptimal initial clinical response (SICR) and weight gain recurrence (WGR) are challenging issues following bariatric surgery. Recently, the promising weight loss effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been applied to bariatric patients. We aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of GLP-1 RAs in the treatment of SICR and WGR after bariatric surgery.

A literature search was performed across online databases. The primary outcomes were percentage of total weight loss (%TWL) and absolute weight loss. Secondary outcomes included changes in biochemical markers and adverse effects (AEs).

Nineteen studies including 1290 patients were included. After at least 3 months of treatment, the pooled %TWL was 9.24% for liraglutide, 11.38% for semaglutide, and 15.50% for tirzepatide, with corresponding weight reductions of 8.56 kg, 11.62 kg, and 12.60 kg, respectively. Additionally, %TWL and weight loss with liraglutide use were 7.65% and 7.47 kg for ≤ 6 months, 10.22% and 9.30 kg for 6-12 months, and 10.80% and 9.72 kg for ≥ 12 months. For semaglutide, the %TWL and weight reduction were 10.18% and 9.43 kg at 6 months, and 13.15% and 14.68 kg at 12 months. Biochemical markers including triglycerides, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin, and alanine aminotransferase levels showed significant reductions after GLP-1 RA treatment. Common AEs were nausea (23%), vomiting (6%), diarrhea (6%), constipation (10%), headache (6%), fatigue (8%), abdominal pain (2%), and abdominal bloating (2%). The proportion of patients who discontinued the treatment due to AEs was 3%.

GLP-1 RAs are effective and safe for treating SICR and WGR after bariatric surgery.

There has been a rapid increase in prevalence of obesity, and bariatric surgery is the most effective treatment to reduce all-cause mortality. Gastrointestinal stromal tumors (GISTs) comprise approximately 1% of GI tumors and are the most commonly encountered incidental tumor at the time of bariatric surgery. They have a reported prevalence of approximately 0.5%; however, there are no established guidelines for incidental GISTs.

This study performed a systematic literature search using PubMed to identify 100 articles from 2005 to 2023 on incidental GIST tumors found during bariatric operations.

Total prevalence of GISTs was 0.54% with an average size of 7.04 mm. Management of these lesions should prioritize negative margins with the least invasive resection. Tumors able to be resected without alteration to bariatric surgery should be managed with a complete wedge resection prioritizing negative margins. In tumors where resection requires alteration to bariatric surgical plan, the decision to proceed with resection and alteration of bariatric surgical plan should be made only if previous discussions have been made with patient. Lastly, if resection of the GIST precludes the ability to perform the bariatric procedure, consideration to resect the GIST with the goal of negative margins should be prioritized with a plan to discuss future bariatric procedures after.

The goal of this paper is to remind bariatric surgeons to be aware of GISTs and provide the possible approaches to management.

The Spatz3® Intragastric Adjustable Balloon (SAB) offers a novel approach to weight loss in super obese patients [body mass index (BMI) ≥50 kg/m 2 ]. This study evaluates the safety, effectiveness, and predictors of success of SAB in this population.

A retrospective study was conducted at King Abdullah Medical City, Makkah, Saudi Arabia, involving 94 patients with SAB implantation. Weight loss metrics (%EWL, %TBWL), complications, and predictors of adverse events were analyzed.

Eleven patients required early SAB removal due to severe symptoms. Complications included gastrointestinal bleeding (3.2%), gastric ulcer/erosion (27.7%), and deflation (5.3%). Significant weight loss was observed at 6 and 12 months. The mean absolute weight loss was 22.03 kg at 12 months, with %EWL of 19.27%. Early weight loss at 3 months predicted long-term success. SAB adjustments did not significantly impact outcomes. Post SAB, 57% of patients proceeded to laparoscopic sleeve gastrectomy (LSG) with rare postoperative complications (2.9%).

SAB is safe and effective for patients with BMI ≥50 kg/m 2 , achieving significant weight loss at 12 months. Early weight loss predicts long-term success, and subsequent LSG can be performed without significant complications. Further research should explore long-term outcomes and comparative analyses.

The current study aimed to evaluate the role of cerium oxide nanoparticles (C-1), a potent antioxidant, in the medication of cardiovascular disease in obese animal model. C-1 was prepared using a modified sonication sol-gel method. Thirty-two adult male rats were equally divided into 4 groups (n=8/each). The first (control) and second (obese) groups are not treated while the obese rats in the third and fourth groups were given 15 and 30 mg/kg C-1(IP), respectively, for 8 weeks. Parameters of insulin resistance, adipocyte hormones, inflammatory markers, lipid profile, cardiac enzymes and cardiac iron content (C-Fe) were estimated. Moreover, histological study and immunohistochemical stain for inducible nitric oxide synthase (INOS) for cardiac and aortic tissues were performed. The XRD patterns of C-1 showed narrow symmetric diffraction peaks. The particle diameters were calculated from the TEM histogram (21.09 nm) and the Debye-Scherrer Method (20.74 nm) which were very similar. Using the most intense peak ( 28 . 47 ∘ ), structural parameters were calculated including nano-crystallite size, Micro-strain, Lorentz factor, Thomson polarization parameter, and Lorentz polarization parameter. BET was used to calculate The total surface area (ST ), and specific surface area (SBET ). The XPS survey spectrum of C-1 showed peaks for C-1s, O-1s and Ce-3d. The treatment of obese rats with C-1 led to a significant decrease in body weight, C-Fe , plasma leptin, tumor necrosis factor-alpha (TNF α ), interleukin-6 (IL6), C-reactive protein (CRP), resistin, cholesterol, triglycerides, low-density lipoprotein (LDL), Troponin, Creatinine Kinase-MB (CK-MB), lactate dehydrogenase (LDH), and malondialdehyde (MDA) in cardiac tissue or in plasma. Also, C-1 lowered plasma monocyte chemoattractant protein-1 (MCP-1), Epithelial Neutrophil-Activating Peptide (ENA-78), and insulin and glucose levels in obese rats. Furthermore, C-1 alleviated the increase of cardiac iNOS. Moreover, C-1 mitigated pathological changes of cardiac muscle and aorta observed in obese rats. On the other hand, C-1 enhanced adiponectin, cardiac glutathione (GSH) and superoxide dismutase (SOD) in obese rats. The effect of C-1 is dose-dependent ( 30 mg/kg of C-1 is more evident than 15 mg/kg). The modified synthesis method may lead to a smaller particle size than that reported in our previously reported work. The XRD patterns of C-1 indicate its cubic structure with space group F m -3 m (225) which was matched by code id 4343161 from COD. The Raman spectrum of C-1 indicates the absence of rearrangement oxygen atoms, the presence of oxygen in its fluorite lattice positions, and the oxygen vacancies in C-1 and the Ce vibration model (F2g). The presence of ten peaks in the high-resolution Ce-3d XP spectrum indicates the existence of both Ce3+ and Ce4+. C-1 showed therapeutic efficacy in atherosclerosis and cardiac muscle abnormalities associated with obese rats, probably because of their antioxidant and anti-inflammatory properties, which lead to lowering oxidative stress.

Bariatric surgery has become the preferred treatment for individuals with morbid obesity. Nutrition is key in optimizing surgical outcomes by reducing risks and enhancing recovery. Preoperative strategies, such as reducing body fat, decreasing liver size, and improving metabolic profiles, have been shown to facilitate safer surgical procedures with fewer complications. This narrative review aims to provide an analysis of the fundamental role of preoperative nutritional management in improving bariatric surgery outcomes, emphasizing the importance of addressing specific nutritional challenges to enhance surgical safety, recovery, and overall health. Preoperative nutritional interventions focus on correcting comorbidities and nutritional deficiencies, particularly hypovitaminosis and micronutrient imbalances, through a multidisciplinary approach involving nutritionists and other healthcare professionals. These interventions not only prepare patients for the physiological demands of surgery but also initiate a period of adaptation to new dietary habits, aiming to improve long-term compliance and mitigate risks such as postoperative weight regain and dumping syndrome. Adopting dietary changes, such as very low-calorie or ketogenic diets 6-12 weeks before surgery, enhances adherence to postoperative restrictions and overall surgical success. Future research should focus on developing comprehensive guidelines for preoperative nutritional care to improve patient outcomes globally.

The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.

Postprandial hypoglycaemia (PPHG) is a frequent late complication of Roux-en-Y gastric bypass (RYGB) in people without diabetes. We aimed to examine the pathogenetic mechanisms of PPHG and its clinical consequences in people with a history of type 2 diabetes.

In this case-control study, 24 participants with type 2 diabetes treated with RYGB (14 women; median [IQR] age 53.5 [13.8] years, BMI 29.3 [6.3] kg/m2, HbA1c 36.0 [6.2] mmol/mol [5.4% (0.6%)]) underwent a dual-tracer, frequently sampled, 300 min, 75 g OGTT for the diagnosis of PPHG (glucose nadir <3.0 mmol/l, or <3.3 mmol/l with symptoms). Plasma glucose, glucose tracers, insulin, C-peptide, glucagon-like peptide-1, gastric inhibitory polypeptide, glucagon, adrenaline (epinephrine), noradrenaline (norepinephrine), cortisol and NEFAs were measured. Mathematical models were implemented to estimate glucose metabolic fluxes and beta cell function. ECG recordings, cognitive testing and hypoglycaemia awareness assessments were repeated during the OGTT. Glycaemic levels and dietary habits were assessed under free-living conditions.

PPHG occurred in 12 (50%) participants, mostly without symptoms, due to excessive tracer-derived glucose clearance (mean group difference ± SE in AUC0-180 min +261±72 ml min-1 kg-1 × min) driven by higher whole-body insulin sensitivity and early glucose-stimulated hyperinsulinaemia, the latter depending on lower insulin clearance and enhanced beta cell function, regardless of incretin hormones. PPHG participants also had defective counterregulatory hormone responses to hypoglycaemia, preventing a physiological increase in endogenous glucose production and the appearance of symptoms and signs of sympathetic cardiovascular activation and neuroglycopenia. PPHG was associated with more frequent and prolonged hypoglycaemia on 14 day continuous glucose monitoring and alterations in free-living dietary habits.

Our results demonstrate that post-bypass PPHG occurs frequently in individuals with a history of type 2 diabetes, often without warning symptoms, and expose its complex pathogenetic mechanisms, revealing potential therapeutic targets.

Treatment of type 2 diabetes (T2DM) in patients with obesity can be challenging. Metabolic and bariatric surgery (MBS) has shown promising results in improving glycemic control and even achieving remission in T2DM patients with obesity. However, the durability of glycemic improvements in T2DM patients following MBS remains insufficiently studied.

Determine the incidence of durable remission and relapse of T2DM rates 10 years after MBS, characterize the glycemic profile after surgery, and identify factors predicting persistent remission of T2DM.

Retrospective observational study of T2DM patients undergoing MBS between 2010 and 2013. Clinical and analytical assessments were performed preoperatively, at 2- and at 10-years postoperatively. Paired t-tests, Wilcoxon-signed-rank and McNemar tests were used to assess the differences in the metabolic status during the follow-up. Logistic regression models were used to identify predictors of T2DM remission.

Ninety-five patients were included (mean age 48.8 ± 9.1 years, mean HbA1c 7.0 ± 1.5%). Ten years after surgery, the rate of complete T2DM remission was 31%, partial remission was 15%, and late recurrence after initial remission was 24%. Patients with lower HbA1c (OR = 0.50; p = 0.05) and taking fewer antidiabetic drugs (OR = 0.31; p = 0.01) preoperatively were more likely to maintain long-term remission. Ten years post-MBS, patients maintained lower fasting plasma glucose (p < 0.001), HbA1c (p < 0.001), number of antidiabetic drugs (p < 0.001), and insulin use (p < 0.001).

MBS can induce a significant improvement and sustainable remission of T2DM. Early intervention, while patients still have a good glycemic control with a lower number of anti-diabetic drugs, is crucial to achieve long-lasting benefits and a potential "surgical cure" for T2DM.

Morbid obesity requires active intervention, with treatment options including lifestyle modification, pharmacotherapy, and surgery. As the prevalence of obesity continues to rise in Korea, it is crucial for specialists and general practitioners to have a comprehensive understanding of obesity and its management. Bariatric surgery is the most effective treatment modality for obesity, leading to significant weight loss and metabolic benefits. It involves surgical alterations of normal anatomical structures to improve overall health. Therefore, selecting the appropriate procedure based on the individual characteristics of patients is crucial. This review highlights the two most commonly performed bariatric procedures worldwide, including in Korea: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, it provides a comprehensive overview of the surgical techniques involved in SG and RYGB, addresses potential complications, and presents findings from key studies on the weight loss and metabolic outcomes of these surgeries. Additionally, to support clinical application, the review provides outcome data for these procedures based on studies conducted in Korean populations. In addition to SG and RYGB, this review briefly introduces other surgical and endoscopic options, as well as pharmacological treatments that are currently available or may become viable options in the near future.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Suicidal ideation and behavior are critical psychological crises among children and adolescents, posing significant concerns for their mental health and safety. This cross-sectional study investigated the factors and underlying psychological mechanisms of suicidal ideation in adolescents. A total of 6474 middle school students from Sichuan and Hebei provinces, China, participated in the study. Data were collected using the Self-Assessment of Suicidal Ideation Scale, the Parental Psychological Control Scale, the Meaning in Life Scale, and the Basic Psychological Needs Scale. Statistical analyses, including mediation and chain mediation analyses, were conducted to examine the relationships between parental psychological control, basic psychological needs, meaning in life, and suicidal ideation. The results revealed the following: (1) Parental psychological control positively predicted suicidal ideation in middle school students; (2) basic psychological needs mediated the relationship between parental psychological control and suicidal ideation; (3) meaning in life mediated the relationship between parental psychological control and suicidal ideation; (4) basic psychological needs and meaning in life together played a chain-mediating role in this relationship. These findings highlight the importance of addressing parental psychological control and fostering a supportive family environment to meet adolescents' psychological needs, enhance their sense of life meaning, and reduce suicidal ideation. Insights from this study provide valuable guidance for prevention and intervention strategies aimed at safeguarding adolescents' mental health and well-being.

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive bariatric procedure of the gastric cavity to facilitate weight loss. We aimed to evaluate the long-term effects of ESG as a monotherapy on obesity-related comorbidities over 5 years.

This prospective study analyzed data from 404 consecutive patients (aged 45 ± 11.9 years, 76% women) who underwent ESG from August 2013 through June 2024. All patients had body mass indices ≥30 or ≥27 kg/m2 with comorbidities. Patients receiving adjuvant therapy were excluded to assess ESG as a monotherapy. All procedures were performed with a flexible endoscopic suturing system to facilitate restriction of the stomach. Patients were evaluated after 12 months (n = 336), 36 months (n = 210), and 60 months (n = 196) for anthropometric features, clinical parameters, metabolic panels, and liver function tests. Primary outcomes were the effects of ESG on obesity-related comorbidities and metabolic biomarkers. Secondary outcomes were total body weight loss (TBWL) and safety.

At 5 years after ESG, patients had significant reductions in levels of hemoglobin A1c (Δ .42%, P = .0007), systolic blood pressure (Δ 4.1 mm Hg, P = .0071), and alanine aminotransferase (Δ 7.4 U/L, P = .002). Body mass indices before the procedure were 37.5 ± 5.8 and 33.8 ± 6.7 kg/m2 at 60 months (P < .001). TBWL was 13.4% at 12 months (84.5% follow-up), 9.9% at 36 months (63.3% follow-up), and 11.8% at 60 months (74.8% follow-up), with 3 moderate adverse events (.7%).

ESG is an effective, noninvasive monotherapy that improved markers of hypertension, diabetes, and metabolic dysfunction-associated steatotic liver disease and led to a TBWL of 11.8% at 5 years after the procedure. (Clinical trial registration number: NCT04494048.).