Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including OAGB-MGB vs SADI-S as a revisional procedures after SG, the impact of SG on pelvic floor disorders, physical function and physical activity after surgery, predictors of psychological distress and body dissatisfaction and more (please note, log-in maybe required to access the full paper).
Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy
Both one anastomosis gastric bypass (OAGB-MGB) and single anastomosis duodeno-ileal bypass (SADI-S) have demonstrated efficacy as revisional procedures for weight regain following sleeve gastrectomy (SG), but according to researchers from Qatar SADI-S exhibits superior outcomes regarding to weight loss, resolution of comorbidities, complication rates and reoperation rates.
Writing in Surgical Endoscopy, they compared the five years outcomes from the two procedures that were carried out at the Hamad General Hospital, Qatar. The study included 91 patients - 42 and 49 in the SADI-S and in the OAGB-MGB group.
They found that significant weight loss (measured by total weight loss percentage, TWL%) was observed at the five-year follow-up for the SADI-S group compared to the OAGB-MGB group (30.0 ± 18.4 vs. 19.4 ± 16.3, p=0.008). In addition, remission of comorbidities, specifically diabetes mellitus and hypertension, was more prevalent in the SADI-S group. However, they noted that the OAGB-MGB group had a higher incidence of complications (28.6% vs. 21.42%) and reoperations (5 patients vs. 1) compared to the SADI-S group.
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Effects of Sleeve Gastrectomy on Pelvic Floor Disorders in Female Patients with Severe Obesity: a Prospective Study
Sleeve gastrectomy (SG) may improve the outcomes in females with pelvic floor disorders (PFD), specifically faecal incontinence (FI), compared to females on a six month low-calorie diet, according to investigators from Turkey.
Reporting in Obesity Surgery, they noted that SG has been found to improve urinary incontinence (UI) and overactive bladder (OAB), its impact on FI remains ‘controversial’. To further assess this issue, they performed a randomised study of 60 female patients with severe obesity who were randomly assigned to the surgery or diet group (n=30 each). The patients’ condition was assessed before and after the study using three questionnaires: the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Overactive Bladder 8-Question Awareness Tool (OAB-V8), and the Wexner Score (CCIS).
At six months, the SG group had a significantly higher percentage of total weight loss (%TWL) compared to the diet group (p<0.01). Both groups showed a decrease in the ICIQ-FLUTS, OAB-V8, and CCIS scores (p<0.05). UI, OAB and FI improved significantly in the SG group (p<0.05), but no improvement was observed in the diet group (p>0.05). However, the correlation between %TWL and PFD was statistically significant but weak, with the strongest correlation between %TWL and ICIQ-FLUTS score and the weakest correlation between %TWL and CCIS score (p<0.05).
“We recommend bariatric surgery for the treatment of PFD,” they concluded. “However, given the weak correlation between %TWL and PFD after SG, further research should explore factors other than %TWL that are effective in recovery, particularly in relation to FI.”
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Changes in physical function and physical activity in patients up to 5 years after bariatric surgery
Physical function and physical activity increased post-bariatric surgery patients and were maintained over five years, according to researchers from Carmel Hospital, Carmel, IN. However, they noted that treadmill testing suggests most patients are still unable to perform sustained activities.
Writing in SOARD, the researchers assessed the physical fitness and activity changes among bariatric surgery patients in a clinical trial of physical activity interventions in 42 bariatric surgery patients at six months and five years post-surgery. Patients wore an accelerometer to track activity and completed strength and cardiovascular endurance testing via treadmill where estimated metabolic equivalents (METs) and ratings of perceived exertion (RPE) were obtained.
Preoperatively, 25% of patients reported exertion of <3 METs (equivalent to walking 2.5 mph) as an RPE of 16 (“hard-to-very-hard”), decreasing significantly to approximately 5% of patients at six months and five years after surgery. Before surgery, 7.5% achieved ≥6 METs (vigorous activity) at an RPE of 16, increasing significantly to 36.6% at six months and 42.1% at five years post-surgery. Body mass index and age, but no physical activity measure, predicted functional ability over time.
The study authors added additional research was needed on the long-term function and interventions optimising outcomes in bariatric patients.
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Weight discrimination, BMI, or weight bias internalization? Testing the best predictor of psychological distress and body dissatisfaction
Investigators from Barcelona, Spain have reported that weight bias internalisation (WBI) plays an important role in psychological distress (PD) and body dissatisfaction (BD).
Writing in the journal Obesity, they compared PD and BD in terms of BMI, WBI and assessed the best predictors of PD and BD. The study included 1,283 participants across all BMI categories (people with obesity were the most predominant (26.1%) group) and examined their experiences of weight-based.
The outcomes revealed that people with obesity, those with WBI, and those who faced current and past weight discrimination reported higher PD and higher BD. WBI was the best predictor after controlling for BMI, WBI, and current and past weight discrimination. The relationship between weight discrimination and BD through WBI was significant, as was the relationship between weight discrimination and WBI through BD.
They authors concluded that there is a need to better understand how WBI is formed and to design effective interventions to reduce it.
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