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 longer biliopancreatic limb lengths has better weight loss, consensus meeting on AI in BMS, Swedish Obese Subjects vascular outcomes, weight loss dynamics after LSG, emergency department use for self vs public payers, real-world use of tirzepatide, and more (please note, log-in maybe required to access the full paper).
Enhanced Total Weight Loss 2 Years Post-Roux-en-Y Gastric Bypass with Longer Biliopancreatic Limb
Longer biliopancreatic (BP) limb lengths (150–175cm) are conducive to total weight loss (TWL) and overall treatment of obesity-related problems without severe rates of complications, researchers from NYU Langone Hospital, NY.
Reporting in Obesity Surgery, this multi-centre retrospective cohort study divided patients into subgroups based on BP limb lengths: short (50–75cm), intermediate (80–125cm) and long (150–175cm). Primary outcomes were TWL and % TWL at 1 and 2 years. Secondary outcomes were post-operative BMI and % BMI change at 1 and 2 years, micronutrient deficiencies, hypothyroidism, acute kidney injury (AKI) requiring treatment, and remission in associated medical problems. Subgroups were compared using multivariate analysis.
Two hundred twenty-eight patients received a long BP limb, 194 patients received an intermediate BP limb, while 152 patients received a short BP limb. Primary outcomes TWL and % TWL were significantly different between the groups at one year: TWL and % TWL were greater in patients with long BP limbs. The difference between the long and short BP limb groups increased at the 2-year mark. Patients who had long BP limbs had higher rates of DM remission (12.3% vs 11.9% 6.6%), HTN (8.8% vs 5.7% vs 7.9%), GERD symptoms (14.5% vs 9.8% vs 5.3%), and OSA (8.8% vs 7.7% vs 5.3%). However, vitamin A deficiency rates were higher in the long BP limb group.
The researchers added that additional longer longitudinal studies are needed to assess the impact of long BP limbs on nutrition and weight loss in the long term.
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International expert consensus on the current status and future prospects of artificial intelligence in metabolic and bariatric surgery
International expert consensus meeting on artificial intelligence in BMS has emphasised the need for ethical guidelines governing AI use and the inclusion of AI’s role in decision-making within the patient consent process.
Writing in Scientific Reports, the consensus sought to examine the role of AI in MBS using a modified Delphi method. A panel of 68 leading metabolic and bariatric surgeons from 35 countries participated in this consensus-building process, providing expert insights into the integration of AI in MBS.
The experts agreed that AI has the potential to enhance the evaluation of surgical skills in BMS by providing objective, detailed assessments, enabling personalised feedback, and accelerating the learning curve. Most experts also recognized AI’s role in identifying qualified candidates for BMS referrals, helping patient and procedure selection, and addressing specific clinical questions.
Nevertheless, the group raised concerns about the potential overreliance on AI-generated recommendations, emphasised the need for ethical guidelines governing AI use and the inclusion of AI’s role in decision-making within the patient consent process. Furthermore, the results suggest that AI education should become an essential component of future surgical training and advancements in AI-driven robotics and AI-integrated genomic applications were also identified as promising developments that could significantly shape the future of MBS.
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Health outcomes and their association with weight regain after substantial weight loss in Sweden: a prospective cohort study
Weight regain was linked to increased vascular disease risk but researchers could not demonstrate an association with life expectancy according to the latest analysis from the Swedish Obese Subjects (SOS) study.
The Scandinavian investigators, reporting in The Lancet Regional Health Europe, analysed 1,346 participants who underwent bariatric surgery and compared individuals who regained ≥20% of their 1-year weight loss after 4 years (regain group) to those who regained less (maintenance group). Average weight loss after 1 year was 29.3 ± 11.7 kg and 31.9 ± 13.8 kg and average weight change from year 1 to year 4 was +12.7 ± 6.6 kg and −0.6 ± 7.3 kg in the regain and maintenance groups, respectively.
During follow-up, regain and maintenance groups showed similar rates of total mortality and cancer, 12.4 (95% CI: 10.9–14.2) vs 12.4 (10.7–14.3), p = 0.740, and 11.3 (95% CI: 9.7–13.0) vs 10.4 (8.8–12.2) per 1000 person-years (p = 0.308), respectively. However, they found that the regain group had a higher incidence of microvascular disease, 11.0 (95% CI: 9.5–12.8) vs 8.7 (7.3–10.4) per 1000 person-years (p = 0.024), and while not statistically significant, also higher incidence of major adverse cardiovascular events (myocardial infarction, stroke, and heart failure) 15.7 (95% CI: 13.8–17.8) vs 13.0 (11.2–15.1) per 1000 person-years (p = 0.055).
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Weight loss dynamics after laparoscopic sleeve gastrectomy: a retrospective single center analysis with age and preoperative weight stratification
Preoperative weight and age significantly influence LSG weight loss outcomes, with younger patients and those with higher pre-op weights achieving greater 12-month %TWL, researchers from Istanbul Aydin University Faculty of Medicine, Istanbul, Turkey, have found.
Featured in Scientific Reports, the study sought to investigate the effects of preoperative weight, height and age on total weight loss percentage (%TWL) following LSG using advanced statistical modelling from 2,014 patients.
A Generalized Additive Model (GAM) was used to calculate Adjusted Total Weight Loss percentage (%ATWL), accounting for height and preoperative weight confounding effects. The population showed weight-dependent %TWL at 12 months, from 32.2%±10.0% (< 90 kg) to 39.8%±7.5% (> 160 kg) (p < 0.001).
GAM-adjusted %ATWL revealed superior outcomes in younger cohorts. The 14–25 and 26–35 year groups had comparable 12-month %ATWL (38.2% vs. 37.0%, p = 0.222), significantly exceeding older groups (p < 0.001). Early postoperative %ATWL (1-week) was similar across ages (4.6–5.7%), with progressive differentiation at 3, 6, and 12 months.
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Association of Insurance Status with Postoperative Resource Utilization after Metabolic/Bariatric Surgery – A Multi-Institutional Study
Postoperative emergency department (ED) utilisation and readmission/reoperation rates after BMS were notably higher in publicly insured (Medicare or Medicaid) patients vs to those with private insurance (PI) or self-pay.
In the study, published in SOARD, Medicaid beneficiaries were younger (40.4 years vs. 46.5 years; p<0.05) than patients with PI patients and more likely to be female. BMI was significantly higher for Medicaid compared to PI or Medicare (49.8 vs. 47.8 vs. 48.2; p<0.05). Medicaid recipients had significantly higher rates of ED utilisation (p<0.0001) compared to PI and self-pay and longer operative times compared to PI and Self-Pay (144.8 min vs 126.7 vs. 108.1 min; p<0.05).
Patients with Medicaid status also had a longer length of stay than patients with PI (1.68 days vs. 1.48 days, p<0.05). Despite these differences, Medicaid status was not associated with increased composite complications, composite infection, length of stay >5 days, or readmission.
The study authors from Pennington Biomedical Research Center, Baton Rouge and Louisiana State University School of Medicine, New Orleans, LA, said the study highlights the importance of implementing targeted quality improvement measures to improve access to care in this population.
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Real-world use of tirzepatide among individuals without evidence of type 2 diabetes: Results from the Veradigm® database
Majority of individuals using tirzepatide had ≥1 obesity-related complication (ORCs) and half had ≥2 ORCs, indicating that in this study cohort tirzepatide was being used in people with multimorbidity, according to researchers from the US.
The investigators sought to understand real-world tirzepatide use among 10,193 individuals without T2D diagnoses in a US electronic health record database, of whom 5931 were AOM-eligible. Most individuals (95.6%) were initiated on a tirzepatide dose of ≤5mg. At the fifth prescription refill (n=448), 91.1% were receiving tirzepatide doses of ≤10mg. At six months, tirzepatide adherence was 55.5% and persistence was 54.2%. Among discontinued individuals (n=346), 10.1% switched to an alternate AOM.
Majority of individuals in the AOM-eligible cohort had ≥1 ORC, and half had ≥2 ORCs, indicating that in this study cohort tirzepatide was being used in people with multimorbidity. Tirzepatide dose escalation in this real-world cohort was slower than in clinical trials, which may have implications for its real-world effectiveness.
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