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 the REBORN study outcomes, pneumonia and respiratory causes are the largest causes of long-term mortality after surgery, GLP1-RAs can optimise post- surgical weight loss, expanding BMS capacity in England is challenging, and DJBL offers significant improvements but with significant removal rates, and more (please note, log-in maybe required to access the full paper).
Who gains the most quality-of-life benefits from metabolic and bariatric surgery: findings from the prospective REBORN cohort study
Patients should not be excluded from surgery due to their weight and comorbidity status and comprehensive eligibility criteria should be established that encompasses all patients who might benefit from metabolic and bariatric surgery (MBS), beyond just weight loss, according to Canadian researchers writing on behalf of the REBORN study team.
Writing in SOARD, the authors noted that prioritising patients for MBS based on their potential postoperative benefits is essential. As a result, they examine changes in quality of life (QoL) during the initial postoperative year among patients with diverse eligibility statuses to determine which group experiences greater benefits.
Patients were categorised into three groups based on obesity class and the presence of comorbidities: Group 1 (obesity class II without comorbidities, n=28); Group 2 (obesity class II with comorbidities, n=36); and Group 3 (obesity class III, n=460). QoL (Short-Form QoL questionnaire [SF-12]) and anthropometrics were measured at six months before, and six and 12 months after surgery.
There was a significant main effect of time (p<0.001) and an interaction between time and group for the physical component of QoL (p=0.007) with consistent improvements across time in all groups, with the greatest benefits seen in Group 3 relative to Group 1. There were no interactions between time and group for the mental (MCS) components of QoL (p=0.402), with significant interaction effects for weight and BMI (p’s<0.001), with Group 3 losing more weight than Groups 1 or 2.
The researchers concluded that all groups that underwent MBS had improvements in the physical aspects of QoL and weight over time, even those who have traditionally not be considered eligible for MBS (i.e., Group 1).
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Causes of Death After Bariatric Surgery: Long-Term Study of 10 Years
Pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric surgery, according to a single-centre study from researchers in the UK.
Reporting their findings in Obesity Surgery, they found that were 39 deaths amongst 891 patients who underwent bariatric surgery between June 2010 to September 2022. The main cause of death was pneumonia and respiratory causes with 15.4% of the cohort. A history of asthma/COPD had an association with the cause of death (p=0.021) and a history of hypertension, ischaemic heart disease (IHD) and smoking were all associated with a higher age at death, whilst a history of IHD was associated with a higher number of days from operation to death.
Age at operation and number of comorbidities both correlated with age at death and multiple linear regression of age at death with age at operation and number of comorbidities as predictors was significant (p<0.001). A Cox regression found age at operation to have a significant effect on survival (p<0.001).
The only factor found to have a detrimental effect on all-cause mortality was age at operation which reduced survival. Hypertension, IHD and smoking are indirect factors that are associated with mortality, they concluded.
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Role of GLP1-RA in Optimizing Weight Loss Post-Bariatric Surgery: A Systematic Review and Meta-Analysis
Prescribing glucagon-like peptide-1 receptor agonists (GLP1-RAs) to optimise weight loss post-bariatric surgery can be effective, according to an international team of researchers.
Writing in Obesity Surgery, this meta-analysis evaluated the effectiveness of GLP1-RAs in improving weight loss after bariatric surgery vs. placebo. The review included data from three randomised controlled trials (RCTs) involving 130 patients and found that GLP1-RA therapy, particularly liraglutide (1.8-3mg), significantly reduced mean BMI and body weight percentage at six months.
Future studies should explore newer GLP1-RAs with weekly dosing and include longer follow-up periods to assess the durability of these outcomes, the authors added.
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Assessing economic investment required to scale up bariatric surgery capacity in England: a health economic modelling analysis
Expanding BMS capacity in England is challenging given the significant economic investment and additional requirement of personnel and infrastructure, according to UK researchers.
Writing in BMJOpen, the authors sought to quantify the economic investment required to increase BMS current capacity. They found that at current capacity, the number of BMS procedures and the total cost over 20 years were estimated to be 140,220 and £1.4 billion, respectively.
For strategy 1 (maximising NHS capacity), these costs were projected to increase to 157,760 and £1.7 billion, respectively. For strategy 2 (maximising current NHS and private sector capacity), the values were projected to increase to 232,760 and £2.5 billion, respectively. Strategy 3 (adding infrastructure to increase the current NHS capacity) showed the highest increase to 564,784 and £6.4 billion, respectively, with an additional 4,081 personnel and 49 facilities required over 20 years.
“The expansion of BaS capacity in England beyond a small proportion of the eligible population will likely be challenging given the significant upfront economic investment and additional requirement of personnel and infrastructure,” they concluded.
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Efficacy and safety of duodenal–jejunal bypass liner for obesity and type 2 diabetes: A systematic review and meta-analysis
Duodenal–jejunal bypass liner (DJBL) offers significant improvement in weight loss and glycaemic control, as well as cardiovascular parameters while in situ, researchers from Jinan University, Guangzhou, China, have reported.
Writing in Obesity Reviews, the systematic review included 30 studies involving 1,751 patients. At 12 months post-implantation, the reduction in BMI was 4.8 kg/m2 (95% CI 4.1, 5.5), with an excess weight loss of 41.3% (95% CI 33.4%,49.2%) and a total weight loss of 13.1% (95% CI 10.1%, 16.0%). A significant decrease was also observed in HbA1c and fasting glucose, but these improvements in weight loss and glycaemic control were only partially sustained after explantation.
The pooled early removal rate was 19% and the incidence of severe adverse events was 17% - including device migration (6%), gastrointestinal haemorrhage (4%), device obstruction (4%) and hepatic abscess (2%).
“Further studies are warranted to better understand the long-term efficacy and safety of DJBL,” the researchers concluded. “The benefits of DJBL need to be carefully weighed against the risks in clinical decision-making.”
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