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 multisociety clinical practice guidance for GLP-1s in the perioperative period, EASO publishes position statement on the role of obesity in cancer and to provide insights on the major nutritional interventions, preoperative upper GI investigations and the management of bariatric patients, 5-year Nissen sleeve gastrectomy outcomes and a survey of anti-obesity treatment preferences of healthcare providers and people living with obesity, and more (please note, log-in maybe required to access the full paper).
Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period
Most patients may continue to safely take glucagon-like peptide-1 (GLP-1) receptor agonists as prescribed before undergoing elective surgery and gastrointestinal endoscopies, according to new clinical guidance released by five surgical and medical societies including the American Society for Metabolic and Bariatric Surgery, American Society of Anesthesiologists, American Gastroenterological Association, International Society of Perioperative Care of Patients with Obesity and Society of American Gastrointestinal and Endoscopic Surgeons.
The guidance recommendations that the use of GLP-1RAs in the perioperative period should be based on shared decision-making of the patient with procedural, anaesthesia, and prescribing care teams balancing the metabolic need for the GLP-1RA with individual patient risk. This can be achieved by developing multidisciplinary protocols/procedures appropriate for individual practices.
The guidance also states at this time based on pharmacology and clinical experience, the following recommendations may be applied for current medications containing a GLP-1RA. For this reason, this multisociety clinical practice document should be considered guidance and not an evidence-based guideline, focusing on shared decision-making and balancing safety processes with therapeutic metabolic need for the safe continuation of surgical and procedural care in patients taking GLP-1RAs.
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European Society for the Study of Obesity (EASO) Position Statement on medical nutrition therapy for the management of individuals with overweight or obesity and cancer
The European Society for the Study of Obesity has published a position statement aimed to summarise current evidence on the role of obesity in cancer and to provide insights on the major nutritional interventions, including Mediterranean Diet (MedDiet), ketogenic diet (KD), and intermittent fasting (IF), that should be adopted to manage individuals with overweight or obesity and cancer.
Published in Obesity Facts, on behalf of EASO Nutrition Working Group, the state that the MedDiet, characterised by high consumption of plant-based foods and moderate intake of olive oil, fish, and nuts, has been associated with a reduced cancer risk. The KD and the IF are emerging dietary interventions with potential benefits for weight loss and metabolic health. KD, by inducing ketosis, and IF, through periodic fasting cycles, may offer anticancer effects by modifying tumour metabolism and improving insulin sensitivity.
Despite the promising results, current evidence on these dietary approaches in cancer management in individuals with overweight or obesity is limited and inconsistent, the paper concludes, with challenges including variability in adherence and the need for personalized dietary plans.
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How preoperative upper gastrointestinal investigations affect the management of bariatric patients: results of a cohort study of 897 patients
Routine upper endoscopies are recommended for all patients undergoing LRYGB or LSG, while reserving upper GI series only for selected cases, according to researchers from Switzerland.
Writing in Surgical Endoscopy, the study explored the impact of diverse preoperative findings on bariatric management and procedure selection and retrospective analysed the prospective data of 897 patients (741 RYGB, 156 SG).
Upper endoscopy prompted a therapeutic consequence in 216 patients (24.3%), resulting in a number needed to screen (NNS) of 4.1. Upper GI series and manometry were more frequently performed before LSG. Upper GI series detected hiatal hernias and motility disorders but did not result in any change of procedures. Esophageal manometry found pathologies in 37 (25.3%) patients rising to 41.5% if symptoms were present. Overall, 16 (1.8%) patients experienced a change in the planned procedure, with 14 changes prompted by preoperative findings and two by technical difficulties.
They conclude that manometry should be exclusively performed on symptomatic patients undergoing LSG, ensuring a balanced and individualized preoperative assessment.
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Nissen sleeve gastrectomy: 5-year follow-up results
French investigators, writing on behalf of the Bariatric Surgery Study Group, have concluded Nissen sleeve gastrectomy achieves a satisfactory long-term TWL% and a significant improvement in comorbidities, particularly regarding the incidence of GERD.
Writing in SOARD, a total of 144 patients underwent a Nissen sleeve gastrectomy. After adjusting for exclusion criteria, 133 patients comprised the initial study population, 81.9% of whom had complete follow-up for weight and GERD clinical symptom outcomes at 5 years.
The mean total weight loss (TWL%) was 22 (±12.3)% and the mean excess weight loss percentage (EWL%) was 59.4% (±34.2)%. Of the 63 patients with preoperative clinical symptoms of GERD, we observed an 85.5% 5-year clinical remission rate; however only 25 patients had a gastroscopy at five years. The cumulative short- and long-term reoperation rate was 8.1% and the mortality rate was zero.
The rate of complications requiring surgical reoperation was low, they noted.
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Anti-obesity treatment preferences of healthcare providers and people living with obesity: A survey-based study
The use of, satisfaction with, awareness of and understanding of current anti-obesity medications (AOMs) is suboptimal, according to researchers from the University College Dublin, Dublin, Ireland and Novo Nordisk.
Writing in Clinical Obesity, they conducted a cross-sectional, online survey was conducted in the UK, France, Germany and the US to investigate preferences for AOM among people with obesity (PwO) and healthcare providers (HCPs).
They identified that the most important barriers to use of AOMs differ between HCPs and PwO and by geographic location. To overcome these, HCPs wanted country-specific guidelines/recommendations, whereas PwO wanted HCP recommendations, and more information on safety and oral therapies.
“There is an unmet need to improve education and awareness of AOMs for HCPs so they can treat obesity appropriately and have meaningful discussions with PwO on the full range of treatment options available,” they concluded. “The preferences and barriers identified may also help inform the development of new AOMs in the future.”
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