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 IFSO publishes international consensus on the role of OMMs in the context of MBS, BPD/DS betters RYGB and SG, the benefits of low-energy diets before MBS, a systematic review of OMMs before and after MBS and dual GLP-1ra G49 mimics bariatric surgery effects, and more (please note, log-in maybe required to access the full paper).
International consensus position statement on the role of obesity management medications in the context of metabolic bariatric surgery: expert guideline by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
An international team of researchers writing on behalf of the experts of the International Consensus on the Role of Obesity Management Medications in the Context of Metabolic Bariatric Surgery, has published an international consensus position statement on the role of obesity management medications (OMMs) in the context of metabolic bariatric surgery (MBS).
The authors hope the consensus will guide clinical practice and assist in creating an algorithm to aid clinicians in their decisions when treating patients with a suboptimal initial clinical response or recurrent weight gain after MBS.
Published in the British Journal of Surgery, experts included members of IFSO, the World Obesity Federation (WOF), the European Association for the Study of Obesity (EASO) and the International Diabetes Federation (IDF). In summary, they agreed:
OMMs should be generally withheld until the achievement of a weight plateau, allowing the assessment of the effect of MBS alone, before starting OMMs
There may be some patients who may benefit from early concomitant OMMs and MBS, therefore the experts agreed that research is needed to identify predictors of which patients will likely substantially benefit from combined pharmaco-surgical therapy for obesity and its complications.
There is a need for additional studies on the eventual additive effects of OMMs and MBS on cardiovascular, renal, T2DM and weight loss outcomes
There was broad agreement regarding the effectiveness of adjunctive pharmacotherapy in patients with a suboptimal initial clinical response or recurrent weight gain after MBS
There consensus for using modern OMMs and endoscopic therapies before offering revisional/conversion surgery, which may be a safer and more effective strategy.
“Future studies need to include weight loss and the remission or improvement of obesity complications as a composite primary outcome, as no robust evidence exists regarding the eventual mechanistic synergy or added benefits for modern pharmacotherapy and MBS,” the authors noted. “...Finally, consensus was reached regarding the need for studies to determine the mechanisms of action of combined medical and surgical treatments and a better understanding of payors about obesity treatments in equipoise with other chronic diseases.”
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Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Results in Superior Weight Loss and Diabetes Remission in Patients with Baseline BMI≥50 kg/m2
Researchers at the Geisinger Health System, Danville, PA, have reported biliopancreatic diversion with duodenal switch (BPD/DS) achieves superior sustained weight loss and T2DM remission vs. Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG).
Published in SOARD, the study sought to compare the weight loss and T2DM remission of the three procedures in all patients with a BMI≥50 kg/m2.
At three years, excess weight loss was 40.1% for SG, 54.1% for RYGB and 67.4% for BPD/DS, with BPD/DS performing significantly better (p<0.001). At five years, complete T2DM remission was 29% for SG, 61% for RYGB and 79% for BPD/DS. However, BPD/DS had significantly longer operative times (p<0.001) and rates of minor complications (p=0.02).
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Low-energy diets before metabolic bariatric surgery: A systematic review of the effect on total body weight, liver volume, glycemia and side effects
A low-energy diet and very low-energy diet for 2–4 weeks prior to surgery resulted in similar reductions in total body weight, but longer treatment correlated to a more pronounced weight reduction, Swedish researchers have reported in Obesity Reviews.
For the systematic review, the investigators compared the effect of different hypocaloric diets on reductions in total body weight, liver volume, glucose and insulin concentrations and side effects. They identified 33 articles (1,868 patients).
They also reported a low-energy diet for 2–4 weeks led to decreased liver volume, which they noted could facilitate the surgical procedure and insulin resistance was generally reduced after a low-energy diet for 2–4 weeks.
They cautioned that most studies were within-group control and since >60% of the studies lacked variance measures for our outcomes, they did not perform a meta-analysis and thus, their results should be interpreted carefully.
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Role of obesity-management medications before and after metabolic bariatric surgery: a systematic review
Although modern OMMs are emerging as valuable options in managing obesity, their role appears to be complementary to MBS, requiring a tailored, multimodal approach to optimise both short-term and long-term outcomes – according to an international team of researchers.
Published in the British Journal of Surgery, this systematic review examined current research on OMMs use in patients after MBS. Whilst acknowledging that OMMs have been shown to accelerate pre-operative weight loss and provide a non-surgical alternative for patients post-MBS, possibly reducing the need for revisional surgery, the current evidence base is limited by the retrospective nature of most studies with inconsistent protocols and few RCTs. Therefore, they called for more well-designed RCTs to validate these findings.
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The dual GLP-1/glucagon receptor agonist G49 mimics bariatric surgery effects by inducing metabolic rewiring and inter-organ crosstalk
The dual GLP-1/glucagon receptor agonist - G49 - mimics bariatric surgery effects by inducing metabolic rewiring and inter-organ crosstalk, an international team of researchers has reported in Nature Communications.
G49 is an oxyntomodulin (OXM) analog and dual glucagon/glucagon-like peptide-1 receptor (GCGR/GLP-1R) agonist that triggers an inter-organ crosstalk between adipose tissue, pancreas and liver which is initiated by a rapid release of free fatty acids by white adipose tissue (WAT) in a GCGR-dependent manner. This interactome leads to elevations in adiponectin and fibroblast growth factor 21 (FGF21), causing WAT beiging, brown adipose tissue activation, increased energy expenditure and weight loss.
They also found that elevation of OXM, under basal and postprandial conditions, and similar metabolic adaptations after G49 treatment were found in plasma from patients with obesity early after metabolic bariatric surgery.
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