Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Impact of Bariatric Surgery on the Pharmacokinetics Parameters of Amoxicillin Factors Related with Adiponectinemia in Obese and Normal-Weight Women and with Its Variation in Weight Loss Programs Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity Assessment of the Effects of a Taped Cognitive Behavior Message on Postoperative Complications (Therapeutic Suggestions under Anesthesia) Evaluation of the biochemical, inflammatory and oxidative profile of obese patients given clinical treatment and bariatric surgery. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Use of Enoxaparin in Obese Adolescents During Bariatric Surgery—a Pilot Study Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies Gender effect on vascular inflammation following bariatric surgery. Gastric Bypass Surgery Is Followed by Lowered Blood Pressure and Increased Diuresis - Long Term Results from the Swedish Obese Subjects (SOS) Study Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Intensive Medical Weight Loss or Laparoscopic Adjustable Gastric Banding in the Treatment of Mild to Moderate Obesity: Long-Term Follow-up of a Prospective Randomised Trial Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study—A Two-Year Randomized Controlled Clinical Trial Weight loss maintenance in successful weight losers: surgical versus non-surgical methods The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Roux-en-Y Gastric Bypass and Vertical Banded Gastroplasty Induce Long-Term Changes on the Human Gut Microbiome Contributing to Fat Mass Regulation Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes.
Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment Background Bariatric surgery leads to several anatomo-physiological modifications that may affect pharmacokinetic parameters and consequently alter the therapeutic effect of drugs , such as antibiotics . The pharmacokinetics of oral amoxicillin after Roux-en-Y gastric bypass ( RYGB ) surgery is unknown . Objectives The objective of this study was to evaluate the impact of bariatric surgery on the pharmacokinetics of  amoxicillin . Methods This study was performed as a r and omized , open-label , single-dose clinical trial , with two periods of treatment , in which obese subjects ( n = 8) received an amoxicillin 500 mg capsule orally before and 2 months after the RYGB surgery . The  amoxicillin plasma concentration was determined by liquid chromatography coupled to mass spectrometry ( LC-MS/MS ) . Results After the surgery , the mean weight loss was 17.03 ± 5.51 kg , and mean body mass index ( BMI ) decreased from 46.21 ± 2.82 to 38.82 ± 3.32 kg/m2 . The mean amoxicillin area under the plasma concentration versus time curve from time zero to the time of the last quantifiable concentration ( AUC0–tlast ) increased significantly ( 3.5-fold ) ; the maximum plasma concentration ( Cmax ) increased 2.8-fold after the bariatric surgery . No correlation was found between amoxicillin absorption , BMI , and weight loss percentage . Conclusion The alterations observed in the amoxicillin pharmacokinetics suggest that obese subjects included in this trial had a substantially increase in amoxicillin systemic exposure after RYGB surgery . However , despite this increase , its exposure was lower than the values reported for non-obese volunteers . Trial Registration Identifiers : Objective : To assess different factors influencing adiponectinemia in obese and normal-weight women ; to identify factors associated with the variation ( Δ ) in adiponectinemia in obese women following a 6-month weight loss program  , according to surgical/non-surgical interventions . Methods : We studied 100 normal-weight women and 112 obese premenopausal women ; none of them was on any medical treatment . Women were characterized for anthropometrics , daily macronutrient intake , smoking status , contraceptives use , adiponectin as well as IL-6 and TNF-α serum concentrations . Results : Adiponectinemia was lower in obese women ( p < 0.001 ) , revealing an inverse association with waist-to-hip ratio ( p < 0.001 ; r = -0.335 ) . Normal-weight women presented lower adiponectinemia among smokers ( p = 0.041 ) ; body fat , waist-to-hip ratio , TNF-α levels , carbohydrate intake , and smoking all influence adiponectinemia ( r2 = 0.436 ) . After weight loss interventions , a significant modification in macronutrient intake occurs followed by anthropometrics decrease ( chiefly after bariatric procedures ) and adiponectinemia increase ( similar after surgical and non-surgical interventions ) . After bariatric intervention , Δ adiponectinemia was inversely correlated to Δ waist circumference and Δ carbohydrate intake ( r2 = 0.706 ) . Conclusion : Anthropometrics , diet , smoking , and TNF-α levels all influence adiponectinemia in normal-weight women , although explaining less than 50 % of it . In obese women , anthropometrics modestly explain adiponectinemia . Opposite to non-surgical interventions , after bariatric  surgery adiponectinemia increase is largely explained by diet composition and anthropometric changes Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients OBJECTIVE It is of vital importance to eluci date the triggering factors of obesity and type 2 diabetes to improve patient care . Bariatric surgery has been shown to prevent and even cure diabetes , but the mechanism is unknown . Elevated levels of lipopolysaccharide ( LPS ) predict incident diabetes , but the sources of LPS are not clarified . The objective of the current study was to evaluate the potential impact of plasma LPS on abdominal obesity and glycemic control in subjects undergoing bariatric surgery .  RESEARCH DESIGN AND METHODS This was a prospect i ve observational study involving a consecutive sample of 49 obese subjects undergoing bariatric surgery and 17 controls .  Main assessment s were plasma LPS , HbA1c , adipose tissue volumes ( computed tomography ) , and quantified bacterial DNA in adipose tissue compartments . RESULTS Plasma levels of LPS were elevated in obese individuals compared with controls ( P < 0.001 ) and were reduced after bariatric surgery ( P = 0.010 ) . LPS levels were closely correlated with HbA1c ( r = 0.56 ; P = 0.001 ) and intra-abdominal fat volumes ( r = 0.61 ; P < 0.001 ) , but only moderately correlated with subcutaneous fat volumes ( r = 0.33 ; P = 0.038 ) . Moreover , there was a decreasing gradient ( twofold ) in bacterial DNA levels going from mesenteric via omental to subcutaneous adipose tissue compartments ( P = 0.041 ) . Finally , reduced LPS levels after bariatric surgery were directly correlated with a reduction in HbA1c ( r = 0.85 ; P < 0.001 ) . CONCLUSIONS Our findings support a hypothesis of translocated gut bacteria as a potential trigger of obesity and diabetes , and suggest that the antidiabetic effects of bariatric surgery might be mechanistically linked to , and even the result of , a reduction in plasma levels of LPS Background : The authors studied whether playing a taped cognitive-behavior message during and immediately following bariatric surgery will improve performance of a postoperative regimen design ed to enhance recovery . Methods : The double-blinded placebo-controlled study consisted of 27 morbidly obese bariatric surgical patients r and omly assigned to listen to either a blank ( Controls ) or a positive therapeutic message audiotape ( Tape ) . A Postoperative Regimen Checklist ( PRC ) quantified different parts of the postoperative recovery regimen . Results : The data showed that patients in the Tape group , compared to the Controls : 1 ) achieved better scores at most PRC assessment points ( p<0.05 ) , 2 ) required less encouragement to perform tasks ( p<0.05 ) , and 3 ) were discharged from the hospital a mean of 1.6 days earlier . Conclusions : A taped cognitive-behavioral message , played to patients repetitively during and immediately following bariatric surgery , is effective in enhancing postoperative compliance and reducing in-patient length of stay BACKGROUND We investigated the biochemical and inflammatory parameters as well as biomarkers of oxidative stress in morbidly obese patients before and after bariatric surgery and clinical treatment .  METHODS This study was conducted using 60 individuals ( 10 men and 50 women ) distributed into 3 groups :  the control group , 20 non-diabetic obese patients given clinical treatment , the bariatric group , 20 non-diabetic obese patients given a Roux-en-Y bypass gastroplasty , and the bariatric diabetic group , 20 diabetic obese patients given a Roux-en-Y bypass gastroplasty .  Measurements were made before and 1 , 3 , 6 , and 12months after surgery and clinical treatment . RESULTS We showed a significant decrease in body weight , body mass index ( BMI ) and waist circumference , accompanied by a decrease in the lipid profile and glucose and glycated hemoglobin concentrations in the groups that received bariatric surgery . The concentrations of lipid peroxidation , carbonyl protein and NPSH , as well as superoxide dismutase ( SOD ) and catalase ( CAT ) activity , significantly decreased in both groups after surgery . The concentrations of inteleukin-6 , inteleukin-1 , TNF-α and resistin were also significantly lower , while adiponectin concentrations significantly increased 12months after bariatric surgery . No significant alterations were observed in the biochemical , inflammatory or oxidative parameters of the control group . CONCLUSIONS Our findings demonstrate a decrease in body mass and a subsequent improvement in biochemical , metabolic and anthropometric parameters in patients given bariatric surgery .  This may contribute to the reduction of oxidative damage in these patients and consequently a reduction in the risk of the development and progression of multiple co-morbidities associated with obesity Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity Background Obese patients have a higher risk of venous thromboembolism when immobilized due to surgery . The objective of this study was to assess anti-factor Xa activity in adolescent bariatric surgical patients receiving prophylactic enoxaparin .  Methods Four morbidly obese adolescents undergoing laparoscopic sleeve gastrectomy were enrolled . Enoxaparin was administered ( 40 mg subcutaneous ( SC ) if BMI ≤50 kg/m2 or 60 mg SC if BMI > 50 kg/m2 ) for prevention of venous thromboembolism every 12 h starting after induction of anesthesia until discharge . Plasma anti-factor Xa activity was assessed over 12 h after the first dose and used as a surrogate marker for enoxaparin levels . Non-compartmental analysis of anti-factor Xa activity levels was performed and compared with previously published studies . Results Patients recruited were 16 to 18 years of age with a mean BMI of 52.6 ± 5.8 kg/m2 ( > 99th BMI percentile ) . Peak anti-factor Xa activity ranged from 0.20 to 0.23 IU/mL in our study population , compared to 0.38 to 0.53 IU/mL in the cited lean comparator groups . Conclusions Our current dosing practice of 40 mg SC for individuals with a BMI ≤50 kg/m2 and 60 mg for individuals with a BMI ≥50 kg/m2 result ed in anti-factor Xa activity that was sufficient for adequate thromboprophylaxis in adolescent bariatric surgical patients . Our data also demonstrates lower drug exposures in the obese when compared to lean patients . Therefore , r and omized controlled efficacy and safety studies are urgently needed to guide the use of low-molecular-weight heparins in the pediatric and adolescent obese population Importance Bariatric surgery is a life-changing treatment for patients with severe obesity , but little is known about its association with interpersonal relationships . Objectives To investigate if relationship status is altered after bariatric surgery . Design , Setting , and Participants Changes in relationship status after bariatric surgery were examined in 2 cohorts : ( 1 ) the prospect i ve Swedish Obese Subjects ( SOS ) study , which recruited patients undergoing bariatric surgery from September 1 , 1987 , to January 31 , 2001 , and compared their care with usual nonsurgical care in matched obese control participants ; and ( 2 ) participants from the Sc and inavian Obesity Surgery Registry ( SOReg ) , a prospect i ve , electronically captured register that recruited patients from January 2007 through December 2012 and selected comparator participants from the general population matched on age , sex , and place of residence . Data was collected in surgical departments and primary health care centers in Sweden . The current analysis includes data collected up until July 2015 ( SOS ) and December 2012 ( SOReg ) . Data analysis was completed from June 2016 to December 2017 . Main Outcomes and Measures In the SOS study , information on relationship status was obtained from question naires . In the SOReg and general population cohort , information on marriage and divorce was obtained from the Swedish Total Population Registry . Results The SOS study included 1958 patients who had bariatric surgery ( of whom 1389 [ 70.9 % ] were female ) and 1912 matched obese controls ( of whom 1354 [ 70.8 % ] were female ) and had a median ( range ) follow-up of 10 ( 0.5 - 20 ) years . The SOReg cohort included 29 234 patients who had gastric bypass surgery ( of whom 22 131 [ 75.6 % ] were female ) and 283 748 comparators from the general population ( of whom 214 342 [ 75.5 % ] were female ) , and had a median ( range ) follow-up of 2.9 ( 0.003 - 7.0 ) years . In the SOS study , the surgical patients received gastric b and ing ( n = 368 ; 18.8 % ) , vertical b and ed gastroplasty ( n = 1331 ; 68.0 % ) , or gastric bypass ( n = 259 ; 13.2 % ) ; controls received usual obesity care . In SOReg , all 29 234 surgical participants received gastric bypass surgery . In the SOS study , bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship ( adjusted hazard ratio [ aHR ] = 1.28 ; 95 % CI , 1.03 - 1.60 ; P = .03 ) and increased incidence of marriage or new relationship ( aHR = 2.03 ; 95 % CI , 1.52 - 2.71 ; P < .001 ) in those who were unmarried or single at baseline . In the SOReg and general population cohort , gastric bypass was associated with increased incidence of divorce compared with married control participants ( aHR = 1.41 ; 95 % CI , 1.33 - 1.49 ; P < .001 ) and increased incidence of marriage in those who were unmarried at baseline ( aHR = 1.35 ; 95 % CI , 1.28 - 1.42 ; P < .001 ) . Within the surgery groups , changes in relationship status were more common in those with larger weight loss . Conclusions and Relevance In addition to its association with obesity comorbidities , bariatric surgery – induced weight loss is also associated with changes in relationship status Studies have shown that mortality was reduced by 31.6 % in patients that underwent bariatric surgery  compared with the non-operative control group . However , in most surgical series the majority of patients were women , and men had higher post-operative mortality rates and a higher postoperative morbidity , regardless of weight . Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss . Methods . A prospect i ve study evaluated vascular inflammation in obese patients before and three months after bariatric surgery .  Markers of vascular inflammation were measured - before surgery and three months afterwards . Results . One hundred and two patients ( 73 women and 29 men , 40.5 ± 12.3 years old ) underwent bariatric surgery .  Correlation was found between BMI change and waist circumference change ( r = 0.658 , P<0.001 ) . Three months post-surgery , BMI was significantly decreased ( p<0.001 ) ( a decrease of 8.82 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 17.33 cm ) . ICAM-1 levels and hs-CRP levels were decreased ( both P = 0.0001 ) . Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus ( men > women ; P = 0.05 ) and hypertension ( men > women ; P = 0.06 ) . In women , following bariatric surgery  , BMI was decreased ( p<0.001 ) ( a decrease of 9.25 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 18.8 cm ) . ICAM-1 levels were decreased ( p = 0.002 ) and hs-CRP levels were also decreased ( P = 0.0001 ) . In men , following bariatric surgery  , BMI was decreased ( p = 0.001 ) ( a decrease of 8.1 ) , waist circumference was reduced ( p<0.005 ) ( a decrease of 14.6 cm ) ; however , although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant ( both P = 0.09 ) . Discussion . Our study examined gender effects of bariatric surgery  on vascular inflammation  . Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients , while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation . These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing  bariatric operation for  weight loss .  This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome , and cardiovascular morbidity and mortality Objective To compare two bariatric surgical principles with regard to effects on blood pressure and salt intake . Background In most patients bariatric surgery induces a sustained weight loss and a reduced cardiovascular risk profile but the long-term effect on blood pressure is uncertain . Methods Cohort study with data from the prospect i ve , controlled Swedish Obese Subjects ( SOS ) study involving 480 primary health care centres and 25 surgical departments in Sweden . Obese patients treated with non-surgical methods ( Controls , n = 1636 and n = 1132 at 2 y and 10 y follow up , respectively ) were compared to patients treated with gastric bypass ( GBP , n = 245 and n = 277 , respectively ) or purely restrictive procedures ( vertical b and ed gastroplasty or gastric b and ing ;  VBG/B , n = 1534 and n = 1064 , respectively ) . Results At long-term follow-up ( median 10 y ) GBP was associated with lowered systolic ( mean : −5.1 mm Hg ) and diastolic pressure ( −5.6 mmHg ) differing significantly from both VBG/B ( −1.5 and −2.1 mmHg , respectively ; p<0.001 ) and Controls ( + 1.2 and −3.8 mmHg , respectively ; p<0.01 ) . Diurnal urinary output was + 100 ml ( P<0.05 ) and + 170 ml ( P<0.001 ) higher in GBP subjects than in weight-loss matched VBG/B subjects at the 2 y and 10 y follow-ups , respectively . Urinary output was linearly associated with blood pressure only after GBP and these patients consumed approximately 1 g salt per day more at the follow-ups than did VBG/B ( P<0.01 ) . Conclusions The purely restrictive techniques VBG/B exerted a transient blood pressure lowering effect , whereas gastric bypass was associated with a sustained blood pressure reduction and an increased diuresis . The daily salt consumption was higher after gastric bypass than after restrictive bariatric surgery Importance Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes , and medical management , including lifestyle changes , may not be successful at lowering risk . Objective To investigate the relationship between bariatric surgery and incident macrovascular ( coronary artery disease and cerebrovascular diseases ) events in patients with severe obesity and type 2 diabetes . Design , Setting , and Participants In this retrospective , matched cohort study , patients with severe obesity ( body mass index ≥35 ) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States ( n = 5301 ) were matched to 14 934 control patients on site , age , sex , body mass index , hemoglobin A1c , insulin use , observed diabetes duration , and prior health care utilization , with follow-up through September 2015 . Exposures Bariatric procedures ( 76 % Roux-en-Y gastric bypass , 17 % sleeve gastrectomy , and 7 % adjustable gastric b and ing ) were compared with usual care for diabetes . Main Outcomes and Measures Multivariable-adjusted Cox regression analysis investigated time to incident macrovascular disease ( defined as first occurrence of coronary artery disease [ acute myocardial infa rct ion , unstable angina , percutaneous coronary intervention , or coronary artery bypass grafting ] or cerebrovascular events [ ischemic stroke , hemorrhagic stroke , carotid stenting , or carotid endarterectomy ] ) . Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately . Results Among a combined 20 235 surgical and nonsurgical patients , the mean ( SD ) age was 50 ( 10 ) years ; 76 % of the surgical and 75 % of the nonsurgical patients were female ; and the baseline mean ( SD ) body mass index was 44.7 ( 6.9 ) and 43.8 ( 6.7 ) in the surgical and nonsurgical groups , respectively . At the end of the study period , there were 106 macrovascular events in surgical patients ( including 37 cerebrovascular and 78 coronary artery events over a median of 4.7 years ; interquartile range , 3.2 - 6.2 years ) and 596 events in the matched control patients ( including 227 cerebrovascular and 398 coronary artery events over a median of 4.6 years ; interquartile range , 3.1 - 6.1 years ) . Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years ( 2.1 % in the surgical group vs 4.3 % in the nonsurgical group ; hazard ratio , 0.60 [ 95 % CI , 0.42 - 0.86 ] ) , as well as a lower incidence of coronary artery disease ( 1.6 % in the surgical group vs 2.8 % in the nonsurgical group ; hazard ratio , 0.64 [ 95 % CI , 0.42 - 0.99 ] ) . The incidence of cerebrovascular disease was not significantly different between groups at 5 years ( 0.7 % in the surgical group vs 1.7 % in the nonsurgical group ; hazard ratio , 0.69 [ 95 % CI , 0.38 - 1.25 ] ) . Conclusions and Relevance In this observational study of patients with type 2 diabetes and severe obesity who underwent surgery , compared with those who did not undergo surgery  , bariatric surgery was associated with a lower risk of macrovascular outcomes . The findings require confirmation in r and omized clinical trials . Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events BACKGROUND Increased adipokine production and hyperfiltration may explain the links between obesity and chronic kidney disease . Indeed , hyperfiltration may precede a subsequent accelerated decline of kidney function in these patients . Glomerular filtration rate decreases after bariatric surgery in young obese patients with hyperfiltration . OBJECTIVE Our aim was to identify the factors associated with this decrease 1 year after bariatric surgery . SETTING We used data from a prospect i ve cohort of severely obese patients who underwent bariatric surgery in Nice University Hospital . METHODS We analyzed 175 patients before and 1 year after bariatric surgery .  Low- grade inflammation was evaluated by serum C-reactive protein levels . Lean body mass and fat body mass were estimated by bioelectric impedance analysis . Body surface area was assessed by the Du Bois formula . Serum creatinine levels were used to estimate glomerular filtration rate by the chronic kidney disease-epidemiology collaboration ( CKD-EPI ) equation . Glomerular filtration rate was de-adjusted from st and ard body surface area and then divided by lean body mass to calculate the decrease in hyperfiltration and to separate the patients into 2 groups : above or below the median decrease of hyperfiltration after bariatric surgery . RESULTS The factors associated with a large correction of hyperfiltration were baseline C-reactive protein levels ( 10.0 ± 5.8 mg/L versus 12.7 ± 7.4 mg/L , P = .01 ) and brachial circumference ( 41 ± 4 cm versus 44 ± 5 cm , P = .006 ) . A high fat mass reduction rate was significantly associated with a substantial hyperfiltration reduction after bariatric surgery ( P<.001 ) independently of sex and surgical procedure . CONCLUSIONS The correction of hyperfiltration is associated with a high reduction rate of fat mass after bariatric surgery but may be limited by low- grade inflammation Background Proven short-term effectiveness of obesity therapy should be re-evaluated in the long-term . The objective of this paper is to determine the long-term ( 10 years ) outcome for patients from a r and omised controlled trial ( RCT ) . Methods A RCT in 2002 compared laparoscopic adjustable gastric b and ( LAGB ) for obesity  with non-surgical therapy . Follow-up has been conducted at 10 years . Eighty patients ( BMI 30–35 ) were r and omised to a non-surgical or a surgical program .  Outcome data are available on 37 ( 92.5 % ) of the surgical patients and 27 ( 62.5 % ) of the non-surgical patients at 10 years . Results Weight change , the metabolic syndrome , quality of life , adverse events and direct costs of the surgical cohort were the main results of the study . A durable weight loss is present in the surgical group with a mean ( SD ) 10-year weight loss of 14.1 ( 7.7 ) kg ( 63.4 % EWL ) , better than the non-surgical group ( mean ( SD ) = 0.4 ( 10.5 ) kg ; p < 0.001 ) . The metabolic syndrome was reduced from 14 to 4 of the 37 patients who completed 10 years within the LAGB groups . Proximal gastric enlargements occurred in 17 ( 30 % ) of the 57 who had LAGB and removal of the b and occurred in 7 ( 12 % ) . The annual maintenance costs including additional surgery was AUD $ 765 per patient per year . Conclusions Bariatric surgery with the LAGB can achieve long-term weight reduction which is better than a program of non-surgical therapy . There is also a sustained reduction of the metabolic syndrome . There is a significant maintenance requirement after LAGB CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Objective : As large weight losses are rarely achieved through any method except bariatric surgery , there have been no studies comparing individuals who initially lost large amounts of weight through bariatric surgery or non-surgical means .  The National Weight Control Registry ( NWCR ) provides a re source for making such unique comparisons . This study compared the amount of weight regain , behaviors and psychological characteristics in NWCR participants who were equally successful in losing and maintaining large amounts of weight through either bariatric surgery or non-surgical methods . Design :  Surgical participants ( n=105 ) were matched with two non-surgical participants ( n=210 ) on gender , entry weight , maximum weight loss and weight-maintenance duration , and compared prospect ively over 1 year . Results : Participants in the surgical and non-surgical groups reported having lost approximately 56 kg and keeping ⩾13.6 kg off for 5.5±7.1 years . Both groups gained small but significant amounts of weight from registry entry to 1 year ( P=0.034 ) , but did not significantly differ in magnitude of weight regain ( 1.8±7.5 and 1.7±7.0 kg for surgical and non-surgical groups , respectively ; P=0.369 ) . Surgical participants reported less physical activity , more fast food and fat consumption , less dietary restraint , and higher depression and stress at entry and 1 year . Higher levels of disinhibition at entry and increased disinhibition over 1 year were related to weight regain in both groups . Conclusions : Despite marked behavioral differences between the groups , significant differences in weight regain were not observed . The findings suggest that weight-loss maintenance comparable with that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts . Increased susceptibility to cues that trigger overeating may increase risk of weight regain regardless of initial weight-loss method Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 Summary Bariatric surgery is currently the most effective procedure for the treatment of obesity . Given the role of the gut microbiota in regulating host metabolism and adiposity , we investigated the long-term effects of bariatric surgery on the microbiome of patients r and omized to Roux-en-Y gastric bypass or vertical b and ed gastroplasty and matched for weight and fat mass loss . The two surgical procedures induced similar and durable changes on the gut microbiome that were not dependent on body mass index and result ed in altered levels of fecal and circulating metabolites compared with obese controls . By colonizing germ-free mice with stools from the patients , we demonstrated that the surgically altered microbiota promoted reduced fat deposition in recipient mice . These mice also had a lower respiratory quotient , indicating decreased utilization of carbohydrates as fuel . Our results suggest that the gut microbiota may play a direct role in the reduction of adiposity observed after bariatric surgery Background : Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery . The aim of this study was to evaluate the effect of a vital capacity manoeuvre ( VCM ) , followed by ventilation with positive end‐expiratory pressure ( PEEP ) , on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery . Methods : Fifty‐two morbidly obese patients ( body mass index > 40 kg m−2 ) undergoing open bariatric surgery were enrolled in this prospect i ve and r and omized study . Anaesthesia and surgical techniques were st and ardized . Patients were ventilated with a tidal volume of 10 mL kg−1 of ideal body weight , a mixture of oxygen and nitrous oxide ( FiO2 = 40 % ) and respiratory rate was adjusted to maintain end‐tidal carbon dioxide at a level of 30–35 mmHg . After abdominal opening , patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O . This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups . Haemodynamics , ventilatory and arterial oxygenation parameters were measured at the following times : T0 = before application of VCM and /or PEEP , T1 = 5 min after VCM and /or PEEP and T2 = before abdominal closure . Results : Patients in the two groups were comparable regarding patient characteristics , surgical , haemodynamic and ventilatory parameters . In Group 1 , arterial oxygen partial pressure ( PaO2 ) and arterial haemoglobin oxygen saturation ( SaO2 ) were significantly increased and alveolar‐arterial oxygen pressure gradient ( A‐aDO2 ) decreased at T2 when compared with T0 and T1 . In Group 2 , PaO2 and SaO2 were significantly increased and A‐aDO2 decreased at T1 and T2 when compared with T0 . Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1 . Conclusion : The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes
Compared with non-surgical treatment of obesity , bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome .
OBJECTIVE To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity .