Published in August 2014 Issue             

The Role of Bariatric Surgery in Morbidly Obese Patients with Inflammatory Bowel Disease (SOARD)

A small prospective study demonstrated bariatric surgery is safe and effective in patients diagnosed with inflammatory bowel diseases (IBD), including Chrohn’s disease and ulcerative colitis. Ten patients with a mean BMI of 42.6 underwent laparoscopic sleeve gastrectomy (LSG) (n=9) or laparoscopic adjustable gastric band (LAGB) (n=1) between October 2006 and January 2014. After a median follow-up of 46 months all patients had lost weight, with an excess body weight loss of 71%, and ten out of 16 obesity-related comorbidities were resolved. Surgical outcomes in the IBD patient group were similar to that of comparable
non-IBD patients.

Ethnic Variation in Weight Loss, but not Comorbidity Remission, After Laparoscopic Gastric Banding and Roux-en-Y Gastric Bypass (SOARD)

Data collected from 1,903 African American, Caucasian and Hispanic patients who underwent surgery between January 1, 2005 and March 31, 2012 was collected to determine ethnic variation in regards to changes in BMI, excess weight loss and comorbidities outcomes at 2- and 3-year follow-up. Overall, those who underwent gastric bypass had a lower BMI and greater percentage of excess weight loss (%EWL) at 1, 2, and 3 years compared to those who had undergone banding procedures. Overall, African American patients had a higher postoperative BMI than either Caucasian or Hispanic patients. African American patients also showed less %EWL than Caucasian and Hispanic patients. Within surgery type, ethnic differences between African American and Caucasian patients were present across all 3 years for gastric bypass, but there were no ethnic differences by year 3 in banding patients. Additionally, African American and Hispanic patients no longer differed by year 3 in bypass and by year 2 in banding. There were no significant ethnic differences in remission of diabetes, hyperlipidemia, hypertension and sleep apnea at 1 year. The study concluded that significant ethnic differences were seen in the postoperative BMI and %EWL, which were more pronounced in patients undergoing bypass than banding procedures at the 3-year
time point.

Effects of a Very Low Calorie Diet in the Preoperative Stage of Bariatric Surgery – A Randomized Trial (SOARD)

A randomized, open-labeled, controlled clinical trial investigated the effect of a liquid very low calorie diets (VLCD) compared to “normal consistency diets” prior to bariatric surgery. Data, including overall weight loss and visceral fat (VF) loss, was collected at baseline, 7 and 14 days after. Fifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet. The liquid diet group lost significantly more weight and VF than the normal diet group. An inverse correlation occurred between VF loss and surgical time among the liquid diet group. Additionally, there was a positive correlation between the percentage of excess weight loss and ketonuria, a sign of starvation. Patients that consumed a liquid diet experienced a positive impact on reducing VF and greater weight loss than normal diet.

Bari-Active: A Randomized Controlled Trial of a Preoperative Intervention to Increase Physical Activity in Bariatric Surgery Patients (SOARD)

This study examined the efficacy of preoperative physical activity intervention (PAI) versus standard pre-surgical care (SC), with the goal of increasing daily moderate-to-vigorous PA in bariatric surgery patients. Seventy-five participants with a mean BMI of 45 were included in the study. The average age of patients was 46 and 86.7% of patients were women. Patients were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome was pre- to post-intervention change in daily bout-related (≥10-min bouts) and total (≥1-minute bouts) moderate-to-vigorous activity minutes. To test physical activity levels patient wore a multi-sensor monitor for 7 days at baseline- and post-intervention. PAI patients achieved a mean increase of 16.6 minutes/day in bout-related moderate-to-vigorous PA, compared to no change for SC patients. Similarly, the PAI group achieved a mean increase of 21.0 minutes/day in total moderate-to-vigorous PA, whereas SC demonstrated no change.

Predictive Factors of Type 2 Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis (Obesity Surgery)

This meta-analysis aimed to assess the preoperative clinical factors for type 2 diabetes mellitus (T2DM) remission after bariatric surgery. In total, 15 studies published between January 1992 and September 2013 were included and involved 1,753 patients. T2DM remission was observed to be negatively correlated with age, diabetes duration, insulin use and HbA1c levels. There was no significant association between gender and remission rate. Patients with younger age, short diabetes duration, better glucose control and better ? cell function were more likely to achieve T2DM remission after bariatric surgery.

Surgical Treatment of Type 2 Diabetes in Subjects with Mild Obesity: Mechanisms Underlying Metabolic Improvements (Obesity Surgery)

In a prospective trial, 36 mildly obese subjects (19 males) with type 2 diabetes using oral antidiabetic drugs with (n = 24) or without insulin (n = 12) underwent gastric bypass. Follow-up was conducted at baseline and 3, 6, 12 and 24 months postsurgery. Endpoints used in the analysis were changes in HbA1c, fasting glucose and insulin, antidiabetic therapy, BMI, oral glucose insulin sensitivity, glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), adiponectin, C-reactive protein and lipids. All subjects achieved a normal-to-overweight BMI after 3 months. Over 24 months, 31 out of 36 patients (86%) presented with HbA1c < 7%. Complete and partial remission of diabetes was achieved in 9 out of 36 patients (22%) and 1 out of 36 patients (3%), respectively. At 3 months postsurgery, improvements were observed in OGIS. At baseline and after 12 months, subjects with diabetes non-remission had longer diabetes duration, higher HbA1c, lower beta-cell secretory function, and higher first 30-min GIP AUCi, compared with those with remission.

Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-En-Y Gastric Bypass for Morbid Obesity and Related Comorbidities: A Meta-Analysis of 21 Studies (Obesity Surgery)

A meta-analysis aimed to compare Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of morbid obesity and its related comorbidities. The analysis included 21 studies published prior to October 2014 including more than 18,766 morbidly obese patients. Percentage of EWL, resolution or improvement rate of comorbidities, and adverse events were all pooled and compared. No significant difference was found in %EWL during 0.5- to 1.5-year follow-up, but after that, LRYGB achieved higher %EWL than LSG. Except for T2DM, the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance. There were more adverse events in LRYGB compared with LSG. The study concluded that LRYGB is superior to LSG in efficacy but inferior to LSG in safety.

Overweight Boys May Benefit from Living with Adult Who Has Bariatric Surgery (Obesity)

A new study from the Geisinger Health System found “a parent’s bariatric surgery could be an opportunity to break the cycle of obesity" in a son with severe obesity. The study is considered the largest study on the effect of an adult gastric bypass on the weight of children in the same household. “The relationship between parent and childhood obesity is likely attributable to a combination of genetic and family environmental influences,” said Dr. Christopher Still. The study showed a clear benefit in boys with a BMI of 85-94 who had a parent or adult in the household who had bariatric surgery.

Safety and Effectiveness of Roux-en-Y Gastric Bypass in Patients Between the Ages of 17 and 19 (Obesity Surgery)

A retrospective review was completed on LRYGB patients between January 2005 and May 2012. Fourteen patients under the age of 20 were matched to 14 patients greater than 20 years of age for gender, preoperative BMI and follow-up interval. Mean postoperative BMI at last follow-up did not show statistical difference between the two surgical groups. At 6, 12, 24, and 36 months postoperative, the mean %EWL in patients was 43.1, 70.5, 69.8 and 54.8 respectively. In patients over the age of 20, mean %EWL was 39.9 ± 12.6, 67.0 ± 18.6, 60.2 ± 11.3, and 56.2 ± 6.2 %. Both groups of patients showed improvement/remission of comorbid conditions. No statistical difference was present between the two groups in terms of weight loss and comorbidity resolution. Each group had a single patient that required a revision for weight regain. The study concluded LRYGB in younger patients almost the age of 20 is both safe and effective when compared to matched adults in regard to weight loss, comorbid condition, and complications.