553: Pregnancy reduces initial weight loss after bariatric surgery but does not influence long-term outcomes

2014 ◽  
Vol 210 (1) ◽  
pp. S273
Author(s):  
Thu Quyên Pham ◽  
Philippe Deruelle ◽  
Marie Pigeyre ◽  
Eric Loridan ◽  
Julien Couster ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Initial Weight ◽  
Long Term Outcomes ◽  
Initial Weight Loss

scholarly journals MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Flavio Cadegiani
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Body Weight ◽  
Weight Regain ◽  
Morbidly Obese ◽  
Biochemical Profile ◽  
Initial Weight ◽  
Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of >20% loss of the initial BW loss, and no weight regain (or < 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p < 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

Foregut Issues After Bariatric Surgery

2022 ◽  
pp. 263451612110674
Author(s):  
Fareed Cheema ◽  
Aurora D. Pryor
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Postoperative Complications ◽  
Weight Loss Surgery ◽  
Long Term Outcomes ◽  
Operative Complications ◽  
Complications After Bariatric Surgery ◽  
Broad Scale ◽  
Post Operative Complications

Weight loss surgery has overall been shown to be very safe and effective. However, long-term outcomes data has allowed codification of post-operative complications specific to the type of weight loss surgery performed. This review focuses specifically on foregut-related postoperative complications after weight loss surgery, most of which are not discussed on a broad scale in the literature yet whose prevalence continues to rise. Clinicians should maintain a broad differential when treating patients with complications after bariatric surgery in order to perform a thorough and precise workup to identify the diagnosis and guide management.

scholarly journals Bariatric surgery proves long-term benefit in patients with cirrhosis

2020 ◽  
Author(s):  
Manhal Izzy ◽  
Mounika Angirekula ◽  
Barham K Abu Dayyeh ◽  
Fateh Bazerbachi ◽  
Kymberly D Watt
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Descriptive Analysis ◽  
Total Body Weight ◽  
Hepatitis C Infection ◽  
Long Term Outcomes ◽  
Hepatic Decompensation ◽  
Compensated Cirrhosis

Abstract Background Obesity is commonly observed in patients with cirrhosis, especially with the increasing prevalence of non-alcoholic steatohepatitis (NASH). Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk; therefore, data are lacking regarding long-term outcomes. In this study, we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery. Methods We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23, 2009 and November 9, 2011, and followed in a pilot study for evaluation of bariatric surgery outcomes. Only patients with more than 4 years of follow-up were included in the analysis. Data regarding their liver disease, metabolic status, and survival were collected. A descriptive analysis was performed. Results The cohort consisted of 10 patients, of whom 7 were females. The median post-surgical follow-up was 8.7 years (± 1.4 years). All patients had biopsy-proven NASH; two patients had concurrent, untreated hepatitis C infection. During the observation period, there was a mean weight loss of 24 kg (19.2% of total body weight pre surgery, P < 0.001) and only one patient regained weight to the baseline pre-surgical measurement. One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died. The remainder of the patients did not have any hepatic decompensation, cardiovascular event, or mortality. Except for one patient with Gilbert syndrome, bilirubin was normal in all patients at last follow-up. Conclusions Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-term follow-up.

Management of Obesity

2016 ◽  
Vol 34 (35) ◽  
pp. 4295-4305 ◽  
Author(s):  
Naji Alamuddin ◽  
Zayna Bakizada ◽  
Thomas A. Wadden
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Weight Regain ◽  
Initial Weight ◽  
The Us ◽  
And Behavior

This review examines weight loss and accompanying improvements in obesity-related comorbidities produced by intensive lifestyle intervention, pharmacotherapy, and bariatric surgery. Obese individuals lose approximately 6 to 8 kg (approximately 6% to 8% of initial weight) with 6 months of participation in a high-intensity lifestyle intervention (≥ 14 treatment visits) consisting of diet, physical activity, and behavior therapy. Such losses reduce progression to type 2 diabetes in at-risk people and decrease blood pressure and triglyceride levels. All diets, regardless of macronutrient composition, can produce clinically meaningful weight loss (> 5%) if they induce a deficit ≥ 500 kcal/d. Physical activity of 150 to 180 min/wk yields modest short-term weight loss compared with diet but contributes to improvements in obesity-related conditions. Gradual weight regain is common after lifestyle intervention but can be prevented by continued participation in monthly weight loss maintenance sessions, as well as by high levels of physical activity (ie, 200 to 300 min/wk). Patients unable to reduce satisfactorily with lifestyle intervention may be candidates for pharmacotherapy, recommended as an adjunct. Five medications have been approved by the US Food and Drug Administration for chronic weight management, and each has its own risk/benefit profile. The addition of these medications to lifestyle intervention increases mean weight loss by 2.5 to 8.9 kg compared with placebo. Patients with severe obesity who are unable to reduce successfully with lifestyle intervention and pharmacotherapy are eligible for bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. The first two procedures yield long-term (≥ 3 years) reductions of ≥ 20% of initial weight that are associated with decreases in morbidity and potentially mortality. Greater resources and dissemination efforts are needed to increase the availability of these three approaches for the millions of Americans who would benefit from them.

scholarly journals Predictors of Long-Term Weight Loss in Adults With Modest Initial Weight Loss, by Sex and Race

Obesity ◽  
2012 ◽  
Vol 20 (9) ◽  
pp. 1820-1828 ◽  
Author(s):  
Laura P. Svetkey ◽  
Jamy D. Ard ◽  
Victor J. Stevens ◽  
Catherine M. Loria ◽  
Deb Y. Young ◽  
...  
Keyword(s):  
Weight Loss ◽  
Initial Weight ◽  
Initial Weight Loss

scholarly journals Improvements in Long-Term Appetite-Regulating Hormones in Response to a Combined Lifestyle Intervention for Obesity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A489-A490
Author(s):  
Susanne Kuckuck
Keyword(s):  
Weight Loss ◽  
Lifestyle Intervention ◽  
Weight Regain ◽  
Initial Weight ◽  
Short Term ◽  
Initial Weight Loss ◽  
Hormone Levels ◽  
Adiposity Signals ◽  
Term Energy

Abstract Altered levels of hormonal appetite regulators have been observed in obesity (BMI ≥ 30.0 kg/m2), most prominently increases of insulin and leptin (indicating resistance) as well as decreases of adiponectin - all of which are long-term energy regulators and adiposity signals. Disrupted signaling of these hormones may have detrimental effects on metabolism, but may also promote weight gain. Weight loss is often accompanied by normalizations of long-term adiposity signals, but findings concerning short-term appetite regulators after weight loss vary across interventions (e.g. very low calorie diets vs. exercise). Moreover, it is debated whether such weight-loss-induced hormonal changes may reflect a disposition for weight regain. Here, we investigated changes of long- and short-term appetite signals in response to an intensive 75-week combined lifestyle intervention (CLI) comprising a normocaloric healthy diet, physical activity and psychotherapy to promote improved long-term weight management. For 39 patients, data on fasting serum levels of appetite-regulating hormones (leptin, insulin, adiponectin, GIP, PP, PYY, CCK, FGF21) were available. Hormone levels were correlated to BMI at baseline (T0) and compared across three time points: T0, T1 (after 10 weeks; initial weight loss) and T2 (after 75 weeks; weight loss maintenance). T0-T1 hormone changes were correlated to BMI changes between T1 and T2 to investigate whether hormonal alterations during initial weight loss are associated with weight regain. At T0, hormone levels were not associated with BMI. BMI decreased significantly from T0 (40.13 kg/m2 ± 5.7) to T1 (38.2 ± 5.4, p < .001) which was maintained at T2 (38.2 kg/m2 ± 5.9, p < .001). There were no significant changes in GIP, PP, PYY, CCK and FGF21. Leptin decreased from T0 (44.9 ng/nl ± 15.3) to T1 (33 ng/nl ± 14.8, p < .001) and T2 (38.6 ng/nl ± 16.0, p < .01), just like insulin which was significantly decreased at T1 (123 pmol/l ± 65, p < .05) and T2 (128 pmol/l ± 64, p < .05) compared to T0 (160 pmol/l ± 80). Adiponectin did not change between T0 (3.36 ug/ml ± 2.1) and T1 (3.2 ug/ml ± 2.1), but was increased at T2 (3.7 ug/ml ± 2.9, p < .01) compared to T1. T0-T2 BMI decrease correlated positively with T0-T2 decreases in leptin (r = .667, p < .001), insulin (rho = .535, p < .001) and increases of adiponectin (r = .412, p < .01), but no other hormone. T0-T1 hormone changes did not predict T1-T2 BMI changes. Thus, a 75-week CLI was associated with beneficial changes in the long-term energy regulators adiponectin, leptin and insulin, but no changes in short-term appetite-regulating hormones were observed despite significant weight loss. Initial changes in appetite-regulating hormones were not associated with subsequent weight regain. Overall, our data suggest that a CLI does not lead to adverse changes in appetite regulation, but rather long-term improvements such as e.g. increased leptin and insulin sensitivity.

Telenutrition: An Integrated Approach to Delivering Medical Nutrition Therapy to Bariatric Surgery Patients via Synchronous Teleconsultation

2014 ◽  
Vol 7 (2) ◽  
pp. 169-174
Author(s):  
Dorothy Roedel Ferraro
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Patient Adherence ◽  
Nutrition Therapy ◽  
Medical Nutrition Therapy ◽  
Long Term Outcomes ◽  
Bariatric Patients ◽  
Improve Patient ◽  
Medical Nutrition

Bariatric surgery has emerged as a safe and effective means to substantial weight loss with subsequent resolution of comorbid conditions, improvement in quality of life, and increased longevity for the morbidly obese. Achieving significant and sustained weight loss following surgery requires lifelong dietary and behavior modifications. Bariatric patients are challenged to adhere to the postoperative plan and the clinician to provide the necessary support services to promote the patient’s adherence. Long-term outcomes rely on lifelong patient adherence and follow-up care. Dietary management is central to weight loss, and medical nutrition therapy (MNT) provides the patient with the knowledge and skills needed to modify dietary behaviors. Telenutrition offers a novel and innovative approach to nutritional counseling for bariatric patients who might otherwise have limited or no access. This article presents the use of synchronous teleconsultation to augment patient care following bariatric surgery by connecting patients with the registered dietitian through web conferencing. The objectives of this multicomponent telenutrition program are to improve patient access to MNT, augment clinician–patient interaction between office visits, increase patient satisfaction, and improve patient adherence to prescribed treatment plans, thereby optimizing both short- and long-term outcomes following bariatric surgery.

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