Effect of weight loss via bariatric surgery for class III obesity on exertional breathlessness

The prevalence of class III obesity (BMI≥40 kg/m2) in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference) remains high.

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Lifestyle modification for weight loss: effects on cardiorespiratory capacity in Patients with Class II and Class III Obesity

Obesity Science & Practice ◽

10.1002/osp4.544 ◽

2021 ◽

Author(s):

Finn Wammer ◽

Andrea Haberberger ◽

Anita Dyb Linge ◽

Tor Åge Myklebust ◽

Sveinung Vemøy ◽

...

Keyword(s):

Weight Loss ◽

Lifestyle Modification ◽

Class Ii ◽

Class Iii ◽

Class Iii Obesity

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Evaluation of liquid ingestion after bariatric surgery

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032011000100004 ◽

2011 ◽

Vol 48 (1) ◽

pp. 15-18 ◽

Cited By ~ 4

Author(s):

Roberto Oliveira Dantas ◽

Leda Maria Tavares Alves ◽

Rachel de Aguiar Cassiani ◽

Carla Manfredi dos Santos

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Normal Values ◽

Normal Body Mass Index ◽

Class Iii ◽

Entire Volume ◽

Solid Foods ◽

Class Iii Obesity ◽

Swallowing Capacity ◽

Liquid Bolus

CONTEXT: Bariatric surgery is an effective treatment for obesity; however, after surgery the patient may have difficulty in swallowing liquid and solid foods. OBJECTIVES: To evaluate liquid ingestion in patients who had undergone bariatric surgery. METHOD: We studied 43 volunteers with normal body mass index (BMI) (BMI: 18.5-24.9 kg/m²), 55 subjects with class III obesity (BMI: >40.0 kg/m²), and 48 subjects with bariatric surgery for treatment of class III obesity. The method chosen for evaluation was the water swallowing test. The subjects drank in triplicate 50 mL of water while being precisely timed and the number of swallows were counted. RESULTS: There was no difference between subjects with normal BMI and subjects with class III obesity. During the first 2 months after bariatric surgery the patients showed an increase in the time needed to drink the entire volume, in the number of swallows, and in the inter-swallow interval, and a decrease in the volume swallowing capacity (volume/swallowing) and swallowing flow rate (volume swallowed/second). After 2 months, the results of the swallowing measurements moved in the direction of normal values. CONCLUSION: Bariatric surgery may cause more intense alterations of liquid bolus swallowing within 2 months after the procedure, which moved to normal values after this time.

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Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab175 ◽

2021 ◽

Author(s):

Andrew J M Lewis ◽

Ines Abdesselam ◽

Jennifer J Rayner ◽

James Byrne ◽

Barry A Borlaug ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Cardiovascular Magnetic Resonance ◽

Stress Responses ◽

Severe Obesity ◽

Systolic Function ◽

Healthy Weight ◽

Class Iii ◽

End Diastolic Volume ◽

Class Iii Obesity

Abstract Aims We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). Methods and results We first determined the effects of World Health Organization class III obesity [body mass index (BMI) > 40 kg/m2, n = 54] vs. healthy weight (BMI < 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P < 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P < 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). Conclusion Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure.

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Effectiveness and Characterization of Severely Energy-Restricted Diets in People with Class III Obesity: Systematic Review and Meta-Analysis

Behavioral Sciences ◽

10.3390/bs9120144 ◽

2019 ◽

Vol 9 (12) ◽

pp. 144 ◽

Cited By ~ 3

Author(s):

Gabrielle Maston ◽

Alice A. Gibson ◽

H. Reza Kahlaee ◽

Janet Franklin ◽

Elisa Manson ◽

...

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Prediction Interval ◽

Meta Analysis ◽

Average Weight ◽

Class Iii ◽

Dietary Interventions ◽

Initial Body Weight ◽

Class Iii Obesity

Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m2) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks’ duration and those of ≥6 weeks’ duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks’ duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.

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Efficacy of the treatment with dapagliflozin and metformin compared to metformin monotherapy for weight loss in patients with class III obesity: a randomized controlled trial

Trials ◽

10.1186/s13063-020-4121-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Aldo Ferreira-Hermosillo ◽

Mario Antonio Molina-Ayala ◽

Diana Molina-Guerrero ◽

Ana Pamela Garrido-Mendoza ◽

Claudia Ramírez-Rentería ◽

...

Keyword(s):

Weight Loss ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Class Iii ◽

Randomized Controlled ◽

Metformin Monotherapy ◽

Class Iii Obesity

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Reductions in knee joint forces with weight loss are attenuated by gait adaptations in class III obesity

Gait & Posture ◽

10.1016/j.gaitpost.2015.12.040 ◽

2016 ◽

Vol 45 ◽

pp. 25-30 ◽

Cited By ~ 12

Author(s):

Paul DeVita ◽

Patrick Rider ◽

Tibor Hortobágyi

Keyword(s):

Weight Loss ◽

Knee Joint ◽

Class Iii ◽

Joint Forces ◽

Class Iii Obesity

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Disease Specific to Chronic Lymphedema and Class III Obesity

Case Reports in Medicine ◽

10.1155/2020/9234183 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Karen G. Figenshau ◽

Matthew B. Lindquist

Keyword(s):

Weight Loss ◽

Lymphatic Vessels ◽

Recurrent Infection ◽

Class Iii ◽

Compression Garments ◽

Secondary Lymphedema ◽

Fibrotic Tissue ◽

Fundamental Goal ◽

Class Iii Obesity ◽

Chronic Lymphedema

Elephantiasis nostras verrucosa (ENV) is a unique, chronic condition found in patients with obesity and chronic secondary lymphedema. It develops due to chronic inflammation and recurrent infection, most commonly on gravity-dependent sites. Progressive tissue enlargement, deformity, and disability necessitate intervention. First, clinicians should explore the etiology of patients’ secondary lymphedema, as this is paramount in determining treatment for ENV. The fundamental goal is alleviating lymphatic obstruction. Our literature review of available cases of ENV elucidates Class III obesity as a factor common to all available cases of ENV. As such, weight loss is a key component of treatment. Medical management and weight loss are most effective when combined with physiologic interventions such as compression garments and decongestive physiotherapy. If surgical intervention is required, one of the mainstays of patient management is a reductive approach, aimed at removing excess adipose and fibrotic tissue to improve lymphatic patency and flow. Optimal postoperative outcomes are achieved when patients also undergo physiologic procedures to bypass obstructions and connect functioning lymphatic vessels.

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Postpartum Weight Loss in Women with Class-III Obesity: Do They Lose What They Gain?

American Journal of Perinatology ◽

10.1055/s-0039-1695778 ◽

2019 ◽

Vol 37 (01) ◽

pp. 053-058 ◽

Cited By ~ 1

Author(s):

Anne M. Siegel ◽

Ann Tucker ◽

LaMani D. Adkins ◽

Courtney Mitchell ◽

Haywood L. Brown ◽

...

Keyword(s):

Weight Loss ◽

Morbidly Obese ◽

Postpartum Weight Retention ◽

Weight Retention ◽

Obese Women ◽

Class Iii ◽

Postpartum Visit ◽

Class Iii Obesity ◽

Postpartum Weight ◽

The Impact

Abstract Objective Excessive gestational weight gain (GWG) increases risk of postpartum weight retention in normal and overweight women but little is known about weight retention in morbidly obese women. We evaluated the impact of GWG on postpartum weight retention in women with class-III obesity. Study Design This is a retrospective cohort of pregnancies at a single institution from July 2013 to December 2017 complicated by body mass index (BMI) ≥ 40 at entry to care. Women were classified as GWG within (WITHIN), less than (LESS), or greater than (MORE) Institute of Medicine's (IOM) recommendations. Women were excluded for multiples, late prenatal care, preterm birth, fetal anomalies, intrauterine demise, weight loss, and missing data. Primary outcome was achievement of intake weight at the postpartum visit. Logistic regression was used to adjust for confounding factors. Results Among 338 women, 93 (28%) gained WITHIN, 129 (38%) LESS, and 144 (43%) MORE. Women in the MORE group were less likely to achieve their intake weight at the postpartum visit (adjusted odds ratio [AOR] = 0.09 95% confidence interval [CI]: 0.05–0.17, p < 0.01). Women gaining MORE were the only group who did not lose weight from intake to postpartum (Median weight change [LESS: −14 lbs (IQR: −20 to −7)] vs. [WITHIN: −7 lbs (IQR: −13 to −1)] vs. [MORE: 5 lbs (IQR: 0–15)]; p < 0.01). Conclusion Excessive GWG in women with class-III obesity is associated with postpartum weight retention.

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