Erratum: Associations of markers in 11 obesity candidate genes with maximal weight loss and weight regain in the SOS bariatric surgery cases

Context and Objective: The magnitude of weight loss-induced high-density lipoprotein cholesterol (HDL-C) changes may depend on genetic factors. We examined the associations of eight candidate genes, identified by genome-wide association studies, with HDL-C at baseline and 10 yr after bariatric surgery in the Swedish Obese Subjects study. Methods: Single-nucleotide polymorphisms (SNP) (n = 60) in the following gene loci were genotyped: ABCA1, APOA5, CETP, GALNT2, LIPC, LIPG, LPL, and MMAB/MVK. Cross-sectional associations were tested before (n = 1771) and 2 yr (n = 1583) and 10 yr (n = 1196) after surgery. Changes in HDL-C were tested between baseline and yr 2 (n = 1518) and yr 2 and 10 (n = 1149). A multiple testing corrected threshold of P = 0.00125 was used for statistical significance. Results: In adjusted multivariate models, CETP SNP rs3764261 explained from 3.2–4.2% (P < 10−14) of the variation in HDL-C at all three time points, whereas CETP SNP rs9939224 contributed an additional 0.6 and 0.9% at baseline and yr 2, respectively. LIPC SNP rs1077834 showed consistent associations across all time points (R2 = 0.4–1.1%; 3.8 × 10−6 < P < 3 × 10−3), whereas LPL SNP rs6993414 contributed approximately 0.5% (5 × 10−4 < P < 0.0012) at yr 2 and 10. In aggregate, four SNP in three genes explained 4.2, 6.8, and 5.6% of the HDL-C variance at baseline, yr 2, and yr 10, respectively. None of the SNP was significantly associated with weight loss-related changes in HDL-C. Conclusions: SNP in the CETP, LIPC, and LPL loci contribute significantly to plasma HDL-C levels in obese individuals, and the associations persist even after considerable weight loss due to bariatric surgery. However, they are not associated with surgery-induced changes in HDL-C levels.

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Dietary and Lifestyle Factors Serve as Predictors of Successful Weight Loss Maintenance Postbariatric Surgery

Journal of Obesity ◽

10.1155/2019/7295978 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Afshan Masood ◽

Lujain Alsheddi ◽

Loura Alfayadh ◽

Bushra Bukhari ◽

Ruba Elawad ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Dietary Habits ◽

Weight Maintenance ◽

Dietary Counseling ◽

Beneficial Effects ◽

Predicting Factors ◽

Lifestyle Practices ◽

Fiber Consumption

Bariatric surgery is considered to be an effective treatment for the resolution of severe obesity; however, in more than half of the bariatric surgery patients, weight reacquisition occurs as early as 18 months postsurgery, compromising the surgery’s beneficial effects. Maintaining weight loss after surgery poses a great challenge, necessitating the identification of predicting factors. In the present study, we explored the association between weight regain and dietary habits and behavioral lifestyle practices in patients following bariatric surgery. Fifty patients who underwent bariatric surgery with ≥18-month postoperative period of follow-up were included. They were classified into two groups: weight maintainers (n = 29) were patients who regained <15% of their weight, and weight regainers (n = 21) were patients who regained ≥15% of their weight compared to their lowest postoperative weight. The mean age of the study participants was 41.4 ± 8.9 years, and twenty-eight patients (56%) of the total, were females. A detailed analysis of dietary and lifestyle habits was performed by questionnaire-based interviews. Significant weight regain was noted in the regainers compared to the maintainers (19.6 ± 8.4 kg vs. 4.5 ± 3.5 kg, respectively, P≤0.001), which was attributed to their following of unhealthy dietary habits and behavioral lifestyle practices. The dietary and behavioral lifestyle practices adopted by the maintainers were higher fiber consumption and water intake, monitored pace of eating, evasion of emotional binge, and distracted eating and following of self-assessment behaviors. Additionally, regular nutritional follow-ups and compliance with postoperative dietary counseling significantly helped to improve weight maintenance. In conclusion, the effectiveness of weight loss postbariatric surgery was compromised by weight regain due to unhealthy dietary and behavioral lifestyle practices stemming from a lack of nutritional guidance and knowledge. The implementation of comprehensive nutritional counseling and advice on behavioral changes before and after surgery will help achieve optimal weight results.

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Correction to: One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery

Obesity Surgery ◽

10.1007/s11695-020-04651-9 ◽

2020 ◽

Vol 30 (9) ◽

pp. 3295-3295

Author(s):

Nathan Poublon ◽

Ibtissam Chidi ◽

Martijn Bethlehem ◽

Ellen Kuipers ◽

Ralph Gadiot ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Weight Regain ◽

One Anastomosis Gastric Bypass ◽

Insufficient Weight Loss ◽

Restrictive Bariatric Surgery

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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?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2340 ◽

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.

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The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2016.10.018 ◽

2017 ◽

Vol 13 (3) ◽

pp. 491-500 ◽

Cited By ~ 62

Author(s):

Fatima Cody Stanford ◽

Nasreen Alfaris ◽

Gricelda Gomez ◽

Elizabeth T. Ricks ◽

Alpana P. Shukla ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Weight Loss Medications ◽

Multi Center Study ◽

Inadequate Weight Loss ◽

Center Study

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Revisional Bariatric Surgery

10.1093/med/9780190608347.003.0024 ◽

2018 ◽

Author(s):

Catherine Frenkel ◽

Aurora Pryor

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Gastric Band ◽

Surgical Techniques ◽

Jejunoileal Bypass ◽

Revisional Bariatric Surgery ◽

Laparoscopic Gastric Band ◽

Ensure Patient Safety ◽

Failed Weight Loss

The annual volume of bariatric surgery is growing, giving rise to an increase in complications requiring complex management, including revision. Bariatric revision procedures are also becoming increasingly necessary for weight-loss recidivism and patients at the extreme of obesity. This chapter outlines clinical management pathways used to address secondary bariatric surgery. It summarizes reasons for, and outcomes with, revision of a laparoscopic gastric band, vertical banded gastroplasty, sleeve gastrectomy, or Roux-en-Y gastric bypass. Surgical techniques used to manage weight regain or failed weight loss after bariatric surgery are also discussed. Finally, surgical solutions for bariatric surgery-induced malnutrition are described, particularly in the setting of biliopancreatic diversion, duodenal switch, or jejunoileal bypass. Overall, the chapter concludes that standardization of revisional procedures can have a significant patient impact, and guidelines must be evidence-based in order to ensure patient safety and success.

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Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201400s100012 ◽

2014 ◽

Vol 27 (suppl 1) ◽

pp. 47-50 ◽

Cited By ~ 5

Author(s):

Simone Dallegrave MARCHESINI ◽

Giorgio Alfredo Pedroso BARETTA ◽

Maria Paula Carlini CAMBI ◽

João Batista MARCHESINI

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Multidisciplinary Team ◽

Weight Regain ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

The Internet ◽

Bariatric Patients ◽

Second Chance

BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

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Weight Regain after Bariatric Surgery

10.1093/med/9780190608347.003.0025 ◽

2018 ◽

Author(s):

Bartolome Burguera ◽

Amani Mohamed Hag ◽

Leslie J. Heinberg

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Scientific Evidence ◽

Treatment Options ◽

Behavioral Factors ◽

Number Of Patients ◽

Medical Therapies ◽

Successful Weight Loss ◽

Definition Of

Bariatric surgery is the most effective therapy for morbid obesity. Unfortunately, a significant number of patients experience significant postoperative weight regain, which undermines the metabolic and cardiovascular benefits of weight loss associated with surgery. When revisional procedures are not indicated and/or when behavioral factors are present (e.g., nonadherence, eating pathology), bariatric programs currently do not have any empirically evaluated treatment options to offer those burdened with less favorable outcomes. This chapter reviews the definition of successful weight loss after bariatric surgery, as well as some biologic and behavioral factors that could be implicated in weight regain after surgery. Finally, we outline the scientific evidence supporting the use of behavioral and medical therapies to prevent weight regain after surgery. Bariatric programs need to determine from clinical experience, as well as through clinical trials, what behavioral/medical therapies are the most effective for managing weight gain after bariatric surgery.

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0876 Obstructive Sleep Apnea, Low PAP Use, and Daytime Sleepiness are Associated with Weight Regain Following Bariatric Surgery in Adolescents with Severe Obesity

SLEEP ◽

10.1093/sleep/zsaa056.872 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A334-A334

Author(s):

J L Kaar ◽

L Patten ◽

A Kaizer ◽

S M Hawkins ◽

J M Moore ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Daytime Sleepiness ◽

Weight Regain ◽

Protective Factor ◽

Severe Obesity ◽

Post Surgery ◽

Obstructive Sleep ◽

Ameliorative Effect ◽

The Impact

Abstract Introduction Significant weight loss is seen following bariatric surgery, leading to an ameliorative effect on obesity-related comorbidities such as OSA. Weight loss maintenance is a priority, and identifying factors that may be associated with weight loss outcomes following bariatric surgery is of high importance. The current study examined whether OSA symptoms and PAP therapy were associated with weight outcomes following bariatric surgery in adolescents. Methods Participants from the Teen-LABS Study, which follows adolescents undergoing bariatric surgery were examined. Demographic and anthropometric data, OSA diagnosis, and PAP prescription and self-reported usage information were assessed 6 months before surgery. Pediatric Sleep Questionnaire (PSQ) responses were utilized from baseline to 48 months post-surgery. All analyses were adjusted for time, age, sex, surgery type, and ethnicity. Results 242 adolescents (76% female, 72% White, age at surgery = 16.6 [1.6] years) were included. 57% had a diagnosis of OSA at pre-surgical baseline, and 56% of adolescents with OSA reported PAP use at pre-surgery. BMI increase over time from year 1-4 post-surgery was 11% more for those with high PSQ severity compared to those with low PSQ severity (p = 0.01). Those with pre-surgical OSA that reported using PAP “often” or “always” at baseline had an 8% lower increase in BMI from year 1-4 post-surgery compared to those that reported using PAP “rarely” or “sometimes” at baseline (p = 0.004). Finally, endorsing daytime sleepiness on the PSQ was associated with a 11% greater increase in BMI during years 1-4 post-surgery (p = 0.01). Conclusion OSA and daytime sleepiness may be associated with greater weight regain following bariatric surgery in adolescents. Adherence to PAP therapy pre-surgery may be a protective factor in preventing or reducing weight regain following surgery. Daytime sleepiness may be an effect of OSA, or due to the insufficient sleep that is prevalent among adolescents. Research is needed to examine the impact of additional aspects of sleep health such as duration, timing, and quality on health outcomes, as well as the impact of PAP adherence and sleep interventions on weight regain following bariatric surgery in adolescents with severe obesity. Support None.

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