Preoperative μ-opioid receptor availability predicts weight loss following bariatric surgery

AbstractBackgroundBariatric surgery is the most effective method for weight loss in morbid obesity. There is significant individual variability in the weight loss outcomes, yet factors leading to postoperative weight loss or weight regain remain elusive. Alterations in the µ-opioid receptor (MOR) and dopamine D2 receptor (D2R) systems are associated with obesity, appetite control, and reward processing. The magnitude of initial brain receptor system perturbation is a plausible predictor of long-term surgical weight loss outcomes. The aim was to test this hypothesis by measuring obese subjects’ MOR and D2R availability with positron emission tomography (PET) preoperatively before bariatric surgery and then assessing their weight development association with regional MOR and D2R availabilities at 2-year follow-up.MethodsWe studied 19 morbidly obese women (mean BMI 40, mean age 43) scheduled to undergo bariatric surgery, i.e. Roux-en-Y gastric bypass or sleeve gastrectomy, according to their standard clinical treatment. Preoperative MOR and D2R availabilities were measured using PET with [11C]carfentanil and [11C]raclopride, respectively. Subject weight was recorded at 3, 6, 12, and 24 months after surgery. Radiotracer binding potentials (BPND) were extracted and correlated with patient weight at different time points. ROIs were delineated in the striatum and in limbic and paralimbic components of the emotion and reward networks.ResultsMOR availabilities were not correlated with preoperative weight. MOR availabilities in the amygdala (r = −0.54), insula (r = −0.46), ventral striatum (r = −0.48) and putamen (r = −0.49) were associated with subject weight at 3 months. Significant association was found in the amygdala at 6 months (r = −0.53), 12 (r = −0.49), and 24 months (r = −0.50). D2R availabilities were associated with neither preoperative weight nor weight loss at any follow-up time point.ConclusionsTo our knowledge, this is the first study to demonstrate that neuroreceptor markers prior to bariatric surgery in patients with morbid obesity are associated with the postoperative weight loss. Preoperative MOR availability in the amygdala was associated with long-term postoperative weight development after surgery suggesting that postoperative weight regain may derive from dysfunction in the opioid system. Postoperative weight loss outcomes after bariatric surgery may be partially predicted based on preoperative receptor availability opening up new potential for treatment possibilities.Clinical Trials RegistrationSleevePET2, NCT01373892, http://www.clinicaltrials.gov

Download Full-text

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.

Download Full-text

Long-Term Follow-up after Gastric Surgery for Morbid Obesity: Preoperative Weight Loss Improves the Long-Term Control of Morbid Obesity after Vertical Banded Gastroplasty

Obesity Surgery ◽

10.1381/096089299765552693 ◽

1999 ◽

Vol 9 (5) ◽

pp. 426-432 ◽

Cited By ~ 35

Author(s):

E.J.H.M. van de Weijgert ◽

C.H. Ruseler ◽

J.W.F. Elte

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Vertical Banded Gastroplasty ◽

Gastric Surgery ◽

Preoperative Weight Loss ◽

Banded Gastroplasty ◽

Long Term Follow Up ◽

Preoperative Weight

Download Full-text

Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience

Journal of Clinical Medicine ◽

10.3390/jcm10214922 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4922

Author(s):

Assim A. Alfadda ◽

Mohammed Y. Al-Naami ◽

Afshan Masood ◽

Ruba Elawad ◽

Arthur Isnani ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Saudi Arabia ◽

Weight Regain ◽

Severe Obesity ◽

Successful Outcome ◽

Post Surgery ◽

Weight Outcomes

Background: Obesity is considered a global chronic disease requiring weight management through lifestyle modification, pharmacotherapy, or weight loss surgery. The dramatic increase in patients with severe obesity in Saudi Arabia is paralleled with those undergoing bariatric surgery. Although known to be beneficial in the short term, the long-term impacts of surgery within this group and the sustainability of weight loss after surgery remains unclear. Objectives: We aimed to assess the long-term weight outcomes after bariatric surgery. Setting: The study was conducted at King Khalid University Hospital (KKUH), King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Methods: An observational prospective cohort study on adult patients with severe obesity undergoing bariatric surgery (sleeve gastrectomy (SG) or Roux-en Y gastric bypass (RYGB)) during the period between 2009 and 2015 was conducted. Weight loss patterns were evaluated pre- and post-surgery through clinical and anthropometric assessments. Absolute weight loss was determined, and outcome variables: percent excess weight loss (%EWL), percent total weight loss (%TWL), and percent weight regain (%WR), were calculated. Statistical analysis using univariate and multivariate general linear modelling was carried out. Results: A total of 91 (46 males and 45 females) patients were included in the study, with the majority belonging to the SG group. Significant weight reductions were observed at 1 and 3 years of follow-up (p < 0.001) from baseline. The %EWL and %TWL were at their maximum at 3 years (72.4% and 75.8%) and were comparable between the SG and RYGB. Decrements in %EWL and %TWL and increases in %WR were seen from 3 years onwards from bariatric surgery until the study period ended. The yearly follow-up attrition rate was 20.8% at 1 year post-surgery, 26.4% at year 2, 31.8% at year 3, 47.3% at year 4, 62.6% at year 5, and 79.1% at end of study period (at year 6). Conclusion: The major challenge to the successful outcome of bariatric surgery is in maintaining weight loss in the long-term and minimizing weight regain. Factors such as the type of surgery and gender need to be considered before and after surgery, with an emphasis on the need for long-term follow-up to enssure the optimal benefits from this intervention.

Download Full-text

Abstract P203: Demographic Predictors of Long-term Weight Loss Beginning One-Year After Bariatric Surgery at Two Medical Centers

Circulation ◽

10.1161/circ.129.suppl_1.p203 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Laura Rasmussen-Torvik ◽

Abigail Baldridge ◽

Jennifer Pacheco ◽

Sharon Aufox ◽

Kwang-Young Kim ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Regain ◽

Mixed Effects ◽

Mixed Effects Models ◽

Linear Mixed Effects ◽

Post Surgery ◽

Percentage Weight

Objective: Existing studies of predictors of weight loss after bariatric surgery suffer from simplistic statistical methods and relatively short follow-up. We sought to determine predictors of long-term weight loss up to 9.6 years after bariatric surgery using data extracted from two electronic health records (EHR) systems and linear mixed effects models. Methods: Participants were selected from patients enrolled in the NUgene biorepository at either Northwestern Memorial HealthCare or NorthShore University HealthSystem. Individuals who had undergone Roux-en-Y gastric bypass (RNY) were identified through billing or surgical history procedure codes in the electronic health records (EHRs). All available weight measurements and dates were extracted from the EHR as well as surgery date. Sex, race/ethnicity, education, marital status, and height were taken from the NUgene intake questionnaire. SAS PROC MIXED was used to create linear mixed effects models to examine weight loss from 1- 9.6 years post-surgery. To examine overall weight loss and slope of weight regain, covariates and covariate interactions with time post-surgery were included in the mixed effects models. Results: 119 individuals from Northwestern and 43 individuals from NorthShore had undergone gastric bypass and had at least 1 weight measurement 1 year post-surgery. There were 3071 weight measurements which occurred at least 1 year post-surgery in the dataset; the median number of observations per person was 10 and the median weight loss represented by these measurements was 32.7% from pre-surgical weight. The regression model indicated that, on average, individuals experienced slight weight regain of about 0.8% of pre-surgical weight per year after their first year post-surgery. Over the 1- 10 years of follow up African Americans lost nearly 5 percentage points less weight than whites ( p =.0025) . People who were older and taller also experienced less percentage weight loss, and people with higher initial weights experienced a higher percentage weight loss (all p <.05), Older age was associated with significantly (p<0.05) slower weight regain after 1 year post-surgery. Discussion: EHR records from multiple institutions can be integrated to study outcomes after bariatric surgery. Demographic factors predict overall weight loss and a rate of weight regain after 1 year post RNY surgery. This information may be useful for both surgeons and prospective patients.

Download Full-text

Place Work on a Scale: What Do We Know About the Association Between Employment Status and Weight Loss Outcomes After Bariatric Surgery?

Obesity Surgery ◽

10.1007/s11695-021-05388-9 ◽

2021 ◽

Author(s):

Marleen M. Romeijn ◽

Marlies Bongers ◽

Daniëlle D.B. Holthuijsen ◽

Loes Janssen ◽

François M.H. van Dielen ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Employment Status ◽

Weight Regain ◽

Weight Loss Outcomes ◽

Working Status ◽

Successful Weight Loss ◽

Patients Experience ◽

The Impact

AbstractDespite the initial successful weight loss after bariatric surgery, a significant amount of patients experience weight loss failure and weight regain. Several factors are known to contribute to this, though the impact of employment status is unknown. The objective of this systematic review was to examine the impact of employment status on post-surgical weight loss outcomes. Eight studies were included with a follow-up ranging between 2 and 10 years. Employed patients seemed to present more weight loss (9.0–11.0% EWL, 1.3–1.6% BMI loss) compared to unemployed patients, but none of these numbers were statistically significant. Moreover, there were contrasting findings in terms of weight regain. This review may highlight the importance of working status after bariatric surgery and warrants further investigation on this topic. Graphical abstract

Download Full-text

A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02276-9 ◽

2021 ◽

Author(s):

Istvan Bence Balint ◽

Ferenc Csaszar ◽

Lajos Orban ◽

Peter Radics ◽

Akos Farics ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Personality Inventory ◽

Gastric Plication ◽

Safety Study ◽

Single Anastomosis ◽

Weight Loss Outcomes ◽

Ileal Bypass

Abstract Background Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. Methods Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. Results Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data. Conclusion According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

Download Full-text

Influence of Weight Loss Attempts on Bariatric Surgery Outcomes

The American Surgeon ◽

10.1177/000313481608201012 ◽

2016 ◽

Vol 82 (10) ◽

pp. 916-920 ◽

Cited By ~ 2

Author(s):

Sayantan Deb ◽

Lindsey Voller ◽

Chase Palisch ◽

Omar Ceja ◽

Wes Turner ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Significant Negative Correlation ◽

Postoperative Weight Loss ◽

Significant Difference ◽

Weight Loss Outcomes ◽

Correlation Tests ◽

Surgery Outcomes ◽

Analyze Data

Many payors require an additional attempt at nonsurgical weight loss before approval of bariatric procedures. This study evaluates this requirement by characterizing the prior weight loss attempts (WLAs) undergone by bariatric surgery patients and correlating those attempts to postoperative weight loss outcomes. Number and duration of WLAs were obtained from a preoperative clinic assessment. Body mass index (BMI) and percentage of excess weight loss (%EWL) were used to assess weight loss. Kruskal-Wallis and Spearman Correlation tests were performed to analyze data using GraphPad Prism 6. Mean number of WLAs before surgery was 3.5 ± 0.2 attempts, with an average duration of 15.2 ± 1.1 years. There was a significant negative correlation between duration of WLAs and preoperative BMI ( r = -0.2637, P = 0.0025). No significant difference was found for preoperative BMI or mean 12-month %EWL among any WLA groups. The number and duration of dietary attempts before surgery do not significantly affect long-term weight loss outcomes after bariatric surgery. Given these data, an additional preoperative WLA may not be efficacious in improving patients’ chances at weight loss.

Download Full-text

A Preliminary Study of the Relationship between Preoperative Depression and Weight Loss following Surgery for Morbid Obesity

The International Journal of Psychiatry in Medicine ◽

10.2190/68ab-9lm9-7q1n-b1pw ◽

1986 ◽

Vol 15 (2) ◽

pp. 185-196 ◽

Cited By ~ 27

Author(s):

Steven L. Dubovsky ◽

Ann Haddenhorst ◽

James Murphy ◽

R. Dale Liechty ◽

Deborah A. CoyLe

Keyword(s):

Morbid Obesity ◽

Weight Loss ◽

Body Weight ◽

Morbidly Obese ◽

Obese Patients ◽

Postoperative Weight Loss ◽

Preliminary Study ◽

Preoperative Weight ◽

The Relationship

Fifty-two consecutive morbidly obese patients were evaluated psychiatrically before they were scheduled to undergo gastroplasty and again an average of twenty-six months later. Ten patients did not undergo surgery; six patients who did undergo gastroplasty were unavailable for follow up. In the remaining thirty-six patients, there was a statistically significant correlation between the degree of clinically estimated preoperative depression and the percent of body weight lost following surgery. Amount of preoperative weight was also correlated with postoperative weight loss, but depression before surgery was a more significant predictor of postoperative weight loss. Patients who expressed less distress prior to surgery tended to lose less weight after surgery and were more likely to manifest increased psychiatric distress postoperatively.

Download Full-text