Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity

Background We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone. Methods This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months. Results This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group ( P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05). Discussion IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.

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Fad Diets: Dietary Dilemmas, Predicaments, and Recommendations for its Use

Current Nutrition & Food Science ◽

10.2174/1573401316999200407092922 ◽

2020 ◽

Vol 16 (9) ◽

pp. 1362-1380

Author(s):

Jyoti Singh ◽

Prasad Rasane ◽

Vidisha Tomer ◽

Sawinder Kaur ◽

Yogesh Gat ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Health Care Expenditures ◽

Overweight And Obesity ◽

Lifestyle Changes ◽

Health Issues ◽

Lifestyle Modifications ◽

Treatment Measures ◽

Long Time ◽

Extra Weight

The health issues, mainly overweight and obesity are the growing concerns nowadays due to the associated factors and lifestyle changes which significantly have increased the individual’s health care expenditures. Fad diets are promoted as the easiest and simplest way of shedding the extra weight despite the availability of several treatments available. The prevention and treatment measures, including modification in lifestyle, dietary pattern, and physical activity, are the foundation of weight loss. However, the standard treatment measures are not effective for certain populations as they require long time adherence, which leads to the search for other approaches like fad diet. We steered a comprehensive literature review to present the facts related to fad diets to their efficacy and sustainability. Although fad diets have yielded tremendous positive results in weight loss and cardiovascular risk prevention, the studies reported death in long-term interventions and the results and some of them show side effects too. Randomized controlled trials have significantly reported weight loss in comparison with the popular fad diets; however, persisting on the same diet has also reported kidney problems, ketosis, and other metabolic related problems. The conclusion of this critical review reported that gradual weight loss could be attained by the combination of lifestyle modifications, physical activity, and recommended dietary approaches.

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Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽

10.1093/qjmed/hcab097.039 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Alaa Abbas Sabry ◽

Karim Sabry Abd-Elsamee ◽

Mohamed Ibrahim Mohamed ◽

Mohammed Mohamed Ahmed Abd-Elsalam

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Weight Regain ◽

Revisional Surgery ◽

One Anastomosis Gastric Bypass ◽

Short Term ◽

Multicenter Studies ◽

Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

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Endoscopic Approaches to Obesity Management

Annual Review of Medicine ◽

10.1146/annurev-med-042320-125832 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Russell D. Dolan ◽

Allison R. Schulman

Keyword(s):

Metabolic Disease ◽

Weight Loss ◽

Small Bowel ◽

Weight Regain ◽

Caloric Intake ◽

Annual Review ◽

Publication Date ◽

Obesity Management ◽

Surgical Interventions ◽

Treatment Of Obesity

The field of endoscopic bariatric and metabolic therapy has rapidly evolved from offering endoscopic treatment of weight regain following bariatric surgery to providing primary weight loss options as alternatives to pharmacologic and surgical interventions. Gastric devices and remodeling procedures were initially designed to work through a mechanism of volume restriction, leading to earlier satiety and reduced caloric intake. As the field continues to grow, small bowel interventions are evolving that may have some effect on weight loss but focus on the treatment of obesity-related comorbidities. Future implementation of combination therapy that utilizes both gastric and small bowel interventions offers an exciting option to further augment weight loss and alleviate metabolic disease. This review considers gastric devices and techniques including space-occupying intragastric balloons, aspiration therapy, endoscopic tissue suturing, and plication interventions, followed by a review of small bowel interventions including endoluminal bypass liners, duodenal mucosal resurfacing, and endoscopically delivered devices to create incisionless anastomoses. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Abstract TMP81: Regional, Race-Ethnic and Sex Disparities in Lifestyle Interventions: Data from the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - the NINDS Stroke Prevention Intervention Research Program

Stroke ◽

10.1161/str.48.suppl_1.tmp81 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Maria A Ciliberti-Vargas ◽

Kefeng Wang ◽

Sofia Oluwole ◽

Erika Marulanda-Londoño ◽

Maranatha Ayodele ◽

...

Keyword(s):

Weight Loss ◽

Lifestyle Modification ◽

Lifestyle Changes ◽

Lifestyle Interventions ◽

Lifestyle Modifications ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Diet Counseling ◽

To Receive

Background: As key components of the AHA Life’s Simple 7 campaign, lifestyle modifications play an integral role in the prevention of vascular disease. Little is known about the prevalence of lifestyle modification counseling in patients with acute ischemic stroke (AIS). We sought to investigate disparities in the delivery of lifestyle interventions to AIS patients in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data. Methods: GWTG-S collects data on the provision of several lifestyle interventions including counseling on exercise/weight loss, Therapeutic Lifestyle Changes (TLC) diet, diabetes (DM) education and antihypertensive (low sodium) diet. 80,598 AIS cases were prospectively included from 82 sites (69 FL; 13 PR) from 2010-2016. Multilevel logistic regression models adjusted for age, race, and aphasia were used to evaluate differences in the provision of lifestyle interventions as indicated for patients prior to hospital discharge. Results: Among AIS cases, 51% were men, 62% non-Hispanic White (NHW), 18% NH-Black (NHB), 13% FL-Hispanic (FLH), and 6% PR-Hispanic (PRH). Mean age was 71±14 years. The highest mean BMI was in PRH (29±7 kg/m 2 ), with the lowest in NHW (27±6 kg/m 2 ) and FLH (28±6 kg/m 2 ). Despite this, PRH were less likely to receive exercise/weight loss counseling compared to NHW (OR 0.43, 95% CI 0.20-0.90) and FLH (OR 0.46, 95% CI 0.22-0.97). PRH also had lower odds of receiving TLC diet counseling compared to NHW and FLH (OR 0.32, 95% CI 0.15-0.68). Though NHB presented with higher rates of DM compared to NHW (38% vs. 25%), they were less likely to receive DM education (OR 0.95, 95% CI 0.91-0.99). Women were less likely to receive TLC diet counseling (OR 0.94, 95% CI 0.90-0.98) and DM education (OR 0.94, CI 0.92-0.97) compared to men. Despite higher HTN frequency in women and NHB (67% and 69%), both were less likely to receive low sodium diet recommendations as compared to men (OR 0.94, 95% CI 0.92-0.97) and NHW (OR 0.95, 95% CI 0.91-0.99). Conclusion: Overall, disparities were identified in the provision of several lifestyle interventions in AIS patients. These interventions can benefit all and providers should continue counseling patients regarding modifiable risk factors to prevent future stroke.

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A Review of Past and Present Weight Loss Strategies and the Potential Role of Bariatric Arterial Embolization

Digestive Disease Interventions ◽

10.1055/s-0040-1712084 ◽

2020 ◽

Vol 04 (02) ◽

pp. 195-205

Author(s):

Varun R. Danda ◽

Christopher R. Bailey ◽

Clifford R. Weiss

Keyword(s):

Weight Loss ◽

Treatment Options ◽

Arterial Embolization ◽

Health Concern ◽

Lifestyle Modifications ◽

Obesity Epidemic ◽

Cost Treatment ◽

Clinically Significant ◽

Treatment Of Obesity ◽

Bariatric Embolization

AbstractThe obesity epidemic is a growing public health concern that has a severe effect on the health care system with significant morbidity, mortality, and cost. Treatment options for obesity include lifestyle modifications, pharmacotherapy, and bariatric surgery. Newer, less-invasive therapies including endoscopic bariatric procedures have been developed in recent years to fill the treatment gap that exists between noninvasive approaches and surgery. Bariatric artery embolization (BAE) is a novel minimally invasive endovascular procedure that has been developed to treat obesity. Recent evidence has suggested that bariatric embolization is well tolerated and can induce clinically significant weight loss through a hormonally mediated mechanism. This article will review existing preclinical and clinical data, and explore future directions of the endovascular treatment of obesity.

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Health benefits and risks during 10 years after Roux-en-Y gastric bypass

Surgical Endoscopy ◽

10.1007/s00464-019-07328-2 ◽

2020 ◽

Vol 34 (12) ◽

pp. 5368-5376

Author(s):

M. Chahal-Kummen ◽

O. B. K. Salte ◽

S. Hewitt ◽

I. K. Blom-Høgestøl ◽

H. Risstad ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Weight Regain ◽

Rating Scale ◽

Gastrointestinal Symptoms ◽

Percent Excess Weight Loss ◽

Gastrointestinal Symptom Rating Scale ◽

Laparoscopic Rygb ◽

Prospective Longitudinal

Abstract Background Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. Methods We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. Results A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. Conclusion We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL.

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Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized Study

Journal of Obesity ◽

10.1155/2020/9792518 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Paolo Gentileschi ◽

Emanuela Bianciardi ◽

Leandro Siragusa ◽

Valeria Tognoni ◽

Domenico Benavoli ◽

...

Keyword(s):

Weight Loss ◽

Sleeve Gastrectomy ◽

Weight Regain ◽

Randomized Study ◽

Banded Sleeve Gastrectomy ◽

Group A ◽

The Mean ◽

Group B ◽

To Receive

Background. Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. Objectives. To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. Methods. Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients’ management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. Results. Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). Conclusions. LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.

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