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 Obesity – A global Burden, Crucial Problem for the Society

2018 ◽  
Vol 29 (2) ◽  
pp. 75-83
Author(s):  
Quazi Tarikul Islam ◽  
Ishrat Binte Reza
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Global Public Health ◽  
Health Crisis ◽  
The Us ◽  
And Behavior ◽  
The Impact ◽  
Care Costs

Objectives: To aware doctors, patients, food producers and consumers.Data source: Online search via Google, 70 articles were down loaded, 52 valid papers were selected. Only 12 full text articles were eligible for review. Obesity rates have increased sharply over the past 30 years, creating a global public health crisis. The impact of obesity on morbidity, mortality, and health care costs is profound. Obesity and weight related complications exert a huge burden on patient suffering and social costs. In recent years, exciting advances have occurred in all 3 modalities used to treat obesity: lifestyle intervention, pharmacotherapy, and weight-loss procedures including 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 of 500 kcal/d. Physical activity of 150 to 180 min/week 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 300min/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.Bangladesh J Medicine Jul 2018; 29(2) : 75-83

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.

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.

Abstract MP003: Development and Validation of a Prediction Model of Weight Loss Maintenance or Regain at 4 Years in the Look AHEAD Trial

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Samantha E Berger ◽  
Gordon S Huggins ◽  
Jeanne M McCaffery ◽  
Alice H Lichtenstein
Keyword(s):  
Machine Learning ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Logistic Regression ◽  
Prediction Model ◽  
Weight Regain ◽  
Initial Weight ◽  
Initial Weight Loss ◽  
Look Ahead

Introduction: The development of type 2 diabetes is strongly associated with excess weight gain and can often be partially ameliorated or reversed by weight loss. While many lifestyle interventions have resulted in successful weight loss, strategies to maintain the weight loss have been considerably less successful. Prior studies have identified multiple predictors of weight regain, but none have synthesized them into one analytic stream. Methods: We developed a prediction model of 4-year weight regain after a one-year lifestyle-induced weight loss intervention followed by a 3 year maintenance intervention in 1791 overweight or obese adults with type 2 diabetes from the Action for Health in Diabetes (Look AHEAD) trial who lost ≥3% of initial weight by the end of year 1. Weight regain was defined as regaining <50% of the weight lost during the intervention by year 4. Using machine learning we integrated factors from several domains, including demographics, psychosocial metrics, health status and behaviors (e.g. physical activity, self-monitoring, medication use and intervention adherence). We used classification trees and stochastic gradient boosting with 10-fold cross validation to develop and internally validate the prediction model. Results: At the end of four years, 928 individuals maintained ≥50% of their initial weight lost (maintainers), whereas 863 did not met that criterion (regainers). We identified an interaction between age and several variables in the model, as well as percent initial weight loss. Several factors were significant predictors of weight regain based on variable importance plots, regardless of age or initial weight loss, such as insurance status, physical function score, baseline BMI, meal replacement use and minutes of exercise recorded during year 1. We also identified several factors that were significant predictors depending on age group (45-55y/ 56-65y/66-76y) and initial weight loss (lost 3-9% vs. ≥10% of initial weight). When the variables identified from machine learning were added to a logistic regression model stratified by age and initial weight loss groups, the models showed good prediction (3-9% initial weight loss, ages 45-55y (n=293): ROC AUC=0.78; ≥10% initial weight loss, ages 45-55y (n=242): ROC AUC=0.78; (3-9% initial weight loss, ages 56-65y (n=484): ROC AUC=0.70; ≥10% initial weight loss, ages 56-65y (n=455): ROC AUC = 0.74; 3-9% initial weight loss, ages 66-76y (n=150): ROC AUC=0.84; ≥10% initial weight loss, ages 66-76y (n=167): ROC AUC=0.86). Conclusion: The combination of machine learning methodology and logistic regression generates a prediction model that can consider numerous factors simultaneously, can be used to predict weight regain in other populations and can assist in the development of better strategies to prevent post-loss regain.

scholarly journals Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Neurology ◽  
2017 ◽  
Vol 88 (21) ◽  
pp. 2026-2035 ◽  
Author(s):  
Mark A. Espeland ◽  
José A. Luchsinger ◽  
Laura D. Baker ◽  
Rebecca Neiberg ◽  
Steven E. Kahn ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Lifestyle Intervention ◽  
Cognitive Test ◽  
Intervention Effect ◽  
Intensive Lifestyle Intervention

Objective:To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.Methods:Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.Results:Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5–13.5) years after enrollment, when participants' mean age was 69.6 (54.9–87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.Conclusions:Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.Clinicaltrials.gov identifier:NCT00017953 (Action for Health in Diabetes).Level of evidence:This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

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

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 47-50 ◽  
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.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery

2016 ◽  
Vol 174 (1) ◽  
pp. R19-R28 ◽  
Author(s):  
Ricard Corcelles ◽  
Christopher R Daigle ◽  
Philip R Schauer
Keyword(s):  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Metabolic Syndrome ◽  
Weight Loss ◽  
Metabolic Effects ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Long Term Impact

Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.

A298 Long-Term Weight Regain After Bariatric Surgery: Does Postoperative Percent Excess Weight Loss Matter?

2019 ◽  
Vol 15 (10) ◽  
pp. S118-S119
Author(s):  
Laura Flores ◽  
Priscila Rodrigues-Armijo ◽  
Mark Ringle ◽  
Salim Hosein ◽  
Vishal Kothari
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Excess Weight Loss ◽  
Excess Weight ◽  
Percent Excess Weight Loss

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

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.

scholarly journals Evaluation of weight loss and metabolic profile of obese patients with type 2 diabetes mellitus (dm2) versus non-dm2 subjects, one and three years after bariatric surgery

2010 ◽  
Vol 23 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Thiago Fraga Napoli ◽  
Mariana Furieri Guzzo ◽  
Douglas Kawashima Hisano ◽  
Paulo Gustavo Figueiredo Salgado Ribeiro ◽  
Vanessa Junqueira Guedes ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
Metabolic Profile ◽  
Weight Regain ◽  
Density Lipoprotein ◽  
Obese Patients

BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2) obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI), fasting glucose (FG), high density lipoprotein (HDL) and triglycerides (TG). RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90) and HDL (P = 0.73). This was not the case when TG (P = 0.043) and FG (P<0.01) were analyzed. In PO1, both DM2 and non-DM2 groups showed a reduction in weight, BMI and TG, just as FG in the DM2 group (P < 0.05). HDL increased (P < 0.05) in PO1 in both groups. In the following period, between PO1 and PO3, only TG continued to decrease in the non-DM2 group (P = 0.039), while the other variables did not change. In the DM2 group mean A1c in PO3 was 6.2% +- 0.75 (P = 0.027). It was compared both group's post-operative data. HDL's and TG's variation between groups did not differ in PO1 or between PO1 and PO3. Weight in PO1 and PO3, just as BMI in PO1 and PO3, were not significantly different either. CONCLUSION: In PO1, weight loss and metabolic improvement was seen in both groups. This was sustained in PO3, with no significant weight regain or lipid/FG change. A1c found suggests a reasonable control of DM2 surgery. A trend towards a less intense weight loss could be noticed in the DM2 group (P = 0.053).

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