First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study

We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100–240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.

New Horizons A New Paradigm for Treating to Target with Second-Generation Obesity Medications

In treating obesity as a chronic disease, the essential goal of weight loss therapy is not the quantity of weight loss as an end unto itself, but rather the prevention and treatment of complications to enhance health and mitigate morbidity and mortality. This perspective on obesity care is consistent with the complications-centric AACE obesity guidelines and the diagnostic term of Adiposity-Based Chronic Disease (ABCD). Many complications require 10-20% weight loss to achieve therapeutic goals; however, existing obesity medications fail to produce ≥10% weight loss in the majority of patients. In June, 2021, semaglutide 2.4 mg/week was approved for chronic weight management. Phase 3 clinical trials demonstrated that this medication produced >10% placebo-subtracted weight loss, more than half of patents lost ≥15%, and over one third lost ≥20% of baseline weight. This essentially doubles effectiveness over existing obesity medications, provides sufficient weight loss to ameliorate a broad range of complications, and qualifies as the first member of a second-generation class of obesity medications. The advent of second-generation medications fully enables a treat-to-target approach for management of ABCD as a chronic disease. Specifically, with this degree of efficacy, second-generation medications permit active management of body weight as a biomarker to targets associated with effective treatment and prevention of specific complications. ABCD can now be managed similar to other chronic diseases such as type 2 diabetes, hypertension, and atherosclerosis which are treated to biomarker targets that can be modified based on the clinical status of individual patients (i.e., HbA1c, blood pressure, and LDL-c) to prevent the respective complications of these diseases.

Social Support and Weight Outcomes Over A Six-Month Weight Loss Intervention for Rural Older Adults

Rural older adults aged ≥65 years with obesity (body mass index (BMI) ≥30 kg/m2) showed an overall favorable response to a six-month, technology-based weight-management intervention. Our objective was to characterize how friends or family support for eating and exercise behaviors at baseline was associated with baseline weight and intervention response. We analyzed data from six subscales of the Social Support and Exercise Survey from 44 participants. Six-month weight change (≥5% of baseline) was considered clinically-significant. For each subscale, continuous and categorial outcomes were modeled with linear and logistic regression models, respectively, adjusted for sex and age. Crude associations of social support clusters, generated in an exploratory hierarchical cluster analysis, and weight outcomes were evaluated. The sample was 73.2 ± 3.9 years, 73% female, with mean baseline weight 97.8±16.3 kg and BMI 36.5±5.2 m/kg2. Family encouragement for healthy eating was negatively associated with baseline weight (β=-0.53, p=0.046). Social support scores were not associated with either six-month weight loss outcome (p>0.10). Two exploratory clusters were found: Cluster 1 (C1) (n=34) and Cluster 2 (C2) (n=9). C2 had higher mean social encouragement and discouragement, with lower mean baseline weight (90.0±11.7 vs 99.8±16.8kg C1; p=0.10). Weight loss was comparable (C1 4.6±3.7 versus C2 4.8±2.6kg; p=0.89), with no differences in clinically-significant weight loss (C1 45% versus C2 67%; p=0.46). These pilot data suggest that family member social support may act as collaterals to support clinical outcomes in the community. Evaluating different types within family support may elucidate associations with physiological outcomes in larger samples.

Evaluation of Wear Properties of Four Bulk-Fill Composites: Attrition, Erosion, and Abrasion

Purpose. Wear and increased surface roughness are among the reasons for failure of posterior composite restorations. Considering the widespread use of bulk-fill composites in the posterior region, information about their wear resistance is imperative. The aim of this study was to compare the wear and surface roughness of four bulk-fill composite resins with a conventional composite. Methods. Thirty composite discs ( 4 mm × 10 mm ) were fabricated from EverX Posterior (GC), X-tra fil (Voco), Filtek Bulk-Fill Posterior (3M, USA), SonicFill 2 (Kerr), and Z250 (3M) composites. The baseline weight and surface roughness of specimens were measured. For the assessment of the attrition wear, the specimens were placed in a chewing simulator (Mechatronik). pH cycling was performed to erode the composite discs. They were then placed in a tooth brushing simulator machine (Dorsa) for abrasion wear. Finally, the weight and surface roughness of the specimens were measured. Data were compared using one-way ANOVA ( alpha ≤ 0.05 ). Results. One-way ANOVA showed that the mean weight changes were significant after attrition, abrasion, and erosion ( P = 0.019 ), but changes in surface roughness were not significant ( P ≥ 0.05 ). The results of Tukey’s test showed no significant difference between the bulk-fill composites and Z250 regarding weight loss ( P ≥ 0.05 ), but the weight loss of X-tra fil was significantly greater than that of EverX ( P = 0.007 ) and Filtek Bulk-Fill ( P = 0.005 ). Conclusions. Considering the limitations of this study, it appears that the wear and surface roughness of bulk-fill composites are within the acceptable range and are not different from those of a conventional composite.

36-Month Evaluation of a Weight Management Programme in Chinese Overweight and Obese Adults

Background: Few comprehensive lifestyle intervention programmes have been investigated on overweight and obese adults in China. This study was to evaluate the effect of a 36-month weight management programme on weight loss and its maintenance among overweight and obese patients in Ningbo, China.Methods: Adults with BMI ≥24kg/m2 enrolled in this programme, including nutritional, physical activity, psychological and endocrinological counselling sessions, from July 2015 to January 2020. Adults participated in face-to-face counselling sessions and group-based education. Then, participants joined 21-day intensive programme using Bohe health APP and WeChat group to get personal advice of nutrition and lifestyle. In the end, participants were requested to join 33-month follow-ups including face-to-face counselling and personal advice on WeChat group. The main outcome was to evaluate the changes in weight at each followup from baseline weight.Results: In total, 692 adults participated in this entire weight management programme. During follow-ups, 579, 475, 299, 219, and 135 adults participated at 3, 6, 12, 24, and 36 months, respectively. All participants had a significant initial weight loss at 3 months, then maintained the weight loss during 33-month follow-ups. At 36 months, 11.0%, 6.4%, and 3.5% of all participants achieved 5%, 10%, and 15% weight loss from the baseline weight, respectively. Adjusted weight at 36 months was significantly reduced from the baseline weight in both sex (−7.2 kg).Conclusion: This weight management programme is suggested to benefit to reduce initial body weight and maintain long-term weight loss among overweight and obese adults.

Outcomes and predictive factors of weight loss: an evaluative retrospective study in Tunisia

Introduction Morbid over-weight is associated with adverse health outcomes such as cardio-vascular diseases, diabetes, hyperlipidemia, hypertension… Obesity treatment needs special and personalized care. Moderate loss weight from 5% to 10% is beneficial for primary reduction of these disorders. Aim Identify predictive factors of weight loss of at least 5% of baseline weight and describe improvement of metabolic syndrome Methods We performed a retrospective evaluative study in Obesity Research Unit in the National Institute of Nutrition of Tunis from October 2016 to March 2018. We included adult women, whose BMI was > =30 kg/m2. Anthropometric and biological parameters were taken in the first consultation (T0). Then, adequate and personalized care (diet, physical activity, and psychological support) was received. Monthly check-ups were done to detect eventual diet errors. Evaluations were done in 3 and 6 months (T1) and (T2). We performed univariate and then, logistic regression to determine predictive factors of successful loss weight by at least 5%. Results We included 73 obese women. Mean age was 42.63 +/- 11.8 yo. One third of the patients were in menopause. At T0: 83.1% have had a weak physical activity while mean BMI was 39.98 +/- 6.47 kg/m2. Fourteen patients had had hypertriglyceridemia and 43 had hypo-HDLemia. Eighteen were hypertensive. Eighteen were diabetic. At T2: mean weight loss was 5.92 +/- 4.34 kg. Fifty-seven percent of patients have successfully lose more than 5% of their baseline weight. Mean BMI was 37.59 +/- 6.51 Kg/m2. A significant improvement of rates of cholesterol and triglycerides was found. Logistic regression found that predictive factors to weight loss were successful loss weight at 1 month, diminution of TSH hormone and augmentation of Phosphorus intake. Conclusions A large proportion of obese women may be sensitive to moderate weight loss but a further effort is necessary to maintain effective weight loss on long term. Key messages Moderate weight loss is beneficial for health. Personnalized care is required to help obese women.

A systematic review and meta-analysis of brief interventions delivered during antenatal care aimed at promoting energy balance behaviours

BackgroundOptimal energy balance behaviours in pregnancy reduce maternal and foetal risk of obesity. A brief intervention (defined as one that is purposefully limited in frequency and time of contact) delivered by during routine antenatal care may promote health behaviour change. We aimed to assess the effectiveness of brief interventions targeting diet, physical activity (PA) and weight monitoring behaviours in improving gestational weight gain (GWG) and/or energy balance behaviours (diet, PA) during pregnancy.Methods We searched twelve databases for RCT or quasi-RCTs until September 2019. Eligible studies were brief interventions delivered during routine antenatal care, targeting GWG, diet and/or PA behaviours. Controls were either standard antenatal care or more intense lifestyle interventions. Pooled effect sizes were calculated using random-effects meta-analysis. Results were stratified by women’s baseline weight status. The ROB2 tool for risk of reporting bias was applied.ResultsWe identified twelve studies of which nine were eligible for meta-analysis. Meta-analysis showed that brief interventions significantly reduced total GWG by -1.26 kg (95% CI -1.80, -0.73) compared with controls. When reported as a proportion of women exceeding Institute of Medicine GWG guidelines, effects were non-significant (OR 0.99 (95% CI 0.82, 1.19)). Subgroup analysis found greater GWG reductions in women entering pregnancy with overweight or obesity. Study quality was variable; five were ‘high risk’, four ‘some concern’, and three ‘low risk’ for study bias.ConclusionOverall, brief interventions during routine antenatal care can lead to small but significant reductions in GWG. GWG reductions in women with overweight/obesity were more pronounced. Observed effect sizes were of equal magnitude to more resource-intensive antenatal lifestyle interventions. Although there is limited evidence for brief interventions changing diet-related or PA behaviours directly, if delivered during routine antenatal care they may offer a pragmatic strategy to prevent excess GWG.

1019Socioeconomic inequities in 5-year weight trajectories in association with baseline weight-related perceptions: a longitudinal study

Background Recognition of overweight may be a necessary pre-cursor for weight-reduction, but some suggest under-perceiving overweight may be protective against obesity. Differential responses may occur across socioeconomic strata. Methods Five-year body mass index (BMI) trajectories were examined using multilevel models of 8174 participants stratified by gender, neighbourhood socioeconomic circumstances, baseline BMI and perceived weight status, adjusting for potential confounders. Results At baseline, weight-related dissatisfaction and perceived overweight were associated with higher mean BMI, regardless of whether people were classified as ‘normal’ or overweight by WHO criteria. Mean BMI did not decrease among people classified as overweight who perceived themselves as overweight, or expressed weight-related dissatisfaction. Among those with ‘normal’ BMI at baseline but dissatisfied with their weight, mean BMI increased disproportionately among people in disadvantaged areas. Mean BMI also rose disproportionately for people in disadvantaged areas among those feeling overweight, despite having a ‘normal’ BMI, compared to people with the same over-perception but living in affluent areas. Conclusions No evidence was found to suggest accurate recognition of overweight or expressing weight-related dissatisfaction leads to a lower BMI. However, there was evidence of an increase in mean BMI among people who felt dissatisfied with, or over-perceived their ‘normal’ weight, especially in socioeconomically disadvantaged areas. Key messages Correction of under-perceptions may not drive weight loss, but circumstances contributing to over-perception and dissatisfaction with weight status may contribute to increased weight gain and exacerbate socioeconomic inequities in BMI.

Effectiveness of Ready-to-Use Therapeutic Food in Improving the Developmental Potential and Weight of Children Aged under Five with Severe Acute Malnourishment in Pakistan: A Pretest-Posttest Study

The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining >15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p < 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p < 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines.

The Effects of Flaxseed Supplementation On Circulating Adipokines Concentration in Patients With Ulcerative Colitis

Introduction: Inflammatory bowel disease (IBD) is one of the most common gastrointestinal diseases that can affect people of all ages. Adipokines secreted from adipose tissue have been shown to play an important role in the pathogenesis of ulcerative colitis (UC). The aim of this study was to evaluate the effect of supplementation with your seed on the concentrations of adiponectin, resistin and visfatin in patients with UC.Methods: This trial is an open-labeled randomized controlled trial which conducted among 70 patients with UC. Patients were randomly divided into two groups: flaxseed and control. Patients in the intervention were received 30 g/day flaxseed powder for 12 weeks. Anthropometric, nutritional and biochemical factors of patients were evaluated at the beginning and end of the intervention period.Results: Totally, 64 patients (36 men and 28 women) with mean age of 31.12 ± 9.67 included in the final analysis. There wasn’t any significant difference between two groups in term of baseline weight and height (P>0.05). After the 12 weeks' intervention, flaxseed supplementation led to a significant reduction in the resistin (-4.85 ± 1.89 vs. -1.10 ± 2.25, P<0.001) and visfatin concentration (-1.33± 1.14 vs. -0.53 ± 1.63, P=0.018). Moreover, we found a significant increase in the adiponectin levels after the flaxseed supplementation (3.49 ± 1.29 vs. -0.35 ± 0.96, P<0.001).Conclusion: It has been reported in this study that flaxseed supplementation could exert beneficial effects on adipokine levels in patients with UC. Trial registration: IRCT registration no. IRCT20180311039043N1