Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial

The Impact of Sleeve Gastrectomy Combined With Lifestyle Interventions on Anthropometric and Health Outcomes in Adults: A Systematic Review and Meta-Analysis

Weight loss from obesity is a global health concern associated with increased risk of chronic illness and significant healthcare costs. Sleeve gastrectomy is an increasingly popular bariatric surgery option for substantial weight reduction; however, sustained success depends on lifestyle modification. Integrating food, exercise, behavioral, and technology-based interventions into surgery can potentially enhance outcomes and promote weight maintenance. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 guidelines, encompassing randomized controlled trials published between 2014 and 2025. Databases like PubMed, Cochrane Library, Embase, Web of Science, and Scopus were searched. Studies included adults (age ≥18 years) with obesity undergoing sleeve gastrectomy and subjected to post-operative lifestyle interventions. The primary outcomes were weight changes, BMI, and body composition, while the secondary outcomes included comorbidities and quality of life. Risk of bias was assessed using the ROB-2 tool (www.cochrane.org). Thirty-one studies with varying follow-up durations (1-60 months) were included. The combined intervention resulted in greater weight loss (5%-30% decrease), improvement in fat mass, BMI, and cardiometabolic profiles compared to usual care. The meta-analysis revealed a high overall effect size for weight reduction, with a value of 2.56 (2.15-2.88) for the high weight reduction group and 1.88 (1.76-1.91) for the low weight reduction group. Heterogeneity among studies was moderate, with I² values ranging from 18% to 46%, indicating some variation in study populations and intervention effects. Technology-augmented interventions, such as wearable devices and mobile apps, provided additional gains in adherence and long-term efficacy. Long-term weight loss maintenance remained a difficulty. Sleeve gastrectomy combined with structured lifestyle interventions significantly improves anthropometric and health outcomes in adults. Technology-derived interventions and behavioral therapy have the potential for improving long-term weight management, but additional studies are required to optimize intervention approaches.

Sex-Specific Factors Influencing Obesity in Women: Bridging the Gap Between Science and Clinical Practice

Obesity in women is a significant public health issue with serious implications for cardiovascular-kidney-metabolic syndrome and cardiovascular disease. This complex challenge is influenced by physiological, hormonal, socioeconomic, and cultural factors. Women face unique weight management challenges due to hormonal changes during pregnancy, perimenopause, and menopause, which affect fat distribution and increase cardiovascular-kidney-metabolic syndrome risk. Current clinical guidelines often overlook these sex-specific factors, potentially limiting the effectiveness of obesity management strategies in women. This review explores the sex-specific aspects of obesity's pathophysiology, epidemiological trends, and associated comorbidities, focusing on cardiovascular and metabolic complications. This review synthesizes literature on obesity in women, emphasizing sex-specific factors influencing its development and progression. It examines the limitations of body mass index as an obesity measure and explores alternative classification methods. Additionally it investigates the relationship between obesity and comorbidities such as diabetes, hypertension, and dyslipidemia, with a focus on postmenopausal women. Obesity in women is linked to increased risks of cardiovascular-kidney-metabolic syndrome and cardiovascular disease. Hormonal fluctuations throughout life contribute to weight gain and fat distribution patterns specific to women, increasing cardiovascular disease risk. Effective obesity management strategies in women must account for these sex-specific variations. Postmenopausal women are particularly affected by obesity-related complications. Lifestyle interventions, pharmacotherapy, and bariatric surgery have shown efficacy in weight management, though success rates vary. Addressing obesity in women requires a comprehensive approach that considers sex-specific physiological factors, life-stage challenges, and sociocultural barriers. Integrating precision medicine and emerging therapies offers potential for more personalized and effective interventions. Personalized strategies that consider women's biological and life-stage challenges can enhance obesity management and improve cardiovascular outcomes. Future research and clinical practice should focus on developing tailored strategies that address women's unique vulnerabilities to obesity and its associated health risks and on validating sex-specific interventions to improve obesity management in women.

Boosting Dietary Compliance After Bariatric Surgery: Winning Tactics for Patients

BACKGROUND

Bariatric metabolic surgery has emerged as a pivotal intervention for managing obesity, with strict adherence to postoperative nutritional guidelines being paramount for patient outcomes. This study seeks to evaluate dietary compliance levels and the factors that influence them among patients who have undergone bariatric surgery, offering insights to enhance clinical strategies.

METHOD

Our research encompassed patients who underwent bariatric metabolic surgery at our institution from February 2022 to December 2023. We utilised a validated dietary compliance scale to assess how well patients followed postoperative nutritional advice. To determine factors linked to dietary compliance, we conducted Pearson correlation and logistic regression analyses.

RESULTS

The study comprised 176 individuals who underwent bariatric metabolic surgery, with a concerning 60.23% exhibiting inadequate dietary compliance. The Pearson correlation analysis revealed significant correlations between poor dietary compliance and several demographic factors: age (r = -0.516), gender (r = 0.467), educational attainment (r = -0.605) and monthly household income (r = -0.558). Logistic regression analysis confirmed age (OR = -2.157, 95% CI: -3.120 to -1.403), gender (OR = 2.006, 95% CI: 1.821-2.665), education level (OR = -3.081, 95% CI: -4.147 to -1.679), and average monthly family income (OR = -2.847, 95% CI: -3.516 to -1.225) as independent predictors of poor dietary compliance in post-bariatric metabolic surgery patients.

CONCLUSION

The high incidence of poor dietary compliance among patients following bariatric metabolic surgery is a significant concern and is notably influenced by demographic variables such as age, gender, education and economic status. It is imperative for healthcare professionals to consider these variables when developing personalised interventions aimed at improving dietary compliance within this patient group.

Bariatric surgeries and cardiac structure and function: Systematic review and network meta-analysis

BACKGROUND

Obesity, a global health problem, is causally implicated in the development of cardiovascular disease. Bariatric surgeries are effective treatment options for obesity; however, the effectiveness of different bariatric surgeries on cardiac structure and function is not fully understood. We undertook a systematic review and network meta-analysis to comprehensively assess this effectiveness.

DATA SOURCE

PubMed, Web of Science, and EMBASE were searched from their inception until November 11, 2023. Studies that compared bariatric surgeries vis-à-vis non-surgical treatment, placebo, and other bariatric surgeries, as well as reported changes in left ventricular mass or its index (LVM or LVMI) or left ventricular ejection fraction (LVEF), were summarized.

RESULTS

Total 19 studies (17 cohort studies and 2 randomized controlled trials) and 2012 adults were meta-analyzed. Patients receiving gastric bypass had appreciably lowered LVM (weighted mean difference [WMD]: -43.86 g, 95% confidence interval [CI] -61.09 to -26.63, p < 0.01) and LVMI (standardized mean difference: -0.67, 95% CI -1.03 to -0.32, p < 0.01) compared with other bariatric surgeries. No significant improvement in LVEF was noted across all surgeries. The drop in body mass index was most pronounced for biliopancreatic diversion with duodenal switch (WMD -16.33 kg/m2, 95% CI -21.60 to -11.05, p < 0.01).

CONCLUSIONS

Our findings of this network meta-analysis indicated that gastric bypass proved best for the improvement in cardiac structure, and there was no obvious improvement in cardiac function for all bariatric surgeries. Further studies are required to better understand the differing effectiveness of bariatric surgeries on cardiac structure and function and the underlying molecular mechanisms.

Bariatric surgery, through beneficial effects on underlying mechanisms, improves cardiorenal and liver metabolic risk over an average of ten years of observation: A longitudinal and a case-control study

BACKGROUND

Bariatric surgery has long-term beneficial effects on body weight and metabolic status, but there is an apparent lack of comprehensive cardiometabolic, renal, liver, and metabolomic/lipidomic panels, whereas the underlying mechanisms driving the observed postoperative ameliorations are still poorly investigated. We aimed to study the long-term effects of bariatric surgery on metabolic profile, cardiorenal and liver outcomes in association with underlying postoperative gut hormone adaptations.

METHODS

28 individuals who underwent bariatric surgery [17 sleeve gastrectomy (SG), 11 Roux-en-Y gastric bypass (RYGB)] were followed up 3, 6 and 12 and at 10 years following surgery. Participants at 10 years were cross-sectionally compared with an age-, sex- and adiposity-matched group of non-operated individuals (n = 9) and an age-matched pilot group of normal-weight individuals (n = 4).

RESULTS

There were durable effects of surgery on body weight and composition, with an increase of lean mass percentage persisting despite some weight regain 10 years postoperatively. The improvements in metabolic and lipoprotein profiles, cardiometabolic risk markers, echocardiographic and cardiorenal outcomes persisted over the ten-year observation period. The robust improvements in insulin resistance, adipokines, activin/follistatin components and postprandial gastrointestinal peptide levels persisted 10 years postoperatively. These effects were largely independent of surgery type, except for a lasting reduction of ghrelin in the SG subgroup, and more pronounced increases in proglucagon products, mainly glicentin and oxyntomodulin, and in the cardiovascular risk marker Trimethylamine-N-oxide (TMAO) within the RYGB subgroup. Despite similar demographic and clinical features, participants 10 years after surgery showed a more favorable metabolic profile compared with the control group, in conjunction with a dramatic increase of postprandial proglucagon product secretion.

CONCLUSIONS

We demonstrate that cardiorenal and metabolic benefits of bariatric surgery remain robust and largely unchanged ten years postoperatively and are associated with durable effects on gastrointestinal- muscle- and adipose tissue-secreted hormones.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04170010.

Milestones in the journey towards addressing obesity; Past trials and triumphs, recent breakthroughs, and an exciting future in the era of emerging effective medical therapies and integration of effective medical therapies with metabolic surgery

The 21st century is characterized by an increasing incidence and prevalence of obesity and the burden of its associated comorbidities, especially cardiometabolic diseases, which are reaching pandemic proportions. In the late '90s, the "black box" of adipose tissue and energy homeostasis was opened with the discovery of leptin, transforming the adipose tissue from an "inert fat-storage organ" to the largest human endocrine organ and creating the basis on which more intensified research efforts to elucidate the pathogenesis of obesity and develop novel treatments were based upon. Even though leptin was eventually not proven to be the "standalone magic bullet" for the treatment of common/polygenic obesity, it has been successful in the treatment of monogenic obesity syndromes. Additionally, it shifted the paradigm of treating obesity from a condition due to "lack of willpower" to a disease due to distinct underlying biological mechanisms for which specific pharmacotherapies would be needed in addition to lifestyle modification. Subsequently, the melanocortin pathway proved to be an equally valuable pathway for the pharmacotherapy of obesity. Melanocortin receptor agonists have recently been approved for treating certain types of syndromic obesity. Other molecules- such as incretins, implicated in energy and glucose homeostasis- are secreted by the gastrointestinal tract. Glucagon-like peptide 1 (GLP-1) is the most prominent one, with GLP-1 analogs approved for common/polygenic obesity. Unimolecular combinations with other incretins, e.g., GLP-1 with gastric inhibitory polypeptide and/or glucagon, are expected to be approved soon as more effective pharmacotherapies for obesity and its comorbidities. Unimolecular combinations with other compounds and small molecules activating the receptors of these molecules are currently under investigation as promising future pharmacotherapies. Moreover, metabolic and bariatric surgery has also demonstrated impressive results, especially in the case of morbid obesity. Consequently, this broadening therapeutic armamentarium calls for a well-thought-after and well-coordinated multidisciplinary approach, for instance, through cardiometabolic expertise centers, that would ideally address effectively and cost-effectively obesity and its comorbidities, providing tangible benefits to large segments of the population.