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Craig HC, Alsaeed D, Heneghan H, Al-Najim W, Al Ozairi E, le Roux CW. Factors that determine patients considering medication for the disease of obesity: an IMI2 SOPHIA study. Int J Obes (Lond) 2024:10.1038/s41366-024-01524-4. [PMID: 38693212 DOI: 10.1038/s41366-024-01524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders. METHODS A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy. RESULTS Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy. CONCLUSION The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.
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Affiliation(s)
- H C Craig
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland.
| | - D Alsaeed
- Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait
| | - H Heneghan
- Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - W Al-Najim
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - E Al Ozairi
- Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait
| | - C W le Roux
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
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Al-Ozairi E, Narula K, Miras AD, Taghadom E, Samad AE, Al Kandari J, Alyosef A, Mashankar A, Al-Najim W, le Roux CW. Obesity Treatments to Improve Type 1 Diabetes (OTID): a randomized controlled trial of the combination of glucagon-like peptide 1 analogues and sodium-glucose cotransporter 2 inhibitors-protocol for Obesity Treatments to Improve Type 1 Diabetes (the OTID trial). Trials 2024; 25:129. [PMID: 38365744 PMCID: PMC10874012 DOI: 10.1186/s13063-024-07930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The guidelines of the American Diabetes Association and European Association for the Study of Diabetes suggest that patients with obesity type 2 diabetics and chronic kidney disease need either glucagon-like peptide 1 receptor analogues or sodium-glucose cotransporter-2 inhibitors. If neither achieve metabolic control, then the recommendation is to combine both drugs. The evidence base for combining glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors is not well researched, and hence, the impact of the guidelines is limited. The aim of this randomized controlled trial is to test the impact of the combination of glucagon-like peptide 1 receptor analogues/sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage, in patients with type 1 diabetes and chronic kidney disease. In addition, we will explore the associated changes in the metabolic pathways with each of the treatments used in this randomized controlled trial. METHODS In this 6-month randomized control trial, 60 participants aged between 21 and 65 years, with a body mass index above 25 kg/m2, and type 1 diabetics with chronic kidney disease will be randomized to receive 1 of 5 possible treatments: (1) standard care (control), (2) glucagon-like peptide 1 receptor analogues alone, (3) sodium-glucose cotransporter-2 inhibitors alone, (4) combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors and (5) combination of glucagonlike peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors with intensive lifestyle advice. The primary objective will be the percentage change in total body weight from baseline at 6 months. The secondary objectives are to compare the change in glycaemia; blood pressure; dyslipidaemia; albuminuria; proportion of participants reaching weight loss of ≥ 5%, ≥ 10% and ≥ 15%; and change in BMI (kg/m2) from baseline and change in waist circumference (cm). All the experiments will be conducted at the Dasman Diabetes Institute after approval from the local research and ethics committee. DISCUSSION The present randomized controlled trial aims to investigate the impact of the combination of glucagon-like peptide 1 receptor analogues and sodium-glucose cotransporter-2 inhibitors on body weight and kidney damage in patients with type 1 diabetes mellitus and chronic kidney disease, as well as exploring the associated changes in the metabolic pathways with each of the treatments used. This study addresses the current gap in the evidence base regarding the combination of these two drugs, which is particularly relevant given the American Diabetes Association and European Association for the Study of Diabetes guidelines recommending their combined use for patients with obesity, type 2 diabetes, and chronic kidney disease who do not achieve metabolic control with either drug alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05390307 Trial registration date - 25th May 2022.
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Affiliation(s)
| | - Kavita Narula
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- School of Medicine, Ulster University, Coleraine, UK
| | - Etab Taghadom
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Jumana Al Kandari
- Dasman Diabetes Institute, Kuwait City, Kuwait
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Anas Alyosef
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Werd Al-Najim
- School of Medicine, Ulster University, Coleraine, UK
- Diabetes Complications Research Centre, Conway Institute, University College of Dublin, Dublin, Ireland
| | - Carel W le Roux
- School of Medicine, Ulster University, Coleraine, UK
- Diabetes Complications Research Centre, Conway Institute, University College of Dublin, Dublin, Ireland
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Grannell A, Al-Najim W, le Roux C. Long-term weight outcomes in patients treated with liraglutide 3.0 mg in real-world clinical practice. Clin Obes 2024; 14:e12622. [PMID: 37615384 DOI: 10.1111/cob.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Long-term weight outcomes reflect the success of obesity treatment. Weight regain during treatment for obesity is a biologically maladaptive response that can be considered a central feature of the disease. This phenomenon has been well documented in patients treated with lifestyle changes and bariatric surgery. In patients treated with liraglutide 3.0 mg this has been documented in randomized control trials, but real-world analysis is lacking. The aim of this retrospective observational study was to explore the long-term weight outcomes in patients treated with liraglutide 3.0 mg in a real-world clinical practice. The association between body composition changes and weight outcomes was also explored. The study included 25 patients treated with multi-modal care that included liraglutide 3.0 mg over a period of 78 weeks. Body composition was examined via dual x-ray absorptiometry at 16 and 32 weeks, with body weight captured up until 78 weeks for all patients. Weight loss (R2 = 0.39, p < .001), fat mass loss (R2 = 0.32, p = .003) and fat-free mass loss (R2 = 0.19, p = .03) were all associated with weight change from artificial nadir, which was, on average, 3.8 kg. For body composition, after adjustment, only fat mass loss was associated weight regain (R2 = 0.32, p = .01). In conclusion, in patients with clinical obesity treated with liraglutide 3.0 mg in a real-world clinical setting, fat mass loss was associated with weight regain. Whilst weight regain occurred on average, the magnitude was less than that observed in patients treated with lifestyle alone and weight loss remained clinically significant for most patients.
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Affiliation(s)
- Andrew Grannell
- Sidekick Health, Medical & Research Department, Kópavogur, Iceland
- UCD Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- UCD Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Carel le Roux
- UCD Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
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Tahrani AA, Panova-Noeva M, Schloot NC, Hennige AM, Soderberg J, Nadglowski J, Tarasenko L, Ahmad NN, Sleypen BS, Bravo R, Al-Najim W, le Roux CW. Stratification of obesity phenotypes to optimize future therapy (SOPHIA). Expert Rev Gastroenterol Hepatol 2023; 17:1031-1039. [PMID: 37791820 DOI: 10.1080/17474124.2023.2264783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Obesity is considered a poor lifestyle choice. 'Obesity' is not a sufficient definition for patients, any more than 'cancer' or 'arthritis' would be. A major obstacle is the lack of understanding of pathogenesis. The disease of obesity is considered homogenous, while response to treatment is thought of as heterogeneous. This can change if pathogenesis, risk profiles for complications, and treatment responses are viewed within the context of obesity consisting of several subsets of disease. AREAS COVERED The European Union-funded Innovative Medicine Initiative project Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy is part of a momentum shift. Operational variables are being used to develop tests and therapies which may allow the prediction of risk of obesities and the prediction of response to obesity treatments. However, changing stakeholder perspectives on obesity may require more than high-quality data and analysis. EXPERT OPINION For patients to benefit, clinicians need to integrate evidence-based treatments and payers need to reimburse the management of the disease of obesity. This will generate commercial opportunities for industry. We need to involve stakeholders (patients, clinicians, regulators, payer, patient organisations) to create a shared value for mutual gain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Werd Al-Najim
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
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Alabduljabbar K, Al-Najim W, le Roux CW. Food preferences after bariatric surgery: a review update. Intern Emerg Med 2023; 18:351-358. [PMID: 36478323 DOI: 10.1007/s11739-022-03157-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
Obesity is a serious and global health problem. The multiple complications of obesity reduce quality of life and increase mortality. Bariatric surgery is one of the best treatment options for obesity management. Bariatric surgery helps people reduce their caloric intake by treating the disease of obesity effectively, in part by increasing signaling from the gut to the brain. The most frequent surgical options are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). There is controversy regarding changes in food preferences and selection after bariatric surgery. In this review, we aim to outline the changes in food intake and selection, clarify the behavior changes in food intake, and assess the potential mechanisms responsible for these changes in patients after bariatric surgery.
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Affiliation(s)
- Khaled Alabduljabbar
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland.
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Aldhwayan MM, Al-Najim W, Ruban A, Glaysher MA, Johnson B, Chhina N, Dimitriadis GK, Prechtl CG, Johnson NA, Byrne JP, Goldstone AP, Teare JP, Le Roux CW, Miras AD. Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner. Nutrients 2022; 14:2141. [PMID: 35631283 PMCID: PMC9145649 DOI: 10.3390/nu14102141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
The duodenal-jejunal bypass liner (Endobarrier) is an endoscopic treatment for obesity and type 2 diabetes mellitus (T2DM). It creates exclusion of the proximal small intestine similar to that after Roux-en-Y Gastric Bypass (RYGB) surgery. The objective of this study was to employ a reductionist approach to determine whether bypass of the proximal intestine is the component conferring the effects of RYGB on food intake and sweet taste preference using the Endobarrier as a research tool. A nested mechanistic study within a large randomised controlled trial compared the impact of lifestyle modification with vs. without Endobarrier insertion in patients with obesity and T2DM. Forty-seven participants were randomised and assessed at several timepoints using direct and indirect assessments of food intake, food preference and taste function. Patients within the Endobarrier group lost numerically more weight compared to the control group. Using food diaries, our results demonstrated similar reductions of food intake in both groups. There were no significant differences in food preference and sensory, appetitive reward, or consummatory reward domain of sweet taste function between groups or changes within groups. In conclusion, the superior weight loss seen in patients with obesity and T2DM who underwent the Endobarrier insertion was not due to a reduction in energy intake or change in food preferences.
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Affiliation(s)
- Madhawi M. Aldhwayan
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland;
| | - Aruchuna Ruban
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (A.R.); (J.P.T.)
| | - Michael Alan Glaysher
- Department of General Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO17 1BJ, UK; (M.A.G.); (J.P.B.)
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK; (B.J.); (A.D.M.)
| | - Navpreet Chhina
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London SW7 2BX, UK; (N.C.); (A.P.G.)
| | | | - Christina Gabriele Prechtl
- Imperial Clinical Trials Unit, Department of Public Health, Imperial College London, London SW7 2BX, UK; (C.G.P.); (N.A.J.)
| | - Nicholas A. Johnson
- Imperial Clinical Trials Unit, Department of Public Health, Imperial College London, London SW7 2BX, UK; (C.G.P.); (N.A.J.)
| | - James Patrick Byrne
- Department of General Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO17 1BJ, UK; (M.A.G.); (J.P.B.)
| | - Anthony Peter Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London SW7 2BX, UK; (N.C.); (A.P.G.)
| | - Julian P. Teare
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK; (A.R.); (J.P.T.)
| | - Carel W. Le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland;
- Centre for Diabetes, Ulster University, BT52 1SA Coleraine, Ireland
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2BX, UK; (B.J.); (A.D.M.)
- Centre for Diabetes, Ulster University, BT52 1SA Coleraine, Ireland
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7
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Ruban A, Miras AD, Glaysher MA, Goldstone AP, Prechtl CG, Johnson N, Chhina N, Al-Najim W, Aldhwayan M, Klimowska-Nassar N, Smith C, Lord J, Li JV, Flores L, Al-Lababidi M, Dimitriadis GK, Patel M, Moore M, Chahal H, Ahmed AR, Cousins J, Aldubaikhi G, Glover B, Falaschetti E, Ashrafian H, Roux CWL, Darzi A, Byrne JP, Teare JP. Duodenal-Jejunal Bypass Liner for the management of Type 2 Diabetes Mellitus and Obesity: A Multicenter Randomized Controlled Trial. Ann Surg 2022; 275:440-447. [PMID: 34647708 PMCID: PMC8820769 DOI: 10.1097/sla.0000000000004980] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the clinical efficacy and safety of the duodenal-jejunal bypass liner (DJBL) while in situ for 12 months and for 12 months after explantation. SUMMARY BACKGROUND DATA This is the largest randomized controlled trial (RCT) of the DJBL, a medical device used for the treatment of people with type 2 diabetes mellitus (T2DM) and obesity. Endoscopic interventions have been developed as potential alternatives to those not eligible or fearful of the risks of metabolic surgery. METHODS In this multicenter open-label RCT, 170 adults with inadequately controlled T2DM and obesity were randomized to intensive medical care with or without the DJBL. Primary outcome was the percentage of participants achieving a glycated hemoglobin reduction of ≥20% at 12 months. Secondary outcomes included weight loss and cardiometabolic risk factors at 12 and 24 months. RESULTS There were no significant differences in the percentage of patients achieving the primary outcome between both groups at 12 months [DJBL 54.6% (n = 30) vs control 55.2% (n = 32); odds ratio (OR) 0.93, 95% confidence interval (CI): 0.44-2.0; P = 0.85]. Twenty-four percent (n = 16) patients achieved ≥15% weight loss in the DJBL group compared to 4% (n = 2) in the controls at 12 months (OR 8.3, 95% CI: 1.8-39; P = .007). The DJBL group experienced superior reductions in systolic blood pressure, serum cholesterol, and alanine transaminase at 12 months. There were more adverse events in the DJBL group. CONCLUSIONS The addition of the DJBL to intensive medical care was associated with superior weight loss, improvements in cardiometabolic risk factors, and fatty liver disease markers, but not glycemia, only while the device was in situ. The benefits of the devices need to be balanced against the higher rate of adverse events when making clinical decisions. TRIAL REGISTRATION ISRCTN30845205. isrctn.org; Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership reference 12/10/04.
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Affiliation(s)
- Aruchuna Ruban
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Michael A Glaysher
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Christina G Prechtl
- Imperial College London, Department of Public Health, Imperial Clinical Trials Unit, London, UK
| | - Nicholas Johnson
- Imperial College London, Department of Public Health, Imperial Clinical Trials Unit, London, UK
| | - Navpreet Chhina
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Werd Al-Najim
- Diabetes Complications Research Center, University College Dublin, Ireland
| | - Madhawi Aldhwayan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Claire Smith
- Imperial College London, Department of Public Health, Imperial Clinical Trials Unit, London, UK
| | - Joanne Lord
- Southampton Health Technology Assessment Center, University of Southampton, Southampton, UK
| | - Jia V Li
- Section of Nutritional research, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
| | - Lilliam Flores
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Moaz Al-Lababidi
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Mayank Patel
- University Hospital Southampton NHS Foundation Trust, Biomedical Research Center, Southampton, UK
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton Medical School, Southampton, UK
| | - Harvinder Chahal
- Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Ghadah Aldubaikhi
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Ben Glover
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Emanuela Falaschetti
- Imperial College London, Department of Public Health, Imperial Clinical Trials Unit, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Carel W le Roux
- Diabetes Complications Research Center, University College Dublin, Ireland
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College, London, UK
| | - James P Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julian P Teare
- Department of Surgery and Cancer, Imperial College, London, UK
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8
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Grannell A, Fallon F, Al-Najim W, le Roux C. Obesity and responsibility: Is it time to rethink agency? Obes Rev 2021; 22:e13270. [PMID: 33977636 DOI: 10.1111/obr.13270] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
Despite obesity declared a disease, there still exists considerable weight stigma in both popular culture and health care, which negatively impacts policy making regarding prevention and treatment. While viewed as a choice or a failure of willpower by many, evidence exists to challenge the argument that both weight gain and failure to achieve weight loss maintenance are the individuals' fault due to personal failure or lack of responsibility. In this article, we draw upon literature from obesity treatment, neuroscience, philosophy of mind, and weight stigma to challenge the commonly held beliefs that individuals are free to choose how much they can weigh, and achievement of long-term weight loss maintenance is completely subject to conscious choice. In reality, the regulation of hunger, satiety, energy balance, and body weight takes place in subcortical regions of the brain. Thus, hunger and satiety signals are generated in regions of the brain, which are not associated with conscious experience. This points towards biological determinism of weight and challenges ideas of willpower and resultant moralization regarding body weight regulation. In this article, we will thus argue that in the context of dysregulation of hunger and satiety contributing to the obesity epidemic, a wider discourse related to personal responsibility and the stigma of obesity is needed to enhance understanding, prevention, and treatment of this complex disease. Obesity is a chronic disease requiring personalized treatment. Lifestyle interventions alone may not be enough to achieve medically significant and sustained weight loss for many individuals with obesity. By understanding that obesity is not due to a lack of motivation or willpower, the availability and utilization of additional treatments or combination of treatments such as lifestyle, pharmacotherapy, and surgery are likely to improve the quality of life for many suffering with this disease.
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Affiliation(s)
- Andrew Grannell
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Finian Fallon
- Department of Psychology, City Colleges, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
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9
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Grannell A, Martin WP, Dehestani B, Al-Najim W, Murphy JC, le Roux CW. Liraglutide Does Not Adversely Impact Fat-Free Mass Loss. Obesity (Silver Spring) 2021; 29:529-534. [PMID: 33528919 DOI: 10.1002/oby.23098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed to examine fat-free mass (FFM) loss between successful responders to lifestyle intervention alone compared with lifestyle intervention plus liraglutide 3.0 mg. An additional objective was to examine the effects of varying resistance training frequencies (days per week) on FFM retention. METHODS This prospective study examined patients with BMI ≥ 35 kg/m2 receiving treatment in a tertiary care obesity clinic. Body composition (dual-energy x-ray absorptiometry) was captured at baseline and after 16 weeks of treatment. Exercise-related data (aerobic minutes per week and resistance training frequency) were captured at week 16. A total of 78 individuals were examined in two groups, the first with lifestyle intervention alone (n = 19) and the second with lifestyle intervention plus liraglutide 3.0 mg (n = 59). Linear mixed-effects models were used to examine between-group differences. RESULTS Compared with lifestyle intervention alone, participants on liraglutide lost more weight (-12.2 kg vs. -9.7 kg, P = 0.048) and FFM (-2.3 kg vs. -1.5 kg, P = 0.06). After controlling for weight loss, there was no difference in FFM loss between groups (0.14 kg/wk vs. -0.09 kg/wk, P = 0.12). Absolute weight loss (kilograms) was associated with FFM loss (kilograms) (ρ = 0.58, P < 0.0001). Exercise did not increase weight loss, and resistance training frequency (days per week) did not attenuate FFM loss. CONCLUSIONS Liraglutide does not have effects on FFM beyond what can be expected from total weight loss. Resistance training did not attenuate FFM loss in the liraglutide or lifestyle-alone groups. To ameliorate FFM loss after liraglutide, a new strategy may be needed that may combine exercise with specific nutritional interventions.
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Affiliation(s)
- Andrew Grannell
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - William P Martin
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Babak Dehestani
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - John C Murphy
- MedFit Proactive Healthcare, Blackrock, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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10
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Glaysher MA, Ward J, Aldhwayan M, Ruban A, Prechtl CG, Fisk HL, Chhina N, Al-Najim W, Smith C, Klimowska-Nassar N, Johnson N, Falaschetti E, Goldstone AP, Miras AD, Byrne JP, Calder PC, Teare JP. The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids. Clin Nutr 2020; 40:2343-2354. [PMID: 33131909 DOI: 10.1016/j.clnu.2020.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Duodenal-jejunal bypass liners (DJBLs) prevent absorption in the proximal small intestine, the site of fatty acid absorption. We sought to investigate the effects of a DJBL on blood concentrations of essential fatty acids (EFAs) and bioactive polyunsaturated fatty acids (PUFAs). METHODS Sub-study of a multicentre, randomised, controlled trial with two treatment groups. Patients aged 18-65 years with type-2 diabetes mellitus and body mass index 30-50 kg/m2 were randomised to receive a DJBL for 12 months or best medical therapy, diet and exercise. Whole plasma PUFA concentrations were determined at baseline, 10 days, 6 and 11.5 months; data were available for n = 70 patients per group. RESULTS Weight loss was significantly greater in the DJBL group compared to controls after 11.5 months: total body weight loss 11.3 ± 5.3% versus 6.0 ± 5.7% (mean difference [95% CI] = 5.27% [3.75, 6.80], p < 0.001). Absolute concentrations of both EFAs, linoleic acid and α-linolenic acid, and their bioactive derivatives, arachidonic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid, were significantly lower in the DJBL group than in the control group at 6 and 11.5 months follow-up. Total serum cholesterol, LDL-cholesterol and HDL-cholesterol were also significantly lower in the DJBL group. CONCLUSION One year of DJBL therapy is associated with superior weight loss and greater reductions in total serum cholesterol and LDL-cholesterol, but also depletion of EFAs and their longer chain derivatives. DJBL therapy may need to be offset by maintaining an adequate dietary intake of PUFAs or by supplementation. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02459561.
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Affiliation(s)
| | - James Ward
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Madhawi Aldhwayan
- Imperial College London, London, UK; Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Helena L Fisk
- School of Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Werd Al-Najim
- Imperial College London, London, UK; Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | - James P Byrne
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip C Calder
- School of Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
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11
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Papamargaritis D, Al-Najim W, Lim J, Crane J, Lean M, le Roux C, McGowan B, O'Shea D, Webb D, Wilding J, Davies MJ. Effectiveness and cost of integrating a pragmatic pathway for prescribing liraglutide 3.0 mg in obesity services (STRIVE study): study protocol of an open-label, real-world, randomised, controlled trial. BMJ Open 2020; 10:e034137. [PMID: 32060156 PMCID: PMC7044994 DOI: 10.1136/bmjopen-2019-034137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In the UK and Ireland, severe and complex obesity is managed in specialist weight management services (SWMS), which provide multicomponent lifestyle interventions to support weight loss, and use of medication if available. Liraglutide 3 mg (LIRA 3 mg) is an effective weight-loss medication, but weight loss in individual patients is variable, and its efficacy has not been assessed in SWMS. This study aims to investigate whether a targeted prescribing pathway for LIRA 3 mg with multiple prespecified stopping rules could help people with severe obesity and established complications achieve ≥15% weight loss in order to determine whether this could be considered a clinically effective and cost-effective strategy for managing severe and complex obesity in SWMS. METHODS AND ANALYSIS In this 2-year, multicentre, open-label, real-world randomised controlled trial, 384 adults with severe and complex obesity (defined as body mass index ≥35 kg/m2 plus either prediabetes, type 2 diabetes, hypertension or sleep apnoea) will be randomised via a 2:1 ratio to receive either standard SWMS care (n=128) or standard SWMS care plus a targeted prescribing pathway for LIRA 3 mg with prespecified stopping rules at 16, 32 and 52 weeks (n=256).The primary outcome is to compare the proportion of participants achieving a weight loss of ≥15% at 52 weeks with a targeted prescribing pathway versus standard care. Secondary outcomes include a comparison of (1) the weight loss maintenance at 104 weeks and (2) the budget impact and cost effectiveness between the two groups in a real-world setting. ETHICS AND DISSEMINATION The Health Research Authority and the Medicines and Healthcare products Regulatory Authority in UK, the Health Products Regulatory Authority in Ireland, the North West Deanery Research Ethics Committee (UK) and the St Vincent's University Hospital European Research Ethics Committee (Ireland) have approved the study. The findings of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov-Identifier: NCT03036800.European Clinical Trials Database-Identifier: EudraCT Number 2017-002998-20.
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Affiliation(s)
- Dimitris Papamargaritis
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Jonathan Lim
- Obesity and Endocrinology Clinical Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - James Crane
- Institute of Diabetes, Endocrinology and Obesity (IDEO), Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mike Lean
- Human Nutrition, University of Glasgow, Glasgow, UK
| | - Carel le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity (IDEO), Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Donal O'Shea
- Department of Endocrinology and Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - David Webb
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - John Wilding
- Obesity and Endocrinology Clinical Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
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12
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Grannell A, Al-Najim W, Mangan A, Kapoor N, Martin WP, Murphy JC, Docherty NG, le Roux CW, Davenport C. Fat free mass is positively associated with hunger and energy intake at extremes of obesity. Appetite 2019; 143:104444. [DOI: 10.1016/j.appet.2019.104444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/07/2019] [Accepted: 09/04/2019] [Indexed: 01/15/2023]
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13
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Ruban A, Prechtl CG, Glaysher MA, Chhina N, Al-Najim W, Miras AD, Smith C, P Goldstone A, Patel M, Moore M, Ashrafian H, Byrne JP, Teare JP. Effectiveness of different recruitment strategies in an RCT of a surgical device: experience from the Endobarrier trial. BMJ Open 2019; 9:e032439. [PMID: 31727662 PMCID: PMC6886935 DOI: 10.1136/bmjopen-2019-032439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recruiting participants into clinical trials is notoriously difficult and poses the greatest challenge when planning any investigative study. Poor recruitment may not only have financial ramifications owing to increased time and resources being spent but could adversely influence the clinical impact of a study if it becomes underpowered. Herein, we present our own experience of recruiting into a nationally funded, multicentre, randomised controlled trial (RCT) of the Endobarrier versus standard medical therapy in obese patients with type 2diabetes. Despite these both being highly prevalent conditions, there were considerable barriers to the effectiveness of different recruitment strategies across each study site. Although recruitment from primary care proved extremely successful at one study site, this largely failed at another site prompting the implementation of multimodal recruitment strategies including a successful media campaign to ensure sufficient participants were enrolled and the study was adequately powered. From this experience, we propose where appropriate the early engagement and investment in media campaigns to enhance recruitment into clinical trials. Trial Registration: ISRCTN30845205.
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Affiliation(s)
- Aruchuna Ruban
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Michael Alan Glaysher
- Division of Surgery, Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Navpreet Chhina
- PsychoNeuroEndocrinology Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Alexander Dimitri Miras
- Division of Diabetes, Endocrinology and Metabolic Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Claire Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - Mayank Patel
- Department of Diabetes and Endocrinology, University Hospital Southampton, Southampton, UK
| | - Michael Moore
- Primary Care Medical Group, University of Southampton Medical School, Southampton, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James P Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, University Hospital Southampton, Southampton, UK
| | - Julian P Teare
- Department of Surgery and Cancer, Imperial College London, London, UK
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14
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Miras AD, Pérez-Pevida B, Aldhwayan M, Kamocka A, McGlone ER, Al-Najim W, Chahal H, Batterham RL, McGowan B, Khan O, Greener V, Ahmed AR, Petrie A, Scholtz S, Bloom SR, Tan TM. Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2019; 7:549-559. [PMID: 31174993 DOI: 10.1016/s2213-8587(19)30157-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many patients with type 2 diabetes do not achieve sustained diabetes remission after metabolic (bariatric) surgery for the treatment of obesity. Liraglutide, a glucagon-like peptide-1 analogue, improves glycaemic control and reduces bodyweight in patients with type 2 diabetes. Our aim was to assess the safety and efficacy of liraglutide 1·8 mg in patients with persistent or recurrent type 2 diabetes after metabolic surgery. METHODS In the GRAVITAS randomised double-blind, placebo-controlled trial, we enrolled adults who had undergone Roux-en-Y gastric bypass or vertical sleeve gastrectomy and had persistent or recurrent type 2 diabetes with HbA1c levels higher than 48 mmol/mol (6·5%) at least 1 year after surgery from five hospitals in London, UK. Participants were randomly assigned (2:1) via a computer-generated sequence to either subcutaneous liraglutide 1·8 mg once daily or placebo, both given together with a reduced-calorie diet, aiming for a 500 kcal per day deficit from baseline energy intake, and increased physical activity. The primary outcome was the change in HbA1c from baseline to the end of the study period at 26 weeks, assessed in patients who completed the trial. Safety was assessed in the safety analysis population, consisting of all participants who received either liraglutide or placebo. This trial is registered with EudraCT, number 2014-003923-23, and the ISRCTN registry, number ISRCTN13643081. FINDINGS Between Jan 29, 2016, and May 2, 2018, we assigned 80 patients to receive either liraglutide (n=53) or placebo (n=27). 71 (89%) participants completed the study and were included in the principal complete-cases analysis. In a multivariable linear regression analysis, with baseline HbA1c levels and surgery type as covariates, liraglutide treatment was associated with a difference of -13·3 mmol/mol (-1·22%, 95% CI -19·7 to -7·0; p=0·0001) in HbA1c change from baseline to 26 weeks, compared with placebo. Type of surgery had no significant effect on the outcome. 24 (45%) of 53 patients assigned to liraglutide and 11 (41%) of 27 assigned to placebo reported adverse effects: these were mainly gastrointestinal and in line with previous experience with liraglutide. There was one death during the study in a patient assigned to the placebo group, which was considered unrelated to study treatment. INTERPRETATION These findings support the use of adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery. FUNDING JP Moulton Foundation.
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Affiliation(s)
- Alexander Dimitri Miras
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Belén Pérez-Pevida
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Madhawi Aldhwayan
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Anna Kamocka
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Emma Rose McGlone
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Werd Al-Najim
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK; Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Harvinder Chahal
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK; Bariatric Centre for Weight Management and Metabolic Surgery and National Institute for Health Research Biomedical Research Centre, University College London Hospital, London, UK
| | - Barbara McGowan
- Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Omar Khan
- Surgery, St George's University Hospitals NHS Trust, London, UK
| | - Veronica Greener
- Diabetes and Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ahmed R Ahmed
- Department of Surgery & Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Aviva Petrie
- Eastman Dental Institute, University College London, London, UK
| | - Samantha Scholtz
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Stephen R Bloom
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Tricia M Tan
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
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15
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Al-Najim W, le Roux CW. Pharmacotherapy in conjunction with lifestyle for the treatment of obesity complications, is it enough? Ann Transl Med 2019; 6:S109. [PMID: 30740430 DOI: 10.21037/atm.2018.11.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland.,Investigative Science, Imperial College London, London, UK
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16
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Abstract
Obesity is an escalating global chronic disease. Bariatric surgery is a very efficacious treatment for obesity and its comorbidities. Alterations to gastrointestinal anatomy during bariatric surgery result in neurological and physiological changes affecting hypothalamic signaling, gut hormones, bile acids, and gut microbiota, which coalesce to exert a profound influence on eating behavior. A thorough understanding of the mechanisms underlying eating behavior is essential in the management of patients after bariatric surgery. Studies investigating candidate mechanisms have expanded dramatically in the last decade. Herein we review the proposed mechanisms governing changes in eating behavior, food intake, and body weight after bariatric surgery. Additive or synergistic effects of both conditioned and unconditioned factors likely account for the complete picture of changes in eating behavior. Considered application of strategies designed to support the underlying principles governing changes in eating behavior holds promise as a means of optimizing responses to surgery and long-term outcomes.
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Affiliation(s)
- Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin , Dublin , Ireland ; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden ; and Investigative Science, Imperial College London , London , United Kingdom
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin , Dublin , Ireland ; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden ; and Investigative Science, Imperial College London , London , United Kingdom
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin , Dublin , Ireland ; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden ; and Investigative Science, Imperial College London , London , United Kingdom
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Abstract
INTRODUCTION Prediabetes is a state wherein blood glucose levels are above normal but below the diagnostic threshold for diabetes. Seventy percent of patients with prediabetes develop type 2 diabetes in their lifetime. Despite this, prediabetes frequently goes undiagnosed. AREAS COVERED This review focuses on the pharmacological treatment of prediabetes and the prevention of progression to diabetes. A literature search was carried out on PubMed and Embase to review randomized controlled trials examining treatment of prediabetes. Emerging pharmacological therapies with potential benefit are discussed. EXPERT OPINION Lifestyle intervention is the cornerstone for preventing progression to diabetes, but metformin remains the first line pharmacological intervention. There appears to be minimal additive effect of combining metformin with lifestyle changes. It would be interesting to assess whether using combination pharmacological approaches plus or minus lifestyle interventions have any additive benefit. Despite the good level of evidence available, the penetrance of any interventions remains very low in part due to the prodromal categorization of the prediabetic state.
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Affiliation(s)
- Aisling Mangan
- a Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences , University College Dublin , Dublin , Ireland
| | - Neil G Docherty
- a Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences , University College Dublin , Dublin , Ireland
| | - Carel W Le Roux
- a Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences , University College Dublin , Dublin , Ireland.,b Medicine Department, Investigative Science , Imperial College London , Dublin , Ireland
| | - Werd Al-Najim
- a Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences , University College Dublin , Dublin , Ireland.,b Medicine Department, Investigative Science , Imperial College London , Dublin , Ireland
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18
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Abdelhafez AH, Taha O, Abdelaal M, Al-Najim W, le Roux CW, Docherty NG. Impact of Abdominal Subcutaneous Fat Reduction on Glycemic Control in Obese Patients with Type 2 Diabetes Mellitus. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Osama Taha
- Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Abdelaal
- Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, United Kingdom
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, United Kingdom
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Neil G. Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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19
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Al-Najim W, le Roux CW, Docherty NG. Integrated insights into the role of alpha-melanocyte stimulatory hormone in the control of food intake and glycaemia. Peptides 2018; 100:243-248. [PMID: 29412826 DOI: 10.1016/j.peptides.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
Identifying peptide hormones with multipotent actions on both weight and glycaemia can have a significant impact on therapeutic options in the treatment of obesity and diabetes. This has been exemplified by recent advances involving pharmacological exploitation of glucagon-like peptide 1 biology. Herein, we summarise evidence supporting the potential candidacy in this light of alpha-melanocyte stimulatory hormone, an endogenous peptide hormone and a breakdown product of the neuropeptide pro-opiomelanocortin. We reference its well described central actions in the control of food intake and moreover highlight new data pointing to an important role for this peptide hormone in the periphery, in relation to glycaemic control.
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Affiliation(s)
- Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Ireland; Investigative Science, Imperial College London, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Investigative Science, Imperial College London, UK
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Ireland; Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
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20
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Glaysher MA, Mohanaruban A, Prechtl CG, Goldstone AP, Miras AD, Lord J, Chhina N, Falaschetti E, Johnson NA, Al-Najim W, Smith C, Li JV, Patel M, Ahmed AR, Moore M, Poulter N, Bloom S, Darzi A, Le Roux C, Byrne JP, Teare JP. A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus. BMJ Open 2017; 7:e018598. [PMID: 29146657 PMCID: PMC5695522 DOI: 10.1136/bmjopen-2017-018598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in the metabolic improvements that occur following bariatric surgery, which are independent of weight loss. Endoscopically placed duodenal-jejunal bypass sleeve devices, such as the EndoBarrier (GI Dynamics, Lexington, Massachusetts, USA), have been designed to create an impermeable barrier between chyme exiting the stomach and the mucosa of the duodenum and proximal jejunum. The non-surgical and reversible nature of these devices represents an attractive therapeutic option for patients with obesity and T2DM by potentially improving glycaemic control and reducing their weight. METHODS AND ANALYSIS In this multicentre, randomised, controlled, non-blinded trial, male and female patients aged 18-65 years with a body mass index 30-50 kg/m2 and inadequately controlled T2DM on oral antihyperglycaemic medications (glycosylated haemoglobin (HbA1c) 58-97 mmol/mol) will be randomised in a 1:1 ratio to receive either the EndoBarrier device (n=80) for 12 months or conventional medical therapy, diet and exercise (n=80). The primary outcome measure will be a reduction in HbA1c by 20% at 12 months. Secondary outcome measures will include percentage weight loss, change in cardiovascular risk factors and medications, quality of life, cost, quality-adjusted life years accrued and adverse events. Three additional subgroups will investigate the mechanisms behind the effect of the EndoBarrier device, looking at changes in gut hormones, metabolites, bile acids, microbiome, food hedonics and preferences, taste, brain reward system responses to food, eating and addictive behaviours, body fat content, insulin sensitivity, and intestinal tissue gene expression. TRIAL REGISTRATION NUMBER ISRCTN30845205, ClinicalTrials.gov Identifier NCT02459561.
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Affiliation(s)
- Michael Alan Glaysher
- Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, Hampshire, UK
| | | | | | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Neuropsychopharmacology Unit, Centre for Psychiatry and Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - Alexander Dimitri Miras
- Division of Diabetes, Endocrinology and Metabolic Medicine, Hammersmith Hospital, London, UK
| | - Joanne Lord
- Southampton HTA Centre, University of Southampton, University of Southampton Science Park, Southampton, UK
| | - Navpreet Chhina
- Computational Cognitive and Clinical Neuroimaging Group, Hammersmith Hospital, Imperial College London, London, UK
| | | | | | - Werd Al-Najim
- Department of Investigative Medicine, Imperial College London, London, UK
- Diabetes Complications Research Centre, Conway Institute, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Claire Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jia V Li
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Mayank Patel
- Department of Diabetes and Endocrinology, Southampton General Hospital, Southampton, UK
| | - Ahmed R Ahmed
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Michael Moore
- Primary Care Medical Group, University of Southampton Medical School, Southampton, UK
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Stephen Bloom
- North West London Pathology, Head of Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Ara Darzi
- Division of Surgery, Imperial College London, London, UK
| | - Carel Le Roux
- Head of Pathology, University College Dublin, Dublin, Ireland
| | - James P Byrne
- Division of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julian P Teare
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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21
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Abstract
PURPOSE OF REVIEW Bariatric surgery is currently the most effective treatment for obesity. Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure and results in long-term weight loss. Alterations in food preference and choices may contribute to the long-term benefits of RYGB. This manuscript reviews the available literature documenting changes in food preference in both humans and experimental animals after RYGB and discusses the current theory on the underlying mechanisms involved. RECENT FINDINGS Obesity is associated with an increased preference for sweet and high-fat foods, and the most consistent evidence has been the shift away from these calorie-dense foods in both animal and human studies after RYGB. Self-reporting is the most common method used to record food preferences in humans, while more direct approaches have been used in animal work. This methodological heterogeneity may give rise to inconsistent findings. Future studies in humans should focus on direct measures to permit corroboration of mechanistic insights gained from animal studies.
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Affiliation(s)
- Natasha Kapoor
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Investigative Science, Imperial College London, London, UK
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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22
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Tan T, Behary P, Tharakan G, Minnion J, Al-Najim W, Albrechtsen NJW, Holst JJ, Bloom SR. The Effect of a Subcutaneous Infusion of GLP-1, OXM, and PYY on Energy Intake and Expenditure in Obese Volunteers. J Clin Endocrinol Metab 2017; 102:2364-2372. [PMID: 28379519 PMCID: PMC5505203 DOI: 10.1210/jc.2017-00469] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/30/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) surgery is currently the most effective treatment of obesity, although limited by availability and operative risk. The gut hormones Glucagon-like peptide-1 (GLP-1), Peptide YY (PYY), and Oxyntomodulin (OXM) are elevated postprandially after RYGB, which has been postulated to contribute to its metabolic benefits. OBJECTIVE We hypothesized that infusion of the three gut hormones to achieve levels similar to those encountered postprandially in RYGB patients might be effective in suppressing appetite. The aim of this study was to investigate the effect of a continuous infusion of GLP-1, OXM, and PYY (GOP) on energy intake and expenditure in obese volunteers. METHODS Obese volunteers were randomized to receive an infusion of GOP or placebo in a single-blinded, randomized, placebo-controlled crossover study for 10.5 hours a day. This was delivered subcutaneously using a pump device, allowing volunteers to remain ambulatory. Ad libitum food intake studies were performed during the infusion, and energy expenditure was measured using a ventilated hood calorimeter. RESULTS Postprandial levels of GLP-1, OXM, and PYY seen post RYGB were successfully matched using 4 pmol/kg/min, 4 pmol/kg/min, and 0.4 pmol/kg/min, respectively. This dose led to a mean reduction of 32% in food intake. No significant effects on resting energy expenditure were observed. CONCLUSION This is, to our knowledge, the first time that an acute continuous subcutaneous infusion of GOP, replicating the postprandial levels observed after RYGB, is shown to be safe and effective in reducing food intake. This data suggests that triple hormone therapy might be a useful tool against obesity.
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Affiliation(s)
- Tricia Tan
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - Preeshila Behary
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - George Tharakan
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - James Minnion
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - Werd Al-Najim
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
| | - Nicolai J Wewer Albrechtsen
- Department of Biochemical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Jens J Holst
- Department of Biochemical Sciences and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Stephen R Bloom
- Division of Diabetes, Endocrinology, and Metabolism, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
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23
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Miras AD, Al-Najim W, Jackson SN, McGirr J, Cotter L, Tharakan G, Vusirikala A, le Roux CW, Prechtl CG, Scholtz S. Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions. Scand J Surg 2014; 104:10-7. [PMID: 25053582 DOI: 10.1177/1457496914543977] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. MATERIAL AND METHODS This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. RESULTS AND CONCLUSIONS Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.
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Affiliation(s)
- A D Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - W Al-Najim
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S N Jackson
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - J McGirr
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - L Cotter
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - G Tharakan
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - A Vusirikala
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - C W le Roux
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - C G Prechtl
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S Scholtz
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
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