Identifying factors associated with metabolic and weight-loss success following bariatric surgery

Background/Objectives: Bariatric surgery is the most effective treatment for people with severe obesity. In order to maximise the benefit to risk ratio and gain more insights into the pathophysiology of obesity, identifying factors associated with metabolic and weight- loss success after bariatric surgery would be valuable. Methods: Three studies were performed. 1) Association study of pre- and early post- operative (6 weeks) factors with 1-year weight loss after LRYGB and LSG were examined in a prospective cohort of 85 subjects. 2) 13 subjects with T2D remission were compared with matched percentage weight loss (PWL) 13 subjects without remission. Gut hormones, hepatic, pancreatic and visceral fat, insulin sensitivity, beta-cell function and metabolomics were compared between groups. 3) 1,401 patients with severe obesity who were due to undergo primary bariatric surgery were prospectively investigated and genotyped. The GWAS was performed to identify SNPs associated with PWL after surgery. Two genetic risk scores (GRSs) of 941 variants associated with BMI and 49 variants associated with WHR adjusted for BMI (WHRadjBMI) were also constructed to examine the association with PWL. Results: 6-week post-operative PWL, weight change velocity, and PYY parameters were significantly associated with 52-week PWL. The rise in an AUC of postprandial PYY at 6 weeks from pre-surgery less than 16,000 pg x min/mL was connected with 8 times greater chance of being poor weight loss (PWL<20%) at 1 year. T2D remitters had significantly greater beta-cell function, circulating levels of FGF-19 and acyl ghrelin, but lower visceral fat area and plasma branched-chain amino acids (BCAAs) levels than non-remitters. The GWAS revealed 4 significant SNPs (KLF3-rs1491199, MAMDC2-rs2975907, GSAP- rs740158, CASZ1-rs7555879) associated with 52-week PWL. There is a significantly negative association between GRS of WHRadjBMI and PWL at 2 and 3 years. Conclusions: Genetics and 6-week weight loss and PYY parameters could predict the weight loss outcome from bariatric surgery. b-cell function, acyl ghrelin, FGF-19, visceral fat and BCAAs related to T2D remission

Patients' views and experiences of live supervised tele-exercise classes following bariatric surgery during the COVID-19 pandemic: The BARI-LIFESTYLE qualitative study.

The BARI-LIFESTYLE trial is a randomized controlled trial evaluating the efficacy of a post-surgery nutritional and behavioural tele-counselling, and supervised exercise programme to maximize the health benefits of bariatric surgery. Due to the coronavirus disease 2019 (COVID-19) pandemic, the in-person supervised exercise component had to be converted to remote tele-exercise. However, patients' acceptability of this method of exercise provision is unknown. Between 3 and 6 months following bariatric surgery, 13 adults participated in weekly, structured, 60-min supervised exercise classes delivered via Zoom by a trained exercise therapist. A total of 12 participants (n = 8 female), with a mean age of 46.3 (range 33-63) years, who had undergone either sleeve gastrectomy (n = 8) or Roux-en-Y gastric bypass (n = 4) surgery, participated in one-to-one semi-structured interviews following the tele-exercise classes. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Participants described how the tele-exercise classes helped them to cope with the changes to their lives brought about by the COVID-19 pandemic. Participants found the tele-exercise schedule, content and intensity to be acceptable, and were satisfied with the privacy, security and safety of the technology and classes. Professional supervision and guidance from an exercise therapist were described as central to the tele-exercise provision. Importantly, participation in the tele-exercise provided physical, emotional and social benefits. Few participants reported barriers to participation. Overall, the tele-exercise classes were deemed acceptable and compared favourably to in-person exercise classes

Impact of nutritional-behavioral and supervised exercise intervention following bariatric surgery: The BARI-LIFESTYLE randomized controlled trial

Objective: The study's aim was to investigate the impact of a 12-month adjunctive lifestyle intervention on weight loss and health outcomes after bariatric surgery.// Methods: A total of 153 participants (78.4% females; mean [SD], age 44.2 [10.6] years; BMI 42.4 [5.7] kg/m2) were randomized to intervention (n = 79) and control (n = 74). The BARI-LIFESTYLE program combined 17 nutritional-behavioral tele-counseling sessions plus once-weekly supervised exercise for 12 weeks. The primary outcome was percentage weight loss at 6 months post surgery. Secondary outcomes included body composition, physical activity levels, physical function and strength, health-related quality of life, depressive symptomatology, and comorbidities.// Results: Longitudinal analysis of the entire cohort showed significant reductions in body weight, fat mass, fat-free mass, and bone mineral density at the total hip, femoral neck, and lumbar spine (all p  0.05). There was no significant difference in the primary outcome between the intervention versus control (20.4% vs. 21.2%; mean difference = −0.8%; 95% CI: −2.8 to 1.1; p > 0.05) and no between-group differences in secondary outcomes.// Conclusions: An adjunctive lifestyle program implemented immediately after surgery had no favorable impact upon weight loss and health outcomes

Patients' views and experiences of a live supervised tele-exercise programme following bariatric surgery during the COVID-19 pandemic: the BARI-LIFESTYLE qualitative study

Funder: Rosetrees Trust; Id: http://dx.doi.org/10.13039/501100000833Funder: Sir Jules Thorn Trust Biomedical Research AwardFunder: University College London Overseas Research Scholarship (UCL‐ORS)Summary: The BARI‐LIFESTYLE trial is a randomized controlled trial evaluating the efficacy of a post‐surgery nutritional and behavioural tele‐counselling, and supervised exercise programme to maximize the health benefits of bariatric surgery. Due to the coronavirus disease 2019 (COVID‐19) pandemic, the in‐person supervised exercise component had to be converted to remote tele‐exercise. However, patients' acceptability of this method of exercise provision is unknown. Between 3 and 6 months following bariatric surgery, 13 adults participated in weekly, structured, 60‐min supervised exercise classes delivered via Zoom by a trained exercise therapist. A total of 12 participants (n = 8 female), with a mean age of 46.3 (range 33–63) years, who had undergone either sleeve gastrectomy (n = 8) or Roux‐en‐Y gastric bypass (n = 4) surgery, participated in one‐to‐one semi‐structured interviews following the tele‐exercise classes. Interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis. Participants described how the tele‐exercise classes helped them to cope with the changes to their lives brought about by the COVID‐19 pandemic. Participants found the tele‐exercise schedule, content and intensity to be acceptable, and were satisfied with the privacy, security and safety of the technology and classes. Professional supervision and guidance from an exercise therapist were described as central to the tele‐exercise provision. Importantly, participation in the tele‐exercise provided physical, emotional and social benefits. Few participants reported barriers to participation. Overall, the tele‐exercise classes were deemed acceptable and compared favourably to in‐person exercise classes

Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial

Abstract Background/Objectives There have been no studies examining the efficacy of meal replacement (MR) on weight loss and metabolic syndrome (MS) improvement in Southeast Asians. Thus, we undertook a 12-week randomised trial to evaluate the effect of a lifestyle education intervention alone (LEI) or with partial MR (LEI + MR) in obese Thai adults with MS. Subjects/Methods A total of 110 patients were randomised to receive either LEI or LEI + MR. Both groups received LEI to achieve weight loss. LEI + MR group additionally received two MR daily to replace either breakfast, lunch or dinner. Mean ± SE body mass index of all participants was 34.6 ± 0.6 kg/m2, mean ± SE age was 42.5 ± 1.1 years and 83% of patients were female. Both groups were compared for anthropometric and cardiometabolic indices at 12-week. Body weight was also compared at weeks 38 and 64. Results At 12 weeks, both groups exhibited statistically significant percentage weight loss (%WL) compared to initial weight but greater %WL was observed in LEI + MR compared to LEI, 2.9% vs. 1.5%, respectively (p < 0.05). MS criteria such as waist circumference and blood pressure improved significantly in both groups compared to baseline. However, improvement in fasting plasma glucose (FPG) was only significant in LEI + MR, and more participants with impaired FPG at baseline in LEI + MR (42.9%) than LEI (19%) returned to normal FPG at 12 weeks (p < 0.05). HbA1c, fasting insulin and HOMA-IR in LEI + MR were significantly lower than with LEI. At the end of the 12-week intervention period, 16% of participants no longer fulfilled MS criteria. A statistically significant weight loss from baseline persisted until 38 weeks but no longer reached statistically significant difference between groups Conclusions LEI and LEI + MR were acceptable and led to improvement in weight and MS. LEI + MR group exhibited additional weight reduction and glycemic benefits at 12 weeks