Obesity among Latinx people in the United States: A review

Obesity is a serious, chronic disease that is associated with a range of adiposity-based comorbidities, including cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease. In the United States, obesity is a public health crisis, affecting more than 40% of the population. Obesity disproportionately affects Latinx people, who have a higher prevalence of obesity and related comorbidities (such as cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver disease) compared with the general population. Many factors, including genetic predisposition, environmental factors, traditional calorie-dense Latinx diets, family dynamics, and differences in socioeconomic status, contribute to the increased prevalence and complexity of treating obesity in the Latinx population. Additionally, significant heterogeneity within the Latinx population and disparities in health care access and utilization between Latinx people and the general population add to the challenge of obesity management. Culturally tailored interventions have been successful for managing obesity and related comorbidities in Latinx people. Antiobesity medications and bariatric surgery are also important options for obesity treatment in Latinx people. As highlighted in this review, when managing obesity in the Latinx population, it is critical to consider the impact of genetic, dietary, cultural, and socioeconomic factors, in order to implement an individualized treatment strategy

Approach to weight management in patients with advanced chronic kidney disease in a real‐life clinical setting

Abstract Objective Excess adiposity represents a risk factor for chronic kidney disease (CKD) and progression to end‐stage kidney disease. Anti‐Obesity Medications (AOMs) are vastly underutilized in patients with advanced CKD because of concerns related to safety and efficacy. This study was conducted to evaluate the real‐world approach to weight management and the efficacy and safety of AOMs in people with advanced CKD. Methods This is a retrospective analysis of individuals with Body Mass Index (BMI) ≥ 27 kg/m2 and eGFR ≤ 30 mL/min/1.73 m2 referred to an academic medical weight‐management program between 01/2015 and 09/2022. Evaluation of weight‐management approaches, body weight change, treatment‐related side effects, and reasons for treatment discontinuation were reported. Results Eighty‐nine patients met inclusion criteria, 16 were treated with intensive lifestyle modifications (ILM) alone and 73 with AOMs (all treated with glucagon‐like peptide‐1 receptor agonist [GLP1‐RA] +/− other AOMs) along with ILM. Patients treated with AOMs had a longer duration of on‐treatment follow‐up (median 924 days) compared to (93 days) the ILM group. Over 75% of patients treated with AOMs lost ≥5% body weight versus 25% of those treated with ILM. Only 15% of patients treated with AOMs discontinued therapy due to treatment‐related side effects. Conclusion In patients with obesity and advanced CKD, GLP‐1RA‐based anti‐obesity treatment was well‐tolerated, effective, and led to durable weight reduction

Discontinuation and reduction of asthma medications after metabolic and bariatric surgery: A systematic review and meta-analysis

Obesity is a risk factor for asthma. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for obesity. Weight reduction via MBS, in turn, may improve asthma outcomes and decrease the need for asthma medications. The aim of the systematic review and meta-analysis is to explore the available evidence focused on the impact of MBS on the improvement of asthma outcomes via the discontinuation and reduction of asthma medications. After a comprehensive search in the PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, 15 studies, including pre-post MBS data on asthma medication use among adults, were eligible for the systematic review. Thirteen studies reported the proportion of patient who discontinued asthma medication post-MBS and was meta-analyzed using random effects. Results showed 54% patients completely discontinued asthma medications (95% confidence interval 42%-67%, I-2 = 86.2%, p < 0.001). The average number of asthma medications was also decreased by approximately 22%-46%. MBS provides strong therapeutic benefits for patients with asthma, as evidenced by the complete discontinuation of asthma medications in over 50% of MBS completers. The inference was limited by the small number, variations in follow-up time and rates, and heterogeneity of studies. Studies that include more ethnically diverse participant samples are needed to improve generalizability

Immunosuppression and Clostridium difficile Infection Risk in Metabolic and Bariatric Surgery Patients

Immunosuppressant use increases the risk of Clostridium difficile infection. To date no studies have analyzed the relationship between immunosuppressant use and Clostridium difficile infections after metabolic and bariatric surgery. A retrospective analysis of the 2015-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data was conducted. The MBSAQIP data includes information from 854 affiliated practices in the United States and Canada. Initial sample size was 760,076 MBS patients. After excluding participants due to missing variables (n= 188,106) and the use of surgical procedures other than Roux-en-Y gastric bypass and sleeve gastroplasty (n=129,712), final analyses were performed on 442,258 participants. Logistic regression models generated the odds of post-MBS Clostridium difficile infection by immunosuppressant status (+/-). Unadjusted logistic regression analysis showed that patients using immunosuppressants were 95% more likely to have post-operative Clostridium difficile infection (OR=1.945, 95% CI= 1.230 to 3.075; p <0.001) versus MBS patients not taking immunosuppressants. After adjusting for age, gender, ethnicity, pre-operative BMI, diabetes status, and surgery procedure type, the association remained unaffected (aOR=1.956, 95% CI=1.236 to 3.095; p <0.01). Patients who completed the laparoscopic Roux-en-Y gastric bypass procedure had more than double the odds of developing Clostridium difficile infection compared to those who completed the laparoscopic sleeve gastrectomy procedure (OR=2.183, 95% CI=1.842 to 2.587; p < 0.0001). Our results using a population-based sample of MBS patients show that those taking immunosuppressants have significantly higher risk of developing Clostridium difficile infection post-operatively. These findings suggest that patients using immunosuppressants should be closely monitored both pre- and post-procedure

Telehealth utilization among multi-ethnic patients with obesity during the COVID-19 pandemic

Introduction The science of telemedicine has shown great advances over the past decade. However, the field needs to better understand if a change in care delivery from in-person to telehealth as a result of the COVID-19 pandemic will yield durable patient engagement and health outcomes for patients with obesity. The objective of this study was to examine the association of mode of healthcare utilization (telehealth versus in-person) and sociodemographic factors among patients with obesity during the COVID-19 pandemic. Methods A retrospective medical chart review identified patients with obesity from a university outpatient obesity medicine clinic and a community bariatric surgery practice. Patients completed an online survey (1 June 2020–24 September 2020) to assess changes in healthcare utilization modality during subsequent changes in infection rates in the geographic area. Logistic regression analysis examined the association of mode of healthcare utilization and key sociodemographic characteristics. Results A total of 583 patients (87% female, mean age 51.2 years (standard deviation 13.0), mean body mass index 40.2 (standard deviation 6.7), 49.2% non-Hispanic white, 28.7% non-Hispanic black, 16.4% Hispanic, 7% other ethnicity, 33.1% completed bariatric surgery) were included. Adjusted logistic regression models showed older age was inversely associated with telehealth use (adjusted odds ratio = 0.58, 95% confidence interval 0.34–0.98) and non-Hispanic black were more likely to use telehealth compared to non-Hispanic white (adjusted odds ratio = 1.72, 95% confidence interval 1.05–2.81). Conclusions The COVID-19 pandemic is impacting access to healthcare among patients with obesity. Telehealth is an emerging modality that can maintain healthcare access during the pandemic, but utilization varies by age and ethnicity in this high-risk population

Substance use, mental health and weight-related behaviours during the COVID-19 pandemic in people with obesity

Studies have shown the negative impact of COVID-19 lockdown orders on mental health and substance use in the general population. The aim of this study was to examine the impact of the COVID-19 pandemic onsubstance use, mental health and weight-related behaviors in a sample of adults with obesity after lockdown orders were lifted (June-September 2020). A retrospective medical chart review identified patients with obesity from one university-based obesity medicine clinic, and two metabolic and bariatric surgery (MBS) practices. Patients who completed an online survey from June 1, 2020 to September 30, 2020 were included. The primary outcome measure was substance use (various drugs, alcohol, tobacco). Substance use and mental health survey questions were based on standardized, validated instruments. A total of 589 patients (83.3% female, mean age 53.6 years [SD 12.8], mean BMI 35.4 [SD 9.1], 54.5% Non-Hispanic white, 22.3% post-MBS) were included. Seventeen patients (2.9%) tested positive for SARS-CoV-2 and 13.5% reported symptoms. Nearly half (48.4%) of the sample reported recreational substance use and 9.8% reported increased use since the start of the pandemic. There was substantial drug use reported (24.3% opioids, 9.5% sedative/tranquilizers, 3.6% marijuana, and 1% stimulants). Patients who reported stockpiling food more (adjusted Odds Ratio [aOR] 1.50, 95% CI 1.03-2.18), healthy eating more challenging (aOR 1.47, 95% CI 1.01-2.16), difficulty falling asleep (aOR 1.64, 95% CI 1.14-2.34), and anxiety (aOR 1.47, 95% CI 1.01-2.14) were more likely to report substance use versus non-users. Results here show that the COVID-19 pandemic is having a deleterious impact on substance use, mental health and weight-related health behaviors in people with obesity regardless of infection status

Type 2 Diabetes and HbA1c Predict All‐Cause Post‐Metabolic and Bariatric Surgery Hospital Readmission

OBJECTIVE: The main goal of this analysis was to determine if type 2 diabetes and HbA1c predict all-cause 30-day hospital readmission post-metabolic and bariatric surgery (MBS). It was hypothesized that a diagnosis of type 2 diabetes or high HbA1c values would predict all-cause hospital readmission rates post-MBS. METHODS: A retrospective analysis from the 2015–2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) cohort was completed (n= 744,776); 30,972 participants were readmitted during the 30-day post-MBS. RESULTS: Mean age of the MBSAQIP sample was 45.1 (±11.5) years, majority female (80.7%) and non-Hispanic white (59.4%). All-cause hospital readmission rate was 4.2% and increased by 10% in those with uncontrolled type 2 diabetes (HbA1c >7.5% [>58 mmol/mol]); after adjustment, diabetes was not associated with increased re-admission. Uncontrolled type 2 diabetes, type 2 diabetes, and prediabetes resulted in less weight loss 30-day post-MBS. CONCLUSION: Our results based on a national MBS cohort showed that uncontrolled type 2 diabetes is associated with a greater likelihood of all-cause hospital readmission and reduced weight loss 30-day post-MBS. Both, type 2 diabetes and prediabetes were also associated with decreased weight loss 30-day post-MBS. Our findings highlight the need to classify and optimize glycemic control prior to MBS

Impact of the COVID-19 Pandemic on Metabolic and Bariatric Surgery Utilization and Safety in the United States

Background Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for severe obesity. The utilization and health and safety outcomes of MBS in the United States (US) during the COVID-19 pandemic versus 2015–2019 among adolescent and adult populations and by ethnic group is largely unknown. Methods The 2015–2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30-day) cohort data was used to compare adolescent and adult ( N  = 1,134,522) post-operative outcomes and to calculate MBS utilization pre-pandemic (2015–2019) versus pandemic (2020). Cochran-Armitage trend tests compared MBS utilization and safety outcomes over time from 2015 to 2020. Logistic regression analysis compared the odds of hospital readmission and MBS completion pre-pandemic versus pandemic by key characteristics. Results MBS utilization increased by 8.1% among youth (from 970 to 1140 procedures) and decreased by 10.2% among adults (from 205,232 to 167,384) from 2019 to 2020, respectively. MBS increased by 18.5% during the pandemic for youth who identified as other/multiracial ( P trend < 0.001). Among US youth, the number of reoperations and reinterventions significantly decreased over the 6-year time frame ( P trend < .001). Among US adults, 30-day post MBS mortality, reoperations, readmissions, and reinterventions all showed a significant decrease over time ( P trend < .001) while septic shock and sepsis increased from pre-pandemic to the first year of the pandemic ( P trend < 0.001). Conclusion In comparison to 2019 (or to previous years), US MBS utilization increased for youth but decreased for adults during the first year of the COVID-19 pandemic. Safety outcomes were comparable to those of the pre-pandemic years. Graphical abstrac