Laparoscopic adjustable gastric banding – should a second chance be given?

Background: Obesity is a chronic relapsing-remitting disease and a global pandemic, being associated with multiple comorbidities. Laparoscopic adjustable gastric banding (LAGB) is one of the safest surgical procedures used for the treatment of obesity, and even though its popularity has been decreasing over time, it still remains an option for a certain group of patients, producing considerable weight loss and improvement in obesity-associated comorbidities. Methods: The aim of this study was to evaluate the impact of weight loss following LAGB on obesity-associated comorbidities, and to identify factors that could predict better response to surgery, and patient sub-groups exhibiting greatest benefit. A total of 99 severely obese patients (81.2% women, mean age 44.19 ± 10.94 years, mean body mass index (BMI) 51.84 ± 8.77 kg/m2) underwent LAGB in a single institution. Results obtained 1, 2, and 5 years postoperatively were compared with the pre-operative values using SPPS software version 20. Results: A significant drop in BMI was recorded throughout the follow-up period, as well as in A1c and triglycerides, with greatest improvement seen 2 years after surgery (51.8 ± 8.7 kg/m2 vs 42.3 ± 9.2 kg/m2, p < 0.05, 55.5 ± 19.1 mmol/mol vs 45.8 ± 13.7 mmol/mol, p < 0.05, and 2.2 ± 1.7 mmol/l vs 1.5 ± 0.6 mmol/l). Better outcomes were seen in younger patients, with lower duration of diabetes before surgery, and lower pre-operative systolic blood pressure. Conclusions: Younger age, lower degree of obesity, and lower severity of comorbidities at the time of surgery can be important predictors of successful weight loss, making this group of patients the ideal candidates for LAGB

Older age does not influence the success of weight loss through the implementation of lifestyle modification

Objective Age is sometimes a barrier for acceptance of patients into a hospital‐based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital‐based obesity service. Design Cross‐sectional study in a cohort of randomly selected patients with morbid obesity (n=242), who attended our hospital‐based obesity service during 2005‐2016 and received only lifestyle weight loss interventions. Primary outcome measures were percentage weight loss (%WL) and percentage reduction in Body Mass Index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age<60 years, n=167); group 2 (age≥60 years, n=75). Weight loss was compared between groups and correlations with age at referral were explored. Results The duration of hospital‐based weight loss interventions ranged between 1 and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7kgm‐2 [SD: 8.7] vs 46.9kgm‐2 [SD: 6.1], respectively; P<0.05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; P=NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; P=NS). Overall, there was no significant correlation between patient age at referral and %WL (r=‐0.13, P=NS). Conclusions Older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital‐based obesity service. Therefore, age per se should not influence clinical decisions regarding acceptance of patients to hospital‐based obesity services

Additive fiber-cerclages in proximal humeral fractures stabilized by locking plates: No effect on fracture stabilization and rotator cuff function in human shoulder specimens

Background and purpose The effect of additive fiber-cerclages in proximal humeral fractures stabilized by locking plates on fracture stabilization and rotator cuff function is unclear. Here it was assessed in a human cadaver study

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Self-reported disability in adults with severe obesity

Self-reported disability in performing daily life activities was assessed in adults with severe obesity (BMI ≥ 35 kg/m2) using the Health Assessment Questionnaire (HAQ). 262 participants were recruited into three BMI groups: Group I: 35–39.99 kg/m2; Group II: 40–44.99 kg/m2; Group III: ≥45.0 kg/m2. Progressively increasing HAQ scores were documented with higher BMI; Group I HAQ score: 0.125 (median) (range: 0–1.75); Group II HAQ score: 0.375 (0–2.5); Group III HAQ score: 0.75 (0–2.65) (Group III versus II P < 0.001; Group III versus I P < 0.001; Group II versus I P = 0.004). HAQ score strongly correlated with BMI and age. Nearly three-fourths of the study participants reported some degree of disability (HAQ score > 0). The prevalence of this degree of disability increased with increasing BMI and age. It also correlated to type 2 diabetes, metabolic syndrome, and clinical depression, but not to gender. Our data suggest that severe obesity is associated with self-reported disability in performing common daily life activities, with increasing degree of disability as BMI increases over 35 kg/m2. Functional assessment is crucial in obesity management, and establishing the disability profiles of obese patients is integral to both meet the specific healthcare needs of individuals and develop evidence-based public health programs, interventions, and priorities

Application of mindfulness in a tier 3 obesity service improves eating behaviour and facilitates successful weight-loss

Objective: To demonstrate the clinical utility of mindfulness within a tier 3 obesity service. Methods: Recruitment of participants (n=54, including n=33 completers) from patients attending a tier 3-based obesity service at University Hospitals Coventry and Warwickshire (UHCW). Each participant attended 4 group sessions over 8-weeks, at which mindfulness-based eating behaviour strategies were taught. Self-reported eating behaviour was assessed at baseline and following completion of attendance at the group sessions. Body-weight was measured at baseline and at 4-months following completion of the group sessions. Paired-sample t-tests were performed. A p-value <0.05 was considered significant. Data are reported for the 33 completers. Results: Mean age was 44.4 years (SD 11 years). There was a statistically significant improvement in self-reported eating behaviour (p=0.009), driven by improvements in ‘fast-foodism’ (p=0.031). There was a statistically significant reduction in body-weight (3.1kg [SD 5.2kg], p=0.002) at 4-months following completion of the group sessions. Participants (97%) reported improved self-esteem and confidence in self-management of body-weight. Conclusion: Application of mindfulness-based eating behaviour strategies, taught at group sessions within a tier 3 obesity service, resulted in significant improvement in eating behaviour, and facilitated subsequent weight-loss over 4-months. Such a novel strategy has potential for scalability to the wider obese population