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Objective: Adolescents who opt for metabolic and bariatric surgery (MBS) will use the internet to learn about the procedure. The objective of this study is to assess the suitability of electronic patient education materials (ePEM) of North American centers that perform adolescent bariatric surgery. Methods: Canadian and American bariatric centers that perform adolescent MBS were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and Google web-based searches. Suitability of ePEM for the adolescent readership was evaluated using the Suitability Assessment of Materials (SAM). Results: Sixty-five centers were evaluated from June to July 2020 with 41% citing adolescent specific material. Six percent of the ePEM were evaluated as ‘not suitable’, 69% were evaluated as ‘adequate’, and 25% were evaluated as ‘superior’. Conclusion: Adequate ePEM scoring was obtained, but centers had little resources tailored to adolescent patients. Further research is needed to evaluate all the resources provided to adolescents (i.e., resources provided by the health team) to ensure the tools are appropriate for the adolescent readership. Innovation: This environmental scan provided insights to ePEM available for adolescents considering MBS.

Background: The stage of life at the onset of obesity is an important factor in assessing inflammatory state and cardiometabolic risk., Objectives: This study aimed to evaluate the relationship between the obesity onset and the inflammatory profile in women with severe obesity., Setting: Public hospital, Brazil., Methods: Forty-eight women with severe obesity (20-59 yr old) were evaluated according to weight, height, neck circumference (NC), waist circumference (WC), and hip circumference, as well blood metabolic and inflammatory parameters. The participants were grouped according to obesity onset stage of life (early group: ≤19 yr; late group: >19 yr)., Results: The demographic means of the participants were: age of 39.7 years, weight of 122.7 kg and body mass index (BMI) of 48.4 kg/m 2 . The late group presented significantly higher values of leptin (lep)/adiponectin (adipo) ratio and homeostatic model assessment for insulin resistance (HOMA-IR) than the early group. The late group also had a lower adipo/lep ratio. Moreover, the late group showed correlations between the lep/adipo ratio and BMI (r = .460, P = .021), NC (r = .478, P = .016), and WC (r = .535, P = .006). Adipo was also correlated with NC (r = -.418, P = .038), WC (r = -.437, P = .029), and glycated hemoglobin (HbA1C) (r = -.485, P = .019). By contrast, in the early group, the lep/adipo ratio showed correlations with insulin (r = .647, P = .004) and HOMA-B (r = .564, P = .015)., Conclusions: The inflammatory profile is correlated with anthropometric values in women with late-onset obesity. Inflammatory markers seemed to correlate with the glycemic profile in women with early-onset obesity. Furthermore, inflammation was higher in women with late-onset obesity compared to those with early-onset obesity., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Currently, there is no consensus on the best bariatric surgery type for patients with body mass index (BMI) ≥50 kg/m 2 . This systematic review and meta-analysis aimed to compare outcomes of duodenal switch (DS) and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, resolution of obesity-related comorbidities, and complications among patients with a BMI ≥50 kg/m 2 . A systematic search was conducted across databases including PubMed, Embase, Scopus, and Web of Science to include studies that compared outcomes of DS and RYGB in patients with BMI ≥50 kg/m 2 . A meta-analysis was carried out, alongside subgroup analyses based on the type of study and duration of follow-up. Twelve articles were included in this study (2678 patients, follow-up: 1-15 years). Patients with DS had 7.31 kg/m 2 higher BMI loss (95% CI: 5.59-9.03, P < .001) and 9.9% more total weight loss (95% CI: 4.47-15.28%, P < .001) compared with RYGB. The rate of complications, reoperation, mortality, and remission of comorbidities including diabetes, hypertension, dyslipidemia, and obstructive sleep apnea was not significantly different between DS and RYGB. Rate of malnutrition was 8.3% in the DS group compared with 1.2% in RYGB (OR: 5.53, 95% CI: 1.35-22.44, P = .02). In addition, 5.4% DS patients needed revisional surgery for malnutrition versus none in RYGB (OR: 6.1, 95% CI: 1.03-36.33, P = .05), and 24.6% of DS patients developed gallbladder disease needed cholecystectomy versus 4.5% after RYGB (OR: 6.36, 95% CI: 1.70-23.82, P = .01). DS leads to significantly higher BMI and total weight loss in patients with BMI ≥50 kg/m 2 but may be associated with a higher rate of major malnutrition and needed revisional surgery. These should be considered in surgical planning., (Copyright © 2024. Published by Elsevier Inc.)

Background: Obesity, a known independent risk factor for developing malignancy. Additionally, renal transplant recipients (RTR) confer a 2- to 4-fold increased risk of overall malignancies with an excess absolute risk of .7% per year. While transplant recipients are at risk for obesity and malignancy, the effect of bariatric surgery (BS) in the posttransplantation setting is not well known., Objectives: Our study primarily evaluated the impact of BS on cancer incidence in RTR with severe obesity in the posttransplantation setting. Weight loss outcomes were analyzed secondarily., Setting: University Hospital., Methods: A retrospective study using TriNetX database was developed to analyze cancer outcomes in RTR with posttransplantation BS versus RTR without BS from 2000 to 2023. After the exclusion process and propensity matching, both cohorts consisted of 153 patients., Results: RTR-BS had a significantly lower incidence of overall cancer and transplant-related cancers (P < .05). No significant difference was identified in cutaneous, gastrointestinal, and reproductive cancers. Percent Excess Weight Loss (%EWL) was significantly lower in RTR-only cohort (11.4%) versus RTR-BS cohort (57.8%) at 5 years. Sleeve gastrectomy (SG) patients (73.19%) had significantly higher %EWL than Roux en-Y gastric bypass (RYGB) patients (49.33%) at 3 years. No difference in cancer incidence was noted between SG and RYGB patients., Conclusion: Postrenal transplantation BS had a diminishing effect on overall and transplant-related cancer incidence in RTR with severe obesity. Significant weight loss was also demonstrated with post-renal transplantation BS., (Published by Elsevier Inc.)

This study examined the prevalence of obesity and severe obesity among Mississippi K-12 public school students and the obesity rate differences within subgroups categorized by sex, race, and grade level. Anthropometric data from a weighted, representative sample of Mississippi public school students were collected through the biennial Child and Youth Prevalence of Obesity Survey (CAYPOS). Overall prevalence rates and those of the subgroups were calculated and compared. The 2017 data indicated that overall 23.7% of Mississippi public schools students met the criterion of class I obesity, 9.1% met the criterion of class II obesity, and 3.2% met the criterion of class III obesity. Among those with severe obesity, the prevalence was significantly higher among black students (10.9%) when compared to their white counterparts (7.3%) (p

Patients undergoing metabolic and bariatric surgery (MBS) with body mass index (BMI) ≥ 70 kg/m 2 are considered a high-risk group. There is limited literature to guide surgeons on the perioperative safety as well as the different procedural outcomes of MBS in this cohort. Our aim is to compare the safety profiles, early- and medium-term outcomes of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) in patients with BMI ≥ 70 kg/m 2 . A total of 156 patients with BMI ≥ 70kg/m 2  underwent MBS (SG = 40, RYGB = 40, and DS = 76). Mean baseline BMI was 75.5 kg/m 2 . Total weight loss (%TWL) at 24 months was highest in the DS group compared to RYGB (40.6% versus 33.8%, P value = .03) and SG (40.6% versus 28.5%, P value = .006). There was no significant difference in %TWL between RYGB and SG (33.8% versus 28.5%, P value = .20). The 30-day complication rates were similar [SG (7.5%), RYGB (10%), and DS (9.2%) (P value = 1.0)]. There was one reported leak (DS). The 30-day mortality was zero. MBS is safe and effective in patients with BMI ≥ 70 kg/m 2 . All procedures had comparable safety profiles and complication rates. While DS achieved the highest %TWL at 24 months, similar comorbidity resolution rates among the procedures attenuate its clinical significance., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The long-term effect of bariatric surgery on adolescent non-alcoholic fatty liver disease is not clear., Objectives: To evaluate longitudinal change in serum alanine aminotransferase (ALT) levels and to determine the factors independently associated with this change over 2 years after bariatric surgery in adolescents with severe obesity., Setting: An observational prospective cohort from the Teen-LABS Consortium., Methods: We examined the relationship of longitudinal change in serum ALT (% change and normalization) to change in body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides (TG), high- (HDL) and low-density lipoprotein cholesterol, A1C and fasting glucose, accounting for age, sex, race-ethnicity, blood pressure, and baseline BMI in 219 adolescents during the first 2 years post-surgery., Results: Mean BMI declined from a baseline of 52.6 to 37.2 kg/m 2 at 2 years (P < .01). Alanine aminotransferase decreased significantly from baseline (36.5 [95% CI: 31.4, 41.7]) to 6 months (30.5 [95% CI: 25.4, 35.6]), and remained stable at 12 and 24 months, all P < .01 versus baseline. After adjustment, improvement in BMI, fasting glucose, HOMA-IR, triglycerides, TG/HDL ratio, and HDL were independently associated with reduced ALT at 6 months. These remained significantly associated with a decline in ALT after adjusting for BMI change. The %participants with elevated ALT decreased from 71% at baseline to 42% and 36% at 1 and 2 years post-surgery., Conclusions: Bariatric surgery resulted in significant and sustained improvement in ALT levels over 2 years. Although associated with weight loss, this decline was also associated with improved metabolic indices, independent of weight loss., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. All rights reserved.)

Purpose: Bariatric surgery is regarded as a valuable treatment option for adolescents with severe obesity. However, high-quality evidence of its superiority over prolonged conservative treatment with multidisciplinary lifestyle intervention (MLI) is limited. This study investigated the efficacy and safety of bariatric surgery in adolescents without sufficient weight loss after MLI for severe obesity., Methods: A two-group randomized controlled trial was designed to assess one-year health effects of bariatric surgery in adolescents with severe obesity. The participants were referred by pediatricians after completing MLI without sufficient effects. Eligible for participation were adolescents aged 14-16 years with severe obesity (age- and sex-adjusted body mass index (BMI) using the International Obesity Task Force cutoffs: BMI ≥40 kg/m 2 , or ≥35 kg/m 2 in combination with comorbidity). Participants were assigned to MLI combined with laparoscopic adjustable gastric banding (n = 29) versus only MLI (n = 30). Participants were included from 2011 to 2019. Main outcomes were weight change and sex- and age-specific BMI loss. Additionaly, glucose metabolism, blood pressure and lipid profile were analysed., Results: 53 patients completed the 12-months follow-up (89.8%). Mean (±standard deviation [SD]) weight loss in the surgery group was 11.2 ± 7.8% after 12 months, compared to a weight gain of 1.7 ± 8.1% in the control group. The fasting insulin, insulin resistance score and lipid profile improved significantly in the surgery group., Discussion: Bariatric surgery was associated with substantial weight loss and improvements in glucose and lipid metabolism after 12 months compared to conservative treatment in adolescents with severe obesity., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The rate of suicide is higher among individuals following bariatric surgery compared with the general population; however, it is not clear whether risk is associated with bariatric surgery beyond having severe obesity., Objective: To compare the risk of a suicide attempt among those who had bariatric surgery versus a nonsurgical cohort with severe obesity., Setting: Aggregate count data were collected from 5 healthcare systems., Methods: Individuals were identified in the surgical cohort if they underwent bariatric surgery between 2009 and 2017 (n = 35,522) and then were compared with a cohort of individuals with severe obesity who never had bariatric surgery (n = 691,752). Suicide attempts were identified after study enrollment date using International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnosis codes from 2009 to 2021., Results: The relative risk of a suicide attempt was 64% higher in the cohort with bariatric surgery than that of the nonsurgical cohort (2.2% versus 1.3%; relative risk = 1.64; 95% CI, 1.53-1.76). Within the cohort with bariatric surgery, suicide attempts were more common among the 18- to 39-year age group (P < .001), women (P = .002), Hawaiian-Pacific Islanders (P < .001), those with Medicaid insurance (P < .001), and those with a documented mental health condition at baseline (in the previous 2 years; P < .001)., Conclusions: The relative risk of suicide attempts was higher among those who underwent bariatric surgery compared with a nonsurgical cohort, though absolute risk remained low. Providers should be aware of this increased risk. Screening for suicide risk after bariatric surgery may be useful to identify high-risk individuals., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Severe obesity could be an independent risk factor for peripheral artery disease (PAD) and critical limb ischemia (CLI). Bariatric surgery reduces cardiac risk factors, decreasing cardiovascular morbidity and mortality in subjects with severe obesity., Objectives: We aimed to describe the impact of bariatric surgery on risk of hospitalization due to PAD and CLI., Setting: Academic hospital., Methods: The National Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment was defined as patients with a previous history of bariatric surgery, and control was defined as patients with a body mass index ≥35 without a history of bariatric surgery. The primary outcome was hospitalization due to PAD; secondary outcomes were CLI, revascularization, major amputation, length of hospital stay (LOS), and total cost of hospitalization. Univariate and multivariate analyses were performed to assess the differences between groups., Results: There were a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatment patients. Hospitalization rate for PAD was significantly lower compared to the control group (.10% versus .21%, P < .0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio= 1.20, confidence interval: 1.15-1.47). Subgroup analysis showed patients without a history of bariatric surgery had a higher prevalence of CLI (59.3% versus 52.4%, P < .0219) and a higher mean LOS (6.7 versus 5.7 days, P = .0023) and cost of hospitalization (78.756 versus 72.621$, P = .0089), with no significant differences in other outcomes. After multivariate analysis, only LOS and total costs were significantly different., Conclusions: Bariatric surgery may decrease the risk of hospitalization due to PAD, similarly to the LOS and total cost of hospitalization. Prospective studies should be performed to describe this relationship., (Copyright © 2023. Published by Elsevier Inc.)

Background: The long-term results after biliopancreatic diversion (BPD) in patients with type 2 diabetes (T2D) and severe obesity is still being debated., Objective: Retrospective evaluation of the long-term metabolic and clinical conditions of patients with T2D following BPD., Setting: University hospital., Methods: A total of 173 patients with T2D and severe obesity were investigated prior to and at 3-5 and 10-20 years after BPD. Anthropometric, biochemical, and clinical findings preoperatively and throughout follow-up were considered. The long-term data were compared with those of a cohort of 173 T2D patients with obesity treated with conventional therapy., Results: T2D resolved within the first postoperative phases in most patients, and in the long and very long term, the fasting blood glucose level remained above the normal range in only 8% of patients. Likewise, a stable improvement of blood lipid pattern was observed (follow-up rate 63%). In contrast, in nonsurgical patients in the long term, the glucose and lipid metabolic parameters remained in the pathologic range in all cases. In the BPD group, a very high number of severe BPD-related complications was recorded, and 27% of the BPD patients died, whereas in the control group, 87% of patients were still alive at the end of the follow-up period (P < .02)., Conclusion: Despite the high T2D stable resolution rate and the normalization of most metabolic data at 10-20 years following surgery, these results indicate that BPD should be indicated with caution in the surgical treatment of T2D in patients with severe obesity., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Iron deficiency (ID), a known complication after metabolic surgery, is common among preoperative patients in the presence of inflammation. Evidence is now accumulating that preoperative ID may adversely affect perioperative outcomes., Objectives: To investigate the relationship between preoperative iron status and the risk of postoperative severe anemia. In addition, this study investigates the relationship between preoperative iron status and length of surgical stay SETTING: A large regional tertiary health system., Methods: Among patients who underwent metabolic surgery between 2004 and 2020, 5171 patients had a full iron nutritional assessment prior to surgery. Study patients were divided into multiple smaller groups (10 female groups and 7 male groups) on the basis of levels of serum ferritin and Transferrin Saturation (T Sat) < or ≥20%. Study patients were followed after surgery and the time to the development of severe anemia (hemoglobin < 8 gm/dL) was recorded. Hospital length of stay (LOS) was analyzed in relation to preoperative iron status., Results: Lower ferritin levels were associated with older age in males (P = .0001) and younger age in females (P < .0001). For males, after adjustment for age, body mass index (BMI), and year of surgery, surgical LOS was prolonged in those with T Sat <20% (P = .0041). For females the time until the development of severe anemia was associated with baseline iron status (P < .0001)., Conclusions: Male preoperative patients for metabolic surgery with T Sat <20% are at risk for increased surgical LOS. Females with low ferritin levels consistent with ID are at increased risk for the development of postoperative severe anemia., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Estimates of health care costs associated with severe obesity, and those attributable to specific health conditions among adults living with severe obesity are needed., Methods: Administrative data was used to identify adults who previously received a procedure, and had (investigational cohort) or did not have (control cohort) a body mass index ≥ 35 kg/m 2 . Two-part models were used to estimate the incremental health care cost of severe obesity and related health conditions during a 1-year observation period., Results: Adjusting for potential confounders, the total health care cost ratio was higher in the investigational (n = 220,190) versus control (n = 1,955,548) cohort (1.32 [95 % CI: 1.32, 1.33]) with a predicted incremental cost of $2221 (95 % CI $2184, $22,265) per person-year; costs were less when obesity-related health conditions were controlled for (1.13 [95 % CI: 1.13, 1.14]; $1097 [95 % CI: $1084, $1110] per person-year). Among those living with severe obesity, incremental costs associated with specific health conditions ranged from $737 (95 % CI: $747, $728) lower (dyslipidemia) to $12,996 (95 % CI: $12,512, $13,634) higher (peripheral vascular disease) per person-year., Conclusions: Adults living with severe obesity had greater costs than those without, largely driven by obesity-related health conditions. For the Alberta adult population with a severe obesity prevalence of 11 %, severe obesity may account for an estimated additional $453-918 million in health care costs per year. Findings of this study provide rationale for resources and strategies to prevent and manage obesity and its complications., Competing Interests: Declaration of Competing Interest The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: HL, KM, TW, and SK are members (AG was a member) of the Alberta Real World Evidence Consortium, and academic entity that conducts research including investigator-initiated industry-funded studies. No other conflict of interest was declared. All authors of this study had complete autonomy over the content and submission of the manuscript, as well as the design and execution of the study., (Copyright © 2023. Published by Elsevier Ltd.)

Background: The stomach, intestinal, and pylorus-sparing (SIPS) procedure is a single-anastomosis duodeno-intestinal bypass used in obesity management., Objective: Weight and metabolic outcomes in patients with severe obesity who underwent the SIPS procedure were evaluated in a community hospital-based study., Setting: Community hospital., Methods: This single-site prospective study of patients who underwent the SIPS procedure evaluated outcomes at 12 and 24 months. Mean changes in total weight loss and body mass index (BMI) and resolution of gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), hypertension, type 2 diabetes (T2D), and hyperlipidemia were evaluated., Results: At baseline, 185 patients were enrolled; mean weight and BMI were 144.0 kg and 52.2 kg/m 2 , respectively. Data for 88 (47.6%) and 29 (15.7%) patients who completed follow-up at 12 and 24 months, respectively, were available. At 12 months, mean total weight loss was 35.6% (weight reduction of 51.3 kg) and BMI reduction of 17.8 points were achieved and were maintained for the 29 patients who completed 24-month follow-up. No leaks or infections occurred. Complications occurred in 8 patients (.4%) and were not serious. Resolution of GERD, OSA, hypertension, T2D, and hyperlipidemia achieved in 87.1%, 59.2%, 32.7%, 93.1%, and 87.6% of patients, respectively, at 12 months was maintained at 24 months. Nutritional deficiency was absent., Conclusions: Patients who underwent the SIPS procedure had meaningful reductions in weight and BMI, and many had resolution of metabolic co-morbidities; procedural complication rates were low. Our results support that the SIPS procedure is a safe and effective primary treatment for clinically severe obesity in a community-based hospital setting., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults., Objective: We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery., Setting: Academic hospital, United States., Methods: Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment)., Results: A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group., Conclusions: After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results., (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

We examined 12 monogenic obesity genes in 72 Portuguese individuals with overweight and obesity (class 1 and class 2), some of which with suspected genetic obesity, to identify known or unknown potential obesity variants. Genomic DNA was analyzed for variants in genes LEP, LEPR, MC4R, POMC, PCSK1, BDNF, NTRK2, SIM1, SH2B1, UCP3, GCG and ADCY3 through next generation sequencing (NGS). The impact of the rare variants was investigated in the ClinVar database and using in silico tools for prediction of pathogenicity. Four potential pathogenic missense variants were detected at the heterozygous state in five individuals: two in the ADCY3 gene, NM&#95;004036.5:c.1153G > A (p.Val385Ile) (rs756783003) and NM&#95;004036.5:c.1222G > A (p.Gly408Arg) (rs201606553), one in gene SH2B1, NM&#95;001145795.1:c.127C > A (p.Arg43Ser) (rs547678855), and the fourth in gene POMC NM&#95;000939.4:c.706C > G (p.Arg236Gly) (rs28932472), which was found in two individuals. Moreover, six rare variants near splicing sites were also identified, as well as eight rare synonymous variants. In summary, some potential pathogenic rare missense variants were identified, two of them in ADCY3 gene, the most recently identified gene as having a role in monogenic obesity. Further analysis should be performed to confirm the clinical relevance of these variants., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objective: With the rate of obesity increasing worldwide, patients with lymphoedema with and without a concomitant diagnosis of severe obesity (SO) were compared in regard to their baseline demographics, health related characteristics, treatment plans, and patient outcomes., Methods: This was a retrospective observational cohort study. The IBM MarketScan database was examined (2013 - 2019) for patients with a new diagnosis of lymphoedema. Of 60 284 patients with lymphoedema identified, 6 588 had SO defined by a body mass index > 40 kg/m 2 . The demographics and other characteristics of SO were compared with patients with lymphoedema without SO., Results: SO and lymphoedema diagnosis increased two fold from 2013 to 2019. The lymphoedema SO+ group was younger (57.8 vs. 60.8 years, p < .001) and with a higher proportion of men (37.7% vs. 24.9%, p < .001) than the lymphoedema SO- group. More comorbidities were observed in the lymphoedema SO+ group than the lymphoedema SO- group: diabetes 46.0% vs. 24.9 % (p < .001), heart failure 18.3% vs. 7.4% (p < .001), hypertension 75.0% vs. 47.6% (p < .001), and renal disease 24.8% vs. 11.9% (p < .001). Use of diuretics in the lymphoedema SO+ group was greater: 57.6% vs. 38.0% (p < .001). Patients with lymphoedema SO+ had higher risk of cellulitis: 34.5% vs. 13.5% (p < .001). Specific lymphoedema treatment was given more often to lymphoedema SO-: 66.3% vs. 64.3% (p = .003). This was significant for manual lymphatic drainage (46.6% vs. 40.0%; p < .001) and physical therapy (55.4% vs. 51.6%; p<.001), but not for compression garments (18.2% vs. 17.7%; p = .38). However, more patients with lymphoedema SO+ received pneumatic compression device treatment: 20.9% vs. 13.7% (p < .001)., Conclusion: There was an increase in SO associated lymphoedema. Patients with lymphoedema SO+ have over a two and half fold increase in cellulitis incidence, with a significant increase in medical resource use and cost. Despite this, patients with lymphoedema and SO receive less specific therapy such as compression, which has proven to reduce cellulitis incidence., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Obesity can worsen outcomes in patients with chronic respiratory diseases., Objectives: The objective of the study was to determine the impact of bariatric surgery (BaS) on risk of hospitalization due to acute exacerbation (AE) of chronic obstructive lung diseases (OLDs)., Setting: Academic, University-affiliated Hospital; United States., Methods: Nationwide Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a previous history of BaS, and control subjects, as patients with a body mass index ≥35 kg/m 2 and without a history of BaS. The primary outcome was hospitalization due to AE of any OLD (chronic obstructive pulmonary disease, asthma, and bronchiectasis), and the secondary outcome was the total length of stay (LOS). Univariate analysis and multivariate regression model were performed to assess the difference in outcomes between groups., Results: We included a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatments. Univariate analysis showed that the hospitalization rate was significantly lower for the treatment group than that for the control group (3.7% versus 9.8%, P < .0001), confirmed after adjusting for covariates (control versus treatment: odds ratio [OR] = 2.46, P < .0001). Subgroup analysis showed that the treatment group had a lower risk of LOS ≥3 days than controls (69.8% versus 77.4%, P < .0001), confirmed by multivariate analysis (control versus treatment: OR = 1.40, P < .0001)., Conclusions: BaS-induced weight loss may decrease the risk of hospitalization due to AE in patients with OLD, also decreasing the LOS. We acknowledge that this comparison is limited by the nature of the database; hence, further prospective studies are needed to better understand these results., (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies have demonstrated stronger associations between metabolic alterations and neck circumference (NC) than with body mass index (BMI) or waist circumference (WC). However, most of these studies were performed in individuals presenting overweight or mild obesity., Objective: To determine which adiposity index among BMI, WC, NC and fat mass (FM) can best predict metabolic alterations in men and women presenting severe obesity., Methods: Anthropometric and plasma biochemical parameters were measured in 81 participants presenting severe obesity (19 men, 62 women; age: 44.5 ± 8.9 years; BMI: 43.5 ± 4.1 kg/m 2 ). Multiple linear regressions were used to determine the best predictors of metabolic alterations among each adiposity index., Results: NC was positively correlated with fasting insulin concentrations, C-peptide concentrations and HOMA-IR values and negatively correlated with HDL-C concentrations. NC was the best predictor of glucose homeostasis indices and HDL-C concentrations in models also including sex, BMI, WC, and FM. The ROC curve analysis indicated that a NC ≥ 37.8 cm best predicted type 2 diabetes., Conclusions: NC seems a better predictor of insulin resistance and lower HDL-C concentrations in patients presenting severe obesity compared to other standard anthropometric indices, and particularly in women. The small sample size in men prevent us to draw clear conclusions. NC could be useful in targeting patients with metabolic alterations who could benefit from medical or surgical treatment of obesity., (Copyright © 2022 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Background: Obesity independently increases the risk of hospitalization due to viral respiratory infections, including influenza virus and, more recently, severe acute respiratory syndrome coronavirus 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations., Objectives: Using influenza as a proxy, we aimed to determine the impact of bariatric surgery (BaS) on the risk of hospitalization due to viral respiratory infections., Setting: Academic hospital, United States., Methods: National (Nationwide) Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a history of BaS and control subjects as patients with a body mass index ≥35 kg/m 2 and without a history of BaS. Any hospitalization with influenza as a primary diagnosis was identified. Univariate analysis and multivariate regression models were performed to assess the differences between groups., Results: A total of 2,300,845 subjects were reviewed, of which 2,004,804 were control subjects and 296,041 were treated patients. Univariate analysis showed that the hospitalization rate in the treatment group was significantly lower than in the control group (.007% versus .019%, P < .0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio = 2.21, P = .0010)., Conclusions: BaS may decrease the risk of hospitalization due to influenza, but further prospective studies are needed to confirm these results. We also suggest that these results should be translated into the development of similar studies to determine the impact of BaS on the incidence and severity of the coronavirus disease 2019., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The presence of chronic low-grade inflammation, commonly identified in patients with severe obesity, alters iron homeostasis and indicators of iron status, fostering the development of updated guidelines for the diagnosis of iron deficiency (ID). Current recommended diagnostic thresholds for ID in obesity derived from expert opinion include a ferritin level of <30 ng/mL and/or transferrin saturation (TSAT) < 20%. Earlier studies of ID among candidates for metabolic surgery using low levels of ferritin or iron as diagnostic thresholds demonstrated a prevalence of 5%-20%., Objectives: Using the current recommended diagnostic thresholds for ID, this study measures the prevalence of ID in a large cohort of surgical candidates and its relationship to surgical outcomes., Setting: Geisinger Medical Center, Danville, Pennsylvania., Methods: The study cohort included 3,723 patients who underwent pre- operative nutritional assessment which included markers of iron nutrition over the period 2004-2018., Results: The cohort included 2,988 women (80.3%) and 735 men (19.7%); body mass index: 49.4 ± 9 kg/m 2 . The diagnosis of ID was based on ferritin level <30 ng/mL (true ID) and/or TSAT < 20% representing a combination of true ID and inflammation (serum ferritin ≥ 30 ng/mL and TSAT < 20%). A total of 399 patients (10.8%) were anemic. A serum ferritin level of < 30 ng/mL was found in 488 patients (13%; 481 women and 7 men). Of these, 122 patients (25.2%) were also anemic. An additional 1,204 had serum ferritin ≥ 30 ng/mL and TSAT < 20%. Overall, 1,692 patients (45.4%) in this cohort had laboratory evidence of ID by current criteria that adjusts for the very high prevalence of inflammation. Men with serum ferritin levels ≥30 ng/mL with TSAT < 20% had an increased surgical length of stay., Conclusion: The prevalence of ID among surgical candidates (45.4%) is more than twice that identified as ID in earlier studies. ID was commonly identified in the absence of anemia. The most severe ID was found in those with a serum ferritin level <30 ng/mL and TSAT < 20%. ID in the presence of inflammation is often unrecognized and has implications regarding surgical outcomes after metabolic surgery., (Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Change in short-term (i.e., 10-year) and lifetime risk of cardiovascular disease (CVD) following Roux-en-Y gastric bypass (RYGB) has significant heterogeneity., Objective: To identify predictors of change in CVD risk and cardiovascular events following RYGB., Methods: Between 2006-2009, 1625 adults without a history of CVD enrolled in a prospective cohort study and underwent RYGB at 1 of 10 U.S. hospitals. Participants were followed annually for a maximum of 7 years. Associations between presurgery characteristics (anthropometric, sociodemographic, physical and mental health, alcohol/drug use, eating behaviors) and 1) pre to postsurgery change in 10 year and lifetime atherosclerotic CVD (ASCVD) risk scores, respectively, and 2) having a CVD event (nonfatal myocardial infarction, stroke, ischemic heart disease, congestive heart failure, angina, percutaneous coronary intervention, coronary artery bypass grafting, or CVD-attributed death) as repeated measures (yr 1-7) were evaluated., Setting: Observational cohort study at ten hospitals throughout the United States., Results: Presurgery factors independently associated with decreases in both 10-year and lifetime risk scores 1-7 years post-RYGB were higher CVD risk score, female sex, higher household income, and normal kidney function. Additionally, Black race and having diabetes were independently associated with decreases in 10-year risk, while not having diabetes and a higher (better) composite mental health score were independently related to decreases in lifetime risk. A lower (worse) presurgery composite physical health score was associated with a higher CVD event risk (RR = 1.68, per 10 points)., Conclusion: This study identified multiple presurgery factors that characterize patients who may have more cardiovascular benefit from RYGB, and patients who might require additional support to improve their cardiovascular health., (Copyright © 2021. Published by Elsevier Inc.)

Rational & Objective: Although the relationship between obesity, anxiety and depression is known, the clinical benefits of nutrition therapy in individuals with obesity have been scarcely studied. This study assessed the effectiveness of a traditional Brazilian diet (DieTBra) and extra virgin olive oil (EVOO) on the symptoms of anxiety and depression in severe obese participants., Method: This was a parallel randomized clinical trial in adults with severe obesity (Body Mass Index - BMI ≥ 35 kg/m 2 ), DietBra Trial. Participants were randomized into three intervention groups in a ratio of 1: 1: 1 and followed up for 12 weeks. The three intervention groups were: 1) DieTBra, 2) 52 mL/day EVOO, and 3) DieTBra +52 mL/day EVOO. The symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. The outcome variables were: anxiety, depression and simultaneous anxiety and depression in the same individual., Results: 149 severe obese individuals were randomized. The mean BMI was 46.3 ± 6.5 kg/m 2 with a mean age of 38.9 ± 8.7 years. After randomization, individuals on medication for depression and anxiety were excluded, totaling 129 at baseline, with 44:43:42 per group. At the end of 12 weeks 113 individuals completed the study. There was a significant reduction of symptoms for the three groups: EVOO, DieTBra and DieTBra + EVOO, respectively: anxiety 38.23% (p = 0.019), 45.83% (p=<0.014), 33.33% (p < 0.013) depression 55.17% (p=<0.001), 50.00% (p=<0.007), 34.61% (p=<0.035), and anxiety/depression 57.69% (p=<0.001), 66.67% (p=<0.014), 27.78% (p=<0.013)., Conclusions: Both DieTBra and olive oil interventions were effective in reducing symptoms of anxiety and depression in severe obese adults. These interventions can be integrated with clinical protocols for treatment of symptoms of anxiety and depression in severe obese individuals., Trial Registration: Clinicaltrials.gov NCT02463435., Competing Interests: Conflict of interest None., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D., Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D., Setting: Longitudinal multicenter studies at University hospitals., Methods: A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up., Results: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m 2 ) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m 2 ) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001)., Conclusion: Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The near universal presence of chronic low-grade systemic inflammation among patients with severe obesity disrupts iron homeostasis and underlies the association between obesity and iron deficiency. Immune activation and inflammation result in a reduction in circulating iron and diminished iron bioavailability for erythropoiesis. Inflammation also alters blood levels of commonly measured markers of iron nutrition status, which makes the diagnosis of iron deficiency difficult and has led to new recommendations regarding laboratory markers for the diagnosis. Recent evidence using these newly recommended laboratory markers, which include levels of ferritin, C-reactive protein, and transferrin saturation, suggests that the actual prevalence of iron deficiency among candidates for metabolic surgery may be double or triple the prevalence identified by low levels of ferritin alone. Thus large numbers of surgical candidates have iron deficiency that has been heretofore largely unrecognized and inadequately treated. The assessment of iron status using the currently recommended markers in the presence of chronic inflammatory diseases and repletion of depleted stores for surgical candidates with deficiency during the preoperative period present an important opportunity for mitigating this condition in postoperative patients., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Long-term changes in cardiovascular disease (CVD) risk after bariatric surgery are not well characterized., Objective: To report sex-specific changes in CVD risk after Roux-en-Y gastric bypass surgery (RYGB)., Setting: Observational cohort study at ten hospitals throughout the United States., Methods: Between 2006 and 2009, 1770 adults enrolled in a prospective cohort study underwent RYGB at 1 of 10 U.S. hospitals. Research assessments were conducted presurgery and annually postsurgery over 7 years. Sex specific-predicted 10-year and lifetime CVD risk were calculated using the Framingham10-year and lifetime risk scores, Framingham-body mass index, and atherosclerotic CVD scoring algorithms among participants with no history of CVD. Of 1566 eligible participants, 1234 (75.9%) with CVD risk determination pre- and postsurgery were included (1013 females, 221 males)., Results: Based on the Framingham10-year and lifetime risk scores, the percentage of females with predicted high (>20%) 10-year CVD risk declined from presurgery (6.5% [95% confidence interval: 6.7-7.5]) to 1 year postsurgery (1.0% [95% confidence interval: .8-1.2]; P < .001), then increased 1 to 7 years postsurgery (to 2.8% [95% confidence interval: 1.6-3.3]; P = .003), but was lower 7 years postsurgery versus presurgery (P < .001). Time trends for percentage of high-risk participants and mean CVD risk scores were similar for both sexes and other evaluated CVD risk scores. For example, among males mean lifetime atherosclerotic CVD score declined from presurgery to 1 year postsurgery, then increased 1 to 7 years postsurgery. However, there was a net decline from presurgery (P < .001)., Conclusion: Among both females and males, predicted 10-year and lifetime CVD risk was substantially lower 7 years post RYGB than presurgery, suggesting RYGB surgery can lead to sustained improvements in short- and long-term CVD risk., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Published estimates of weight regain (WR) after bariatric surgery vary greatly. Understanding the sources of variability in the literature and clarifying the magnitude of WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are critical for informing expectations and planning interventions. A literature search through January 2019 yielded 15 English-language studies that reported WR in at least 30 participants, not selected based on weight loss or WR, at least 3 years after primary RYGB (n = 11) or SG (n = 5). Median follow-up was 5.0 (range, 3.2-10.0) years. Median sample size was 62 (range, 33-464). Samples represented a median of 54.3% (range, 10.7%-100%) of eligible participants. Nadir weight was determined by serial research assessments (n = 1), medical records (n = 7), participant recall (n = 4), or an undisclosed method (n = 4). Three continuous and 8 binary WR measures (the latter, based on various thresholds for clinically meaningful WR) were reported. To enable comparison across studies, the percentage difference in WR in each study versus a reference sample (n = 1433 RYGB), matched on time since surgery and WR measure, was calculated. Median WR in the reference sample increased from 8.2 (25th-75th percentile: 0-19.5) to 23.8 (25th-75th percentile: 9.0-33.9) percent of maximum weight lost, 3 to 6 years post RYGB surgery. Studies of RYGB versus SG, with larger versus smaller samples, with higher versus lower participation rates, that determined nadir weight via participant recall versus medical records, and reported continuous versus binary WR measures tended to have WR values closer to the reference sample and each other. Variation in WR estimates was explained by heterogeneity in WR measures, timing of assessment, surgical procedure, and study design characteristics. The best estimate of WR after RYGB likely comes from the large reference sample. WR after SG versus RYGB appears higher. However, additional high-quality studies with uniform reporting of WR by surgical procedure are needed., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited., Objectives: To measure and compare the changes in fat-free mass with the changes in muscle composition after biliopancreatic diversion with duodenal switch surgery (BPD/DS)., Setting: Bariatric surgery is associated with concomitant loss in both fat and muscle masses. Literature on muscle composition/quality after bariatric surgery is limited., Methods: Forty patients underwent BPD/DS and 22 patients are considered as controls. Bioelectrical impedance analysis (body composition) and computed tomography scan at the midthigh and abdominal levels (muscle composition) were performed at baseline, 6, and 12 months., Results: At 6 and 12 months, the BPD/DS group displayed significant reduction in weight (12 months: -46.6 ± 13.5 kg) and fat-free mass (12 months: -8.2 ± 4.4 kg; both P < .001). A significant reduction in abdominal (-15 ± 8%, P < .001) and midthigh muscle areas (-18 ± 7%, P < .001) was observed during the first postoperative 6 months, followed by a plateau after 6 months (abdominal: -1 ± 5%, midthigh: -1 ± 4%, both P > .05). At 6 months, both midthigh fat-infiltrated muscle (-22 ± 10%, P < .001) and normal-density muscle (-16 ± 9%, P < .001) areas decreased. Further reduction at 12 months was only observed in the fat-infiltrated muscle (-11 ± 8%, P < .001) in comparison with an increase in the normal-density muscle area (5 ± 8%, P = .001). There was no significant change for the control group., Conclusions: Reduction in muscle, assessed with computed tomography scans, occurs mostly during the first 6 months postoperatively after BPD/DS. Focus on muscle quantity as well as quality, using precise imaging methods, instead of quantifying total body lean mass, is likely to provide better assessment in body content modulation after BPD/DS., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is a major independent risk factor for developing type 2 diabetes (T2D)., Objectives: Our goal in this study was to analyze the impact of laparoscopic sleeve gastrectomy in the risk reduction of developing T2D in middle-aged, severely obese nondiabetes patients., Setting: University Hospital, United States., Methods: We retrospectively reviewed our prospectively collected database from 2010 to 2016. All severely obese patients between 45 and 64 years of age without diabetes at baseline that underwent sleeve gastrectomy were included in our study. The T2D risk score for predicting the incidence of diabetes was measured preoperatively and at 12 months postoperatively and was based on the Framingham Offspring Study that calculates an 8-year risk of developing T2D., Results: Of the 1330 patients included in this study, 6.5% (n = 86) met the criteria for the T2D risk score calculation. The population was predominantly composed of females (68.9%; n = 59) with a mean age of 52.8 ± 5.3 years. Preoperative body mass index was 43.1 ± 6.9 kg/m 2 with a percentage of estimated body mass index loss and percentages of total weight loss were 72.2 ± 26.3% and 26.39 ± 18.15%, respectively, with fasting plasma glucose of 103.3 ± 14.9 mg/dL. The preoperative risk for T2D was 13.9 ± 11.6%, with an absolute risk reduction 12 months after surgery of 10.3%, corresponding to a 74.2% relative risk reduction. When comparing between sexes, risk reduction in females was slightly better than in males; however, this was not statistically significant. At 12-month follow-up, all measured variables were significantly improved, except for diastolic blood pressure., Conclusions: Laparoscopic sleeve gastrectomy significantly decreases the risk of developing T2D in middle-aged severely obese patients. Prospective studies are needed to further understand these findings., (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The practice of metabolic and bariatric surgery for adolescents with severe obesity has been increasing, and evidence of the outcomes in the long term remains unclear. The aim of this study was to review and analyze the outcomes of this therapy in adolescents with a follow-up ≥5 years. MEDLINE, EMBASE, and Cochrane databases were systematically searched. Inclusion criteria were 10- to < 20-year-old adolescents, 5 years minimum of follow-up, and a retention rate ≥70% at 5 years of follow-up. Adiposity indicators outcomes, co-morbidity remission, and complications were analyzed. A total of 10 studies met the inclusion criteria. Surgeries performed included gastric bypass, gastric band, and sleeve gastrectomy. The age of the participants ranged from 13 to 17 years. The longest follow-up after intervention was 156 months. Mean body mass index at baseline and follow-up was 47 and 32.4 kg/m 2 , respectively. Most of the studies reported weight regain within 1 to 12 years of follow-up. Remission rate of co-morbidities was 75% for dyslipidemia, 78% for musculoskeletal problems, 85% for hypertension, and 85% for type 2 diabetes. Not all studies stated that they were looking for all complications. Iron deficiency and anemia were high, ranging from 30% to 70% and 16% to 50%, respectively. The review indicates that there is low to moderate evidence that metabolic and bariatric surgery in adolescents with severe obesity after 5 years of follow-up results in substantial reduction in body mass index, and very low to low evidence in the resolution of related co-morbidities. Although long-term complications were inadequately reported or nonreported, a high prevalence of iron deficiency and anemia was found. Because maternal anemia might be implicated in deleterious effects for offspring, monitoring female patients for anemia after metabolic and bariatric surgery is strongly recommended. Further high-quality studies with long-term follow-up are warranted to assess related co-morbidities and long-term complications., (Copyright © 2018. Published by Elsevier Inc.)

We characterized the prevalence of obesity among Florida children 2-19years old using electronic health records (EHRs). The obesity prevalence for 331,641 children was 16.9%. Obesity prevalence at 6-11years (19.5%) and 12-19years (18.9%) were approximately double the prevalence of obesity among children 2-5years (9.9%). The highest prevalence of severe obesity occurred in rural Florida (21.7%) and non-Hispanic children with multiple races had the highest obesity prevalence (21.1%) across all racial/ethnic groups. Our results highlight EHR as a low-cost alternative to estimate the prevalence of obesity and severe obesity in Florida children, both overall and within subpopulations., (Copyright © 2018 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Background: Spexin is a novel peptide predominantly produced in human white adipose tissue and has recently been implicated as a potential signal in the regulation of body weight, energy homeostasis, and satiety. The effect of bariatric surgery on spexin is unknown., Objectives: To study the effect of Roux-en-Y gastric bypass (RYGB) surgery on endogenous spexin concentration and various risk factors of type 2 diabetes and cardiovascular disease in youth with severe obesity., Setting: University hospital, United States METHODS: Spexin, body mass index (BMI), insulin, glucose, total and high molecular weight adiponectin, leptin, and high sensitivity C- reactive protein were measured longitudinally (baseline, 6 mo, and 12 mo) after RYGB surgery in girls with severe obesity (n = 12; age = 16.7 ± 1.5 years; BMI = 51.6 ± 2.9 kg/m 2 )., Results: Serum spexin concentration increased (P = .01) at 6 months after surgery and stabilized afterward. Spexin level correlated negatively with homeostatic model assessment insulin resistance, HOMA-IR (Spearman correlation r = -.796, P < .001) and positively with high molecular weight adiponectin (Spearman correlation r = .691, P = .011). The change in spexin concentration, from baseline to 6 months after surgery, was inversely correlated with the corresponding change in BMI (Spearman correlation r = -.573, P = .051). Furthermore, the 6-month changes in spexin and HOMA-IR were inversely correlated (slope [standard error, SE] = -.0084 (.0019), P = .001)], even after adjusting for the change in BMI., Conclusions: The enhancement of circulating spexin concentration in response to RYGB and correlations with beneficial postoperative changes in various adipokines in youth are novel findings that require further validation., (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates., Objectives: We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates., Setting: Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York., Methods: Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline., Results: Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL., Conclusions: These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population., (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: The prevalence of severe obesity in youth is rising, despite reports of obesity rates stabilizing overall. While reports on treatment outcomes for youth with severe obesity (bariatric surgery, behavioral and pharmacological treatments) exist, very few community-based programs have reported changes in health outcomes in this population. We assessed changes in cardiovascular health risk profiles among racial/ethnic minority youth with severe obesity who participated in Fit2Play™, a park-based afterschool health promotion program., Study Design: A longitudinal cohort study., Methods: Children aged 6-14 years (N = 1546, 51% Hispanic, 44% non-Hispanic black) who participated in the Fit2Play™ in one of 34 urban park sites for one school year over five separate school years (2010-2015) had height, weight, four-site skinfold thicknesses, systolic blood pressure (SBP)/diastolic blood pressure (DBP), fitness tests, and a health/wellness knowledge test collected at the beginning and end of the school year. Two-level repeated measures mixed models examined changes in cardiovascular health outcomes (body mass index [BMI], skinfold thickness, systolic/diastolic blood pressure percentile [SBPP/DBPP], cardiorespiratory fitness [PACER]) in youth with severe obesity over 1- and 2-year follow-up., Results: Compared with baseline, BMI decreased 13% (incidence rate ratio [IRR] 95% confidence interval [CI]: 0.83-0.90), sumof skinfold thicknesses decreased 5% (IRR 95% CI: 0.91-0.99), SBPP decreased 5% (IRR 95% CI: 0.90-0.99), DBPP decreased 19% (IRR 95% CI: 0.77-0.86), and PACER scores increased 12% (IRR 95% CI: 1.0-1.27) after two years of participation in the Fit2Play™ program., Conclusions: Findings here support community/park-based youth programs as effective and accessible treatment options for reducing cardiovascular disease risk among youth with severe obesity., (Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Severely obese patients undergoing bariatric surgery (BS) are at increased risk for venous thromboembolism (VTE). How standard low molecular weight heparin (LMWH) regimen should be adapted to provide both sufficient efficacy and safety in this setting is unclear. We aimed to compare the influence of four body size descriptors (BSD) on peak anti-Xa levels in BS obese patients receiving LMWH fixed doses to identify which one had the greatest impact. One hundred and thirteen BS obese patients [median body mass index (BMI), 43.3 kg/m 2 (IQR, 40.6-48.7 kg/m 2 )] receiving subcutaneous dalteparin 5000 IU twice daily were included in this prospective monocenter study. Peak steady-state anti-Xa levels were measured peri-operatively following thromboprophylaxis initiation. Only 48% of patients achieved target anti-Xa levels (0.2-0.5 IU/ml). In univariate analysis, age, gender, total body-weight (TBW), lean body-weight (LBW), ideal body-weight (IBW), BMI and estimated glomerural filtration rate (eGFR) were associated with anti-Xa levels. The strongest negative association was observed with LBW (r = -0.56, p < .0001). Receiver operating characteristic curves indicated that among BSD, LBW (cut-off >55.8 kg) had the highest sensitivity (73%) and specificity (69%) to predict sub-prophylactic anti-Xa levels. In multivariate analysis, LBW and eGFR remained associated with anti-Xa levels (β = -0.47 ± 0.08, p < .0001 and β = -0.19 ± 0.08; p = .02, respectively). In BS morbidly obese patients receiving LMWH for thromboprophylaxis after BS, LBW and eGFR are the main determinants of anti-Xa level, and could be proposed in LMWH-based thromboprophylaxis dosing algorithms. The efficacy of a LBW-scale based dosing algorithm for optimal VTE prevention deserves further prospective randomized trials., (Copyright © 2018 Elsevier Ltd. All rights reserved.)