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Summary A cross‐sectional, online survey was conducted in the United Kingdom, France, Germany, and the United States (14 November–22 December 2022) to investigate preferences for anti‐obesity medication (AOM) among people with obesity (PwO) and healthcare providers (HCPs). Eligibility: Adult PwO who self‐defined their body type as overweight/obese, were trying to lose weight and had BMI ≥30.0 or 27.0–29.9 kg/m2 with ≥1 obesity‐related complication; HCPs had to see ≥30 PwO in a typical month and be a decision‐maker regarding their weight loss. The survey included 2500 PwO and 500 HCPs. Exercise (96%) and diet (90%) were the most common weight management methods; AOM use was low (8%). Key barriers to use of prescribed AOMs among PwO were not wanting to take AOM (34%), side effects concerns (33%), and not trusting AOM (26%). Most HCPs (79%) had prescribed/recommended AOMs. Efficacy was the most common reason for preferring one of the shown product profiles among PwO (60%) and HCPs (86%); improving cardiovascular risk was also important to 95% of HCPs when deciding which AOM to prescribe. AOM preference is largely driven by efficacy. Increasing knowledge could help to address barriers to AOM use and improve outcomes for PwO. [ABSTRACT FROM AUTHOR]

Aim: To compare hepatic stiffness and fat fraction in patients with obesity and type 1 diabetes (T1D) with type 2 diabetes (T2D) with a similar body mass index (BMI). Methods: In this prospective cross‐sectional study, 90 participants with T1D (BMI 30.5 ± 4.5 kg/m2; diabetes duration 20.5 ± 9.8 years; HbA1c 8.2% ± 1.4%) and 69 with T2D (BMI: 30.8 ± 4.6 kg/m2; diabetes duration: 11.7 ± 7.8 years; HbA1c: 7.3% ± 1.4%) were included. Liver fat fraction and stiffness were examined by magnetic resonance imaging and elastography, respectively. Logistic regressions were used to evaluate associations with biomedical variables. Results: The mean liver stiffness score in patients with obesity and T1D was 2.2 ± 0.5 kPa, while in T2D it was 2.6 ± 0.8 kPa (P <.001). The liver fat fraction in patients with obesity and T1D was 3.7% ± 6.3%, and in T2D it was 10.6% ± 7.9% (P <.001). Metabolic dysfunction‐associated steatotic liver disease (MASLD) was present in 13.3% of patients with T1D and in 69.6% of patients with T2D, whereas fibrosis was suggested in 7.8% of patients with T1D and in 27.5% of patients with T2D. Liver stiffness was four times higher in patients with T2D compared with those with T1D (odds ratio = 5.4, 95% confidence interval: 2.1‐13.6, P <.001). Aspartate transaminase (AST), alanine transaminase, gamma‐glutamyl transferase (GGT), triglycerides and the android‐to‐gynoid ratio were associated with elevated fat fraction in both cohorts. AST and GGT were associated with elevated liver stiffness in both cohorts. Conclusions: Patients with obesity and T1D had lower liver fat and liver stiffness compared with those patients with T2D, despite similar levels of BMI, a longer duration of diabetes and worse glycaemic control. [ABSTRACT FROM AUTHOR]

Aim: Tirzepatide is a glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide‐1 (GLP‐1) dual receptor agonist (RA) that reduces glycated haemoglobin (HbA1c) and weight in patients with type 2 diabetes. We assessed the effectiveness of tirzepatide in real‐world use in an Arab population. Methods: Review of clinical data from a specialist outpatient diabetes centre; study time points and outcome measures were pre‐specified. Results: Tirzepatide was initiated in 8945 patients between 24 October 2022 and 31 December 2023. Of these, 3686 individuals reached 40 weeks of follow‐up. At initiation, the mean ± SD age was 54.1 ± 11.5 years, body mass index 34.6 ± 6.0 kg/m2 and HbA1c 7.3 ± 1.5% (56 ± 17 mmol/mol); 2296 (62%) were switched to tirzepatide from another GLP‐RA and 317 (8.6%) reported previous bariatric surgery. The maximum dose dispensed was ≥12.5 mg/week in 1087, 7.5‐10.0 mg/week in 1688 and 2.5‐5.0 mg/week in 911. The mean 40‐week reduction in HbA1c was 0.6 ± 1.2% (8 ± 13 mmol/mol) and the reduction in weight was 4.5 ± 6.9 kg (4.8 ± 7.3%). GLP‐RA‐naïve patients experienced a significantly greater reduction in HbA1c [1.0 ± 1.3% (11 ± 14 mmol/mol) versus 0.5 ± 1.2% (6 ± 13 mmol/mol), p <.0001] and weight (7.2 ± 8.6 vs. 4.2 ± 6.6 kg, p <.0001) compared with previously exposed individuals. Post‐metabolic bariatric surgery patients lost significantly more weight (7.8 ± 9.4 vs. 4.5 ± 7.0 kg, p <.0001). Improvements in blood pressure, lipid profile, and liver transaminases were noted at 40 weeks. Tirzepatide was well tolerated, with 288 (7.8%) of patients discontinuing treatment because of adverse effects, predominantly gastrointestinal. Conclusion: In real‐world use, tirzepatide significantly reduced HbA1c levels and weight and was well tolerated. Previous GLP‐RA use was associated with significantly lesser HbA1c and weight reduction, and previous metabolic bariatric surgery was associated with greater weight loss. [ABSTRACT FROM AUTHOR]

Objective: This network meta‐analysis evaluates the efficacy and safety of tirzepatide compared to glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) and other weight loss drugs in the treatment of overweight and obesity. Methods: MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP‐1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta‐analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. Results: Thirty‐one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight‐related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42–16.34). As compared to placebo, tirzepatide and GLP‐1 RA across all doses had significant increases in gastrointestinal adverse effects. Conclusions: The superiority of tirzepatide and GLP‐1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity. [ABSTRACT FROM AUTHOR]

Background: Hypothalamic centres have been recognized to play a central role in body weight regulation for nearly 70 years. Aims: In this review, we will explore the current undersanding of the role the hypothalamus plays in controlling food intake behaviours. Materials and Methods: Review of relevant literature from PubMed searches and review article citations. Results: Beginning with autopsy studies showing destructive hypothalamic lesions in patients manifesting hyperphagia and rapid weight gain, followed by animal lesioning studies pinpointing adjacent hypothalamic sites as the 'satiety' centre and the 'feeding' centre of the brain, the neurocircuitry that governs our body weight is now understood to consist of a complex, interconnected network, including the hypothalamus and extending to cortical sites, reward centres and brainstem. Neurons in these sites receive afferent signals from the gastrointestinal tract and adipose tissue indicating food availability, calorie content, as well as body fat mass. Discussion: Integration of these complex signals leads to modulation of the two prime effector systems that defend a body fat mass set point: food intake and energy expenditure. Conclusion: Understanding the hypothalamic control of food intake forms the foundation for understanding and managing obesity as a chronic disease. [ABSTRACT FROM AUTHOR]

Summary: Bariatric surgery in people with obesity can lead to long‐term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia‐independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of tirzepatide 10 and 15 mg with semaglutide 2.4 mg using an indirect treatment comparison. Materials and Methods: Using SURMOUNT‐1 and STEP 1 trial data, mean percentage change in body weight from baseline and odds ratio (OR) of achieving 5% or greater weight loss were compared between tirzepatide 10 and 15 mg at week 72 and semaglutide 2.4 mg at week 68 using matching‐adjusted indirect comparison of the efficacy estimand. Sensitivity analyses were completed using different methods, including the Bucher method, also using different estimands and/or time points. Results: Greater reductions in percentage change in body weight were observed with tirzepatide 10 and 15 mg versus semaglutide 2.4 mg (tirzepatide 10 mg mean difference: −4.67% [95% CI −5.91%, −3.43%]; tirzepatide 15 mg mean difference: −5.92% [95% CI −7.16%, −4.68%]; both P <.001). Similarly, more participants achieved 5% or greater weight loss with tirzepatide 10 mg (OR 2.61 [95% CI 1.48, 4.57]; P <.001) and 15 mg (OR 2.75 [95% CI 1.57, 4.81]; P <.001) compared with semaglutide 2.4 mg. All sensitivity analyses were consistent, except for an OR of achieving 5% or greater weight loss with tirzepatide 10 mg using the Bucher method to analyse the treatment regimen estimand (P =.074). Conclusions: Currently there are no direct comparisons of tirzepatide and semaglutide for weight management. Using the matching‐adjusted indirect treatment comparison method to compare the efficacy of tirzepatide and semaglutide for chronic weight management, this analysis showed greater weight loss with tirzepatide 10 and 15 mg versus semaglutide 2.4 mg. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated whether adding sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) and/or glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) to insulin reduced weight and glycemia in people with type 1 diabetes. Methods: This retrospective analysis of electronic health records evaluated 296 people with type 1 diabetes over 12 months after medications were first prescribed. Four groups were defined: control n = 80, SGLT2i n = 94, GLP1‐RA n = 82, and combination of drugs (Combo) n = 40. We measured changes at 1 year in weight and glycated hemoglobin (HbA1c). Results: The control group did not have changes in weight or glycemic control. The mean (SD) percentage weight loss after 12 months was 4.4% (6.0%), 8.2% (8.5%), and 9.0% (8.4%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group lost the most weight (p < 0.001). The HbA1c reduction was 0.4% (0.7%), 0.3% (0.7%), and 0.6% (0.8%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group had the biggest improvements in glycemic control and total and low‐density lipoprotein cholesterol compared with baseline (all p < 0.01). Severe adverse events were similar between all the groups, with no increased risk of diabetic ketoacidosis. Conclusions: The SGLT2i and GLP1‐RA agents on their own improved body weight and glycemia, but combining the medications resulted in more weight loss. Treatment intensification appears to result in benefits with no difference in severe adverse events. [ABSTRACT FROM AUTHOR]

Objective: Obesity is a growing global concern compounded by limited availability of effective treatment options. The SURMOUNT development program aims to evaluate the efficacy and safety of tirzepatide as an adjunct to lifestyle intervention compared with placebo on chronic weight management in adults with BMI ≥ 27 kg/m2 with or without type 2 diabetes. Methods: The SURMOUNT program includes four global phase 3 trials NCT04184622 (SURMOUNT‐1), NCT04657003 (SURMOUNT‐2), NCT04657016 (SURMOUNT‐3), and NCT04660643 (SURMOUNT‐4). Participants are randomized to once‐weekly subcutaneous tirzepatide versus placebo in a double‐blind manner. The primary end point in all trials is the percentage change in body weight from randomization to end of treatment. Results for the primary end point for SURMOUNT‐1 were published recently and results for the other trials are expected in 2023. Results: Across trials, participants have a mean age of 44.9 to 54.2 years, are mostly female (50.7% to 69.7%), and have a mean BMI of 36.1 to 38.9. Conclusions: The extensive assessment of once‐weekly tirzepatide in the global SURMOUNT program will detail the clinical effects of this first‐in‐class glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide‐1 receptor agonist in chronic weight management. [ABSTRACT FROM AUTHOR]

Objective: Postprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux‐en‐Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon‐like peptide‐1 (GLP‐1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP‐1 receptor agonists (GLP‐1RAs) in managing postprandial hypoglycemia following bariatric surgery. Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer‐reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta‐Analyses Protocols (PRISMA‐P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429). Results and Conclusions: Postprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP‐1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP‐1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability. [ABSTRACT FROM AUTHOR]

The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop's conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD. [ABSTRACT FROM AUTHOR]

Objective: Obesity is a highly stigmatized disease, and despite the understanding of the processes involved, negative language reinforcing outdated views of obesity persists within the scientific literature. This is the first study, to the authors' knowledge, to determine how widespread stigmatizing language is within publications on obesity and examine its impact on patients.Methods: Two standard terms within obesity publications were identified, and a literature search was carried out to determine their prevalence. A parallel qualitative analysis was conducted with patients with obesity to determine perceptions of these terms.Results: Of the 3,020 papers screened, 2.4% included the term fail, and 16.8% contained morbid used in conjunction with obesity. Sixteen patients participated in the qualitative analysis. They felt that negative language, particularly failure, implied a personal responsibility for lack of weight loss. Clinically meaningful terminology fostered a more constructive relationship with health care providers.Conclusions: Although most journals object to overtly stigmatizing language, using phrases or words that carry negative connotations is less clearly discouraged. It is important to recognize that language that implies a moral responsibility for weight loss or the development of obesity contradicts the well-established evidence base that obesity results from complex biological processes. [ABSTRACT FROM AUTHOR]

Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission. [ABSTRACT FROM AUTHOR]

C) Effects of GLP-1RA's on GGT concentration in patients with NASH compared to placebo. BACKGROUND Non-alcoholic steatohepatitis (NASH) is manifested by ectopic fat accumulation on the liver tissue without a secondary cause. FIGURE S1: PRISMA 2009 flow diagram (8).FIGURE S2: A) Effects of GLP-1RA's on AST concentration in patients with NASH compared to placebo. In addition, we compared for the first time the secondary markers of NASH other than aminotransferase levels, which may be utilized to supplement the results of GLP-1RA treatment on histological aspects of NASH. [Extracted from the article]

Summary: Although the deleterious effects of obesity have been well documented in terms of morbidity and mortality, less is known about what it is like to live with this complex and chronic disease. This study systematically reviewed and synthesized peer‐reviewed studies relating to the lived experience of patients with obesity. A total of 12,388 records were screened, resulting in the inclusion of 32 final studies. Meta‐ethnographic synthesis of these 32 studies generated five "third‐order constructs" or themes: the development of obesity; a life limited; stigma, judgment, shame, and blame; treatment and; experiences of specific or minority groups. These constructs describe, from the patient's perspective, the factors associated with the development and maintenance of obesity; the effects of the disease on their day‐to‐day lives; the impact of the stigma and judgment many patients are subjected to; and their experience of accessing, or trying to access, treatment for their healthcare needs. This synthesis reveals the dearth of studies that focus solely on the experience of the patient and highlights the tendency for participant‐informed, rather than participatory, methods in obesity research. It concludes with a call for further participatory research into the experiences of people living with obesity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness and safety of bariatric surgery in patients with coexisting type 1 diabetes and obesity who choose to undergo bariatric surgery for weight management. Materials and Methods: We conducted a retrospective, longitudinal review of the clinical data of patients with type 1 diabetes, followed up at our centre after bariatric surgery had been performed elsewhere. Results: Sixty‐one patients were included, of whom 51% were women, and 57 (93%) were Emirati Arab, three (5%) were other Arab, and one (2%) was White in ethnic origin. The mean age at surgery was 31 years. A total of 42 patients (69%) underwent sleeve gastrectomy, 17 (28%) gastric bypass, and two (3%) gastric banding. In 48 patients with complete follow‐up data, improvements were observed at 12 months in the median (interquartile range [IQR]) values for body mass index (BMI; 38.5 [34.9‐40.9] to 26.1 [24.2‐29.6] kg/m2, P <0.001), glycated haemoglobin concentration (8.6 [7.8‐9.2]% to 7.8 [7.2‐8.5]%; P <0.001), daily insulin dose (1.0 [0.7‐1.2] to 0.8 [0.6‐0.9] units/kg/d; P <0.001), systolic blood pressure (127 [116‐136] to 116 [110‐120] mmHg; P <0.001), total cholesterol: high‐density lipoprotein cholesterol ratio (3.4 [2.9‐4.3] to 3.0 [2.6‐3.5]; P <0.001), and albuminuria. In 32 patients followed up at 3 years, the median (IQR) reduction in BMI was 10.4 (5.9‐11.7) kg/m2, 50% reduced or stopped antihypertensive medication and 58% reduced or stopped lipid‐modifying medication. Three patients each reported a single episode of diabetic ketoacidosis; in one case this was due to cessation of insulin treatment. Conclusions: In our cohort of patients with obesity and type 1 diabetes, bariatric surgery led to significant improvements in weight and cardiometabolic variables, with modest improvements in glycaemia. Few adverse events were reported. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effect of bariatric surgery on sweet taste sensitivity and the hedonic evaluation of sweet, savory, and fatty food stimuli as well as associations with weight loss and food preferences assessed at a buffet meal test.Methods: The detection and recognition threshold for sweet taste and the hedonic rating of sweet, savory, and fatty food stimuli were assessed before and after a preoperative diet-induced weight loss and 6 weeks, 6 months, and 18 months after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) (n = 29).Results: The detection threshold for sweet taste decreased after the diet-induced weight loss and 6 weeks after RYGB (both P ≤ 0.03). The hedonic rating of high-fat food stimuli decreased 6 weeks after RYGB and SG (all P ≤ 0.02). Changes in the hedonic rating of high-fat food stimuli were associated with increased preferences for high-fat foods at the buffet meal (P = 0.03) and tended to be associated with weight loss (P = 0.05). No changes were detected for sweet and savory food stimuli.Conclusions: RYGB increased sweet taste sensitivity; however, this effect was already seen after the diet-induced weight-loss. RYGB and SG decreased the hedonic evaluation of high-fat food stimuli, but this effect did not translate into decreased preferences for high-fat food. [ABSTRACT FROM AUTHOR]

In this study we prospectively collected data on the use of liraglutide 3 mg in obese Arab patients. As part of routine care, 2092 patients were dispensed liraglutide 3 mg. Median age was 38 years and 77% were women. Median baseline weight was 95 kg and body mass index was 36.6 kg/m2. Of the patients, 188 (9%) had previous bariatric surgery. Seven hundred and eighty‐seven patients were treated for ≥16 weeks and their median (interquartile range) weight loss was 6.0 (2.4‐9.4) kg, equivalent to 6.4% (2.6%‐9.7%) of baseline weight (P < 0.0001, n = 787). Of those treated for ≥16 weeks, 474 (60%) achieved a weight loss of >5% of baseline weight while 182 (23%) achieved >10% weight loss. There was no difference in percentage weight loss between postbariatric surgery (n = 76) and non‐surgical patients (n = 711). As a result of adverse events, mainly gastrointestinal symptoms, 140 (6.7%) of the patients stopped treatment. One patient developed acute pancreatitis in the context of gallstone disease but made an uneventful recovery. Liraglutide 3 mg was well tolerated and resulted in weight loss in routine clinical care similar to that seen in randomized controlled trials. [ABSTRACT FROM AUTHOR]

Objective: Using an ad libitum buffet meal targeting direct behavior, the authors of the current study previously reported no effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) surgery on food preferences 6 months after surgery. The current study investigated changes in food preferences at 18 months after surgery and whether changes in food preferences at 6 months predicted weight loss.Methods: Twenty food items separated into the following food categories were served at the buffet meal: high-fat, low-fat, sweet, savory, high-fat savory, high-fat sweet, low-fat savory, and low-fat sweet. Energy intake and intake from each of the food items were registered. Energy intake prior to the meal was standardized.Results: Thirty-nine subjects completed visits before surgery and 18 months following RYGB (n = 29) and SG (n = 10) surgery. Energy intake decreased 41% (4,470 ± 209 kJ vs. 2,618 ± 209 kJ, P < 0.001), but no change occurred in relative energy intake from any of the food categories (all P ≥ 0.23), energy density (P = 0.20), or macronutrient intake (all P ≥ 0.28). However, changes in high-fat food intake, protein intake, energy intake, and energy density at 6 months predicted weight loss at 18 months (P ≤ 0.02).Conclusions: RYGB surgery and SG surgery do not affect food preferences. However, changes in food preferences seem to be predictive of weight loss. [ABSTRACT FROM AUTHOR]

We examined the relationship between weight changes after preoperative glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) treatment and weight changes from the start of medical weight management (MWM) until 12 months after bariatric surgery in patients with type 2 diabetes in a retrospective cohort study. A total of 45 patients (64.4% women, median [interquartile range] age 49 [45‐60] years) were included. The median (interquartile range) weight loss from start of MWM until 12 months post‐surgery was 17.9% (13.0%‐29.3%). GLP‐1RA treatment during MWM resulted in 5.0% (1.9%‐7.7%) weight loss. Weight loss during GLP‐1RA treatment predicted weight loss from the start of MWM until 12 months post‐surgery, but not postoperative weight loss after adjustment. The proportion of weight loss from start of MWM to 12 months post‐surgery attributed to GLP‐1RA treatment was negatively associated with that attributed to surgery, after adjustment. In conclusion, weight change after GLP‐1RA treatment predicted the weight loss achieved by a combination of MWM and bariatric surgery, but not weight loss induced by surgery only. Failure to lose weight after GLP‐1RA treatment should not be considered a barrier to undergoing bariatric surgery. [ABSTRACT FROM AUTHOR]

The goal of the National Institutes of Health-funded American Society for Parenteral and Enteral Nutrition 2017 research workshop (RW) "Gastric Bypass: Role of the Gut" was to focus on the exciting research evaluating gut-derived signals in modulating outcomes after bariatric surgery. Although gastric bypass surgery has undoubted positive effects, the mechanistic basis of improved outcomes cannot be solely explained by caloric restriction. Emerging data suggest that bile acid metabolic pathways, luminal contents, energy balance, gut mucosal integrity, as well as the gut microbiota are significantly modulated after bariatric surgery and may be responsible for the variable outcomes, each of which was rigorously evaluated. The RW served as a timely and novel academic meeting that brought together clinicians and researchers across the scientific spectrum, fostering a unique venue for interdisciplinary collaboration among investigators. It promoted engaging discussion and evolution of new research hypotheses and ideas, driving the development of novel ameliorative, therapeutic, and nonsurgical interventions targeting obesity and its comorbidities. Importantly, a critical evaluation of the current knowledge regarding gut-modulated signaling after bariatric surgery, potential pitfalls, and lacunae were thoroughly addressed. [ABSTRACT FROM AUTHOR]

Objective Mitotane treatment in adrenocortical carcinoma (ACC) results in unreliable measurement of serum total cortisol (TC) levels because of an elevation in corticosteroid-binding globulin (CBG). Design The use of a newly-developed serum-free cortisol (FC) assay was assessed to investigate the characteristics of a more valid measure of cortisol status. Patients Sixty-two serum samples from patients with ACC treated with mitotane were studied. Different subgroups were studied according to mitotane levels (<14, 14–20 and >20 mg/dl), hydrocortisone replacement treatment, presence of Cushing’s syndrome (CS) and adrenocorticotrophin (ACTH) levels. Measurements Serum FC was measured using a newly-developed assay, TC, CBG and plasma ACTH using conventional laboratory kits; TC-to-CBG (Free cortisol index, FCI, nmol/mg) and TC-to-FC (TFR) ratios were calculated. Results CBG levels were elevated and positively correlated to mitotane levels. FC was positively related to TC and FCI in nearly all subgroups studied. Plasma ACTH was negatively related to parameters of cortisol levels in the total samples studied. In the ‘target’ subgroup with normal ACTH levels and mitotane levels 14–20 mg/dl, no correlation of plasma ACTH with any parameter studied was seen, and FC suggested over-replacement with hydrocortisone treatment in the subgroup with CS. Conclusions FC measurement may offer additional information in the follow-up of patients on mitotane, especially when there is a history of CS which invalidates the use of acute changes in plasma ACTH as a parameter of hydrocortisone replacement. These preliminary data suggest that it may prove useful as a biochemical marker when TC or FCI are invalidated by mitotane treatment or plasma ACTH is suppressed by hypercortisolaemia. Larger studies are needed to substantiate the clinical utility of FC measurement in specific groups of patients. [ABSTRACT FROM AUTHOR]

Bariatric surgery is the most effective treatment for morbid obesity. Although calorie malabsorption does not occur in most bariatric procedures, micronutrient deficiencies are possible. Multivitamin supplementation is essential following bariatric surgery. The recommendation would be to screen for multivitamin deficiencies prior to surgery and to monitor vitamin levels postoperatively at regular intervals. In this paper, we review the data for screening and supplementation after bariatric procedures for different vitamins. [ABSTRACT FROM AUTHOR]

Obesity is common in people with chronic kidney disease (1) and is associated with a higher risk of kidney allograft complications (2); thus, BMI >= 35 kg/m SP 2 sp and BMI >= 40 kg/m SP 2 sp are generally considered relative and absolute contraindications, respectively, to kidney transplantation (2). Abdominal surgeries are challenging in people on peritoneal dialysis; differences in outcomes of pre-transplant metabolic surgery between dialysis modalities were not explored. [Extracted from the article]

The article focuses on the use of rimonabant and metformin in the treatment of obese women with polycystic ovary syndrome. Rimonabant are found to reduce weight, free androgen index and insulin resistance. Administration of metformin further leads to improvements in the metabolic and biochemical parameters by activating the protein kinases. The article further describes the methods used in the treatment and the results of the study.

Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m 2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings., (© 2021 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Aim: To determine whether a dose-dependent effect in the stimulation of gut hormone release (plasma cholecystokinin [CCK], active glucagon-like peptide-1 [aGLP-1] and peptide tyrosine tyrosine [PYY]) is found for the natural sweetener erythritol., Materials and Methods: Twelve healthy, lean volunteers received solutions with 10, 25 or 50 g erythritol, or tap water enriched with 13 C-sodium acetate on four study days via a nasogastric tube in this randomized (active treatments), placebo-controlled, double-blind, cross-over trial. Blood samples and breath samples ( 13 C-sodium acetate method for measurement of gastric emptying [GE]) were taken at regular intervals, and sensations of appetite and gastrointestinal symptoms were rated., Results: We found (a) a dose-dependent stimulation of CCK, aGLP-1 and PYY, and slowing of GE, (b) no effect on blood glucose, insulin, motilin, glucagon or glucose-dependent insulinotropic polypeptide, (c) no effect on blood lipids and uric acid, and (d) no abdominal pain, nausea or vomiting., Conclusions: Solutions with 10 and 50 g of erythritol stimulated gut hormone release. Emptying of erythritol-containing solutions from the stomach was slower compared with placebo. There was no effect on plasma glucose, insulin, glucagon, blood lipids or uric acid. All doses were well tolerated., (© 2021 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Obesity is a treatable risk factor for chronic kidney disease progression. We audited the reporting of body-mass index in nephrology outpatient clinics to establish the characteristics of individuals with obesity in nephrology practice. Body-mass index, clinical information and biochemical measures were recorded for patients attending clinics between 3 rd August, 2018 and 18 th January, 2019. Inferential statistics and Pearson correlations were used to investigate relationships between body-mass index, type 2 diabetes, hypertension and proteinuria. Mean ± SD BMI was 28.6 ± 5.8 kg/m 2 (n = 374). Overweight and obesity class 1 were more common in males (P = .02). Amongst n = 123 individuals with obesity and chronic kidney disease, mean ± SD age, n (%) female and median[IQR] eGFR were 64.1 ± 14.2 years, 52 (42.3%) and 29.0[20.5] mL/min/BSA, respectively. A positive correlation between increasing body-mass index and proteinuria was observed in such patients (r = 0.21, P = .03), which was stronger in males and those with CKD stages 4 and 5. Mean body-mass index was 2.3 kg/m 2 higher in those treated with 4-5 versus 0-1 antihypertensives (P = .03). Amongst n = 59 patients with obesity, chronic kidney disease and type 2 diabetes, 2 (3.5%) and 0 (0%) were prescribed a GLP-1 receptor analogue and SGLT2-inhibitor, respectively. Our data provides a strong rationale not only for measuring body-mass index but also for acting on the information in nephrology practice, although prospective studies are required to guide treatment decisions in people with obesity and chronic kidney disease., (© 2020 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Obesity is emerging as a risk factor for COVID-19 disease severity. The impact of the pandemic and knowledge of obesity as a risk factor on the lived experience of people with obesity is not fully understood. The aim of this study was to investigate the impact of the COVID-19 pandemic on people living with severe obesity (BMI ≥35 kg/m 2 ), currently engaged in multi-modal treatment. The primary objectives were to examine the impact of the pandemic on their lived experience from a treatment and psychosocial standpoint and additionally explore their awareness of obesity as a risk factor for COVID-19 disease severity. An in-depth qualitative study was adopted employing semi-structured interviews with open-ended questions. Interpretive thematic analysis was adopted to analyse the data and identify key themes taking a grounded approach. Themes that emerged from the perspective of impact on lived experience were (a) challenge sustaining treatment and (b) psychosocial impact. There was an even split regarding awareness and lack of awareness of obesity as risk factor which itself contributes towards a negative psychosocial impact in most patients. The COVID-19 pandemic is posing a diverse challenge to people with obesity. This has implications for their on-going treatment. From an ethical standpoint, there is a need to fully elucidate the link between obesity and COVID-19, disseminate this information using people friendly language and imagery in a manner that does not exacerbate a harmful psychosocial response or lead to stigmatization., (© 2020 World Obesity Federation.)

Type 2 diabetes mellitus (T2DM) and obesity constitute interwoven pandemics challenging healthcare systems in developed countries, where diabetic kidney disease (DKD) is the most common cause of end-stage renal disease. Obesity accelerates renal functional decline in people with T2DM. Intentional weight loss (IWL) strategies in this population hold promise as a means of arresting DKD progression. In the present paper, we summarize the impact of IWL strategies (stratified by lifestyle intervention, medications, and metabolic surgery) on renal outcomes in obese people with DKD. We reviewed the Medline, EMBASE and Cochrane databases for relevant randomized control trials and observational studies published between August 1, 2018 and April 15, 2019. We found that IWL improves renal outcomes in the setting of DKD and obesity. Rate of progression of DKD slows with IWL, but varying outcome measures among studies makes direct comparison difficult. Furthermore, established means of estimating renal function are imperfect owing to loss of lean muscle mass with IWL strategies. The choice of optimal IWL strategy needs to be individualized; future work should establish the comparative efficacy of IWL strategies in obese people with DKD to better inform such decisions., (© 2019 John Wiley & Sons Ltd.)

Obesity and its related comorbidities can be detrimental for the affected individual, as well as constituting a major challenge to public health systems worldwide. Currently, the most effective treatment option leading to clinically significant and maintained body weight loss and reduction in obesity-related morbidity and mortality is obesity surgery, which is recommended for patients with a body mass index of >40 kg m(-2), or >35 kg m(-2) if obesity-associated comorbidities, such as type 2 diabetes mellitus, are present. This report focuses on the altered eating behaviour after the most common of these operations, the Roux-en-Y gastric bypass. Animal and human experiments designed to understand the underlying physiological mechanisms of altered taste and appetite are discussed., (© 2014 The Authors. Experimental Physiology © 2014 The Physiological Society.)

Roux-en-Y gastric bypass (RYGB) is an efficacious intervention for morbid obesity and has a diabetes-remitting effect in patients with obesity and type 2 diabetes mellitus, which occurs prior to significant weight loss. Roux-en-Y gastric bypass is also associated with early and sustained reductions in the risk factor profile for the progression of diabetic complications. Attention is therefore now being placed on RYGB as a metabolic intervention with the capacity to yield therapeutic benefit in relation to the progression of diabetic complications, such as diabetic kidney disease. As alterations in gut anatomy following RYGB coincide with attendant shifts in downstream enteroendocrine signals with direct and indirect resolutionary effects on the kidney, the concept of an endocrine gut-kidney axis post-RYGB is growing. With the model of a gut-kidney axis in mind, this article summarizes emerging data on the effects of RYGB on risk factors for diabetic kidney disease (hyperglycaemia, dyslipidaemia and hypertension), highlighting a potential role for glucagon-like peptide 1 in risk factor reduction., (© 2014 The Authors. Experimental Physiology © 2014 The Physiological Society.)

Background and Aims: High density lipoprotein (HDL) plays an important role in the transport of cholesterol to the adrenal gland for steroidogenesis and may have actions that modulate response to infection and critical illness. The clinical relevance of HDL level in patients with liver failure remains poorly characterised., Methods: In 164 critically-ill patients with acute (ALF) and acute on chronic liver failure (AOCLF) we evaluated the relationship between HDL levels measured on admission to intensive care unit (ICU) and survival, predisposition to sepsis and adrenocortical function assessed through the cortisol response to short synacthen testing (SST)., Results: In acute liver failure and acute on chronic liver failure, high density lipoprotein levels were significantly lower in non-survivors (P < 0.01). Levels correlated closely with biochemical markers of liver function and the duration of liver failure. However, predictive accuracy was not superior to conventional markers and on multi-variate analysis did not show independent association with survival. Low HDL concentration was not associated with an increased incidence of sepsis either precipitating or complicating ICU admission. Evidence of adrenocortical insufficiency was present in more than half of patients undergoing SST and HDL level but not other lipid parameters correlated closely with cortisol increment after SST (r = 0.364, P < 0.0001)., Conclusions: High density lipoprotein levels are low in patients with liver failure and reflect its severity. Levels are lower in non-survivors but do not offer an advantage as early indicators of prognosis over conventional markers. No evidence of a major predisposing role for infection was found, but findings suggest a close link to adrenal function., (© 2011 John Wiley & Sons A/S.)