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Introduction: Obesity is a chronic disease that increases cardiovascular and metabolic morbidity and mortality, decreases quality of life, and increases health care costs. While the role of lifestyle behavioral factors in the development of obesity is well established, the role of traumatic life events, including violence, is unclear. The purpose of this study was to describe situations of traumatic life events reported by patients undergoing a bariatric surgery program, with a particular focus on sexual violence and its clinical correlates., Methods: In this cross-sectional study, patients with grade II or III obesity, admitted to our digestive surgery department for bariatric surgery from August 01, 2019, to December 31, 2020, underwent a structured interview by a trained psychologist to describe the history of traumatic life events self-reported by the patients. The primary endpoint was the presence of a history of sexual violence (SV). Multivariate logistic regressions were applied to identify independent risk factors for SV., Results: Of the 408 patients interviewed, 87.1% reported at least one traumatic life event and 33.1% reported having had an SV in the past. Female gender (aOR = 7.44, 95% confidence interval: 3.85-15.73; p < 0.001) and higher body mass index (1.05, 1.02-1.08; p = 0.002) were associated with an increased risk of SV. Male gender was associated with a higher risk of difficulties including sports cessation, depression, and work-related distress., Conclusion: In the context of obesity, psychosocial trauma is characterized by a high frequency and several gender specificities that must be taken into account in the management of these patients., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Sleeve gastrectomy (SG) induces weight loss but its effects on body composition (BC) are less well known. The aims of this longitudinal study were to analyse the BC changes from the acute phase up to weight stabilization following SG. Variations in the biological parameters related to glucose, lipids, inflammation, and resting energy expenditure (REE) were concomitantly analysed. Fat mass (FM), lean tissue mass (LTM), and visceral adipose tissue (VAT) were determined by dual-energy X-ray absorptiometry in 83 obese patients (75.9% women) before SG and 1, 12 and 24 months later. After 1 month, LTM and FM losses were comparable, whereas at 12 months the loss of FM exceeded that of LTM. Over this period, VAT also decreased significantly, biological parameters became normalized, and REE was reduced. For most of the BC, biological and metabolic parameters, no substantial variation was demonstrated beyond 12 months. In summary, SG induced a modification in BC changes during the first 12 months following SG. Although the significant LTM loss was not associated with an increase in sarcopenia prevalence, the preservation of LTM might have limited the reduction in REE, which is a longer-term weight-regain criterion.

The obese patient is at risk of perioperative complications including difficult airway access (intubation, difficult or impossible ventilation), and postextubation acute respiratory failure due to the formation of atelectases or to airway obstruction. The association of obstructive sleep apnoea syndrome (OSA) with obesity is very common, and induces a high risk of per and postoperative complications. Preoperative OSA screening is crucial in the obese patient, as well as its specific management: use of continuous positive pre-, per- and postoperative pressure. For any obese patient, the implementation of difficult intubation protocols and the use of protective ventilation (low tidal volume 6-8mL/kg of ideal body weight, moderate positive end-expiratory pressure of 10cmH20, recruitment manoeuvres in absence of contra-indications), with morphine sparing and semi-seated positioning as much as possible are recommended, associated with a close postoperative monitoring. The dosage of anaesthetic drugs is usually based on the ideal body weight or the adjusted body weight and then titrated, except for succinylcholine that is dosed according to the total body weight. Monitoring of neuromuscular blockers should be used where appropriate, as well as monitoring of the depth of anaesthesia, especially when total intravenous anaesthesia is used in association with neuromuscular blockers. The occurrence of intraoperative awareness is indeed more frequent in the obese patient than in the non-obese patient. Appropriate prophylaxis against venous thromboembolism and early mobilisation are recommended, if possible included in an early rehabilitation protocol, to further reduce postoperative complications., (Copyright © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)

Objective: The threefold aim was to (1) compare areal bone mineral density (aBMD), bone turnover markers, and periostin levels in young women with either anorexia nervosa (AN) or obesity (OB) and controls (CON); (2) model the profiles according to age; and (3) determine the parameters associated with aBMD., Subjects and Methods: One hundred and fifty-two young women with ages ranging from 16.0 to 27.0 years were subdivided into 3 groups (AN, OB, CON). The CON group was age-matched by ±6 months. aBMD, bone turnover markers, and periostin levels were evaluated., Results: aBMD modeling showed that hip aBMD was higher in OB than in the other 2 groups from 19 years, and AN presented lower values than CON from 21 years. aBMD at the lumbar spine was higher in older OB and CON women, starting from 20 to 22 years, but in AN the difference with the other 2 groups increased with age. Periostin levels were lower in OB than in AN or CON, but no variation with age was observed. Compared with controls, OB and AN presented similarly lower markers of bone formation, although markers of bone resorption were lower in OB and higher in AN. A modeling approach showed that markers of bone formation and resorption were lower in older than in younger CON, whereas the values of these bone markers remained relatively constant in AN and OB. In all groups, lean body mass (LBM) was the parameter most positively correlated with aBMD., Conclusion: This study demonstrated that weight extremes (AN or OB) influence aBMD, bone remodeling and periostin profiles. Moreover, factors related to aBMD were specific to each condition, but LBM was the parameter most consistently associated with aBMD., (© Endocrine Society 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Dual-energy X-ray absorptiometry (DXA) is used in clinical routine to determine areal bone mineral density (aBMD). However, it is not clear whether excessive fat mass or substantial weight loss modify the aBMD measurements. The aim of this study was to evaluate the effect of soft tissue composition on aBMD measured by DXA using a clinical model (i.e. sleeve gastrectomy: SG) that induces substantial body weight loss., Methods: Areal bone mineral density and body composition (fat mass: FM and lean tissue mass: LTM) were determined by DXA in 41 obese patients (33 women, 80.5%) just before SG and 1 month later., Results: One month after SG, mean weight loss was -9.8 ± 2.6 kg, with a significant decrease in LTM and FM (kg) ranging from -7.3% to -9.5%. The relative variation in aBMD was increased at the lumbar spine (2.45 ± 3.44%) and decreased at the hip (-1.47 ± 2.28%), whereas no variation was observed for the whole body and radius. The variation in aBMD at the lumbar spine was inversely correlated with variations in weight, whole-body FM and trunk FM, but not LTM., Conclusion: This study shows evidence of a potential effect of body composition, particularly FM, on aBMD. However, given the modest change in aBMD, which was close to the precision error of aBMD measurements, it appears that significant weight loss does not have a clinically significant impact on the evaluation of aBMD using DXA., (© 2019 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

Knowledge about animal models for metabolic study is the basis of research in this area. This work aims to review the main animal models used in the study of obesity and metabolic syndrome. For this, we performed a search in the Pubmed database using the terms "animal models", "obesity", "metabolic syndrome" and "bariatric surgery". Several species of animals can be used for the study of metabolic disorders. However, rodents are the most commonly used, both as monogenic models and as diet-induced obesity (DIO) ones. Monogenic animals are the best choice if only one aspect is being evaluated. DIO animals tend to better demonstrate the interaction between disease, environment and genetics. However, they are still not fully effective in providing understanding of all disease mechanisms.

Objective: The aim of this study was to evaluate the prevalence and the kind of psychoactive substances consumed by people with obesity., Methods: Patients were included at their first visit for bariatric surgery. Socio-demographic characteristics, anxiety, depressive disorders and psychoactive substance consumption were assessed. The prevalence of psychoactive substance consumption was compared to that of the general population reported by the French National Institute of Prevention and Health Education., Results: One hundred (100) patients were consecutively recruited: 60 women (mean age 41 ± 14 years) and 40 men (mean age 46 ± 13 years). Sixty-seven percent of subjects consumed alcohol. Consumption rates of cannabis (21% vs. 10%), cocaine (7.0% vs. 0.8%) and amphetamine (6.0% vs. 0.3%) were significantly (p < .0001) higher in people with obesity than in the general population., Conclusions: People with obesity have an excess risk of amphetamine, cocaine and cannabis consumption. This consumption may increase the risk of cardiovascular and psychiatric morbidity and should therefore be detected before surgery.

Few studies have investigated changes in health-related quality of life (HRQOL) in surgical patients who have undergone a laparoscopic sleeve gastrectomy. Prospective data were obtained from 78 consecutive patients undergoing laparoscopic sleeve gastrectomy (LSG; mean age, 42.4 years; mean body weight, 131 kg; mean body mass index (BMI), 47 kg/m(2) (24.4% of superobese patients)). Two HRQOL questionnaires were administered preoperatively and 12 months postsurgery: the generic Medical Outcomes Study Short Form-36 and the weight-specific IWQOL-Lite questionnaire. Excess weight loss at 12 months was 57.18%. No mortality was recorded. HRQOL scores revealed a significant improvement in all areas of both questionnaires. However, changes in HRQOL were not associated consistently with amount of weight loss. Laparoscopic sleeve gastrectomy is an effective and safe procedure, with positive changes in health-related quality of life as well as weight reduction. A fruitful area for future research is the investigation of long-term changes in HRQOL after LSG.

Gastric bypass (GBP) has proved its efficacy 30 years ago in the management of diabetes mellitus (T2DM) for severe obese patients. More recently, interesting results have been published after sleeve gastrectomy (SG) in the same indication. Between 2005 and 2008, three bariatric centers have prospectively collected the data of T2DM patients treated by laparoscopic gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Effects on hemoglobin A1c (HbA1c), pharmacological treatment and excess weight loss after 1 year of surgery have been analyzed. All patients (35 LGBP and 33 LSG) were treated with oral anti-diabetics (OAD) or insulin before surgery (32 OAD and three insulin in LGBP group and 27 OAD and six insulin in LSG group). The average body mass index (BMI) in the LGBP group was 47.9 and 50.6 kg/m² in the LSG group. At 1 year after surgery, the average HbA1c lost was 2,537 in the GBP group and 2,175 in the SG group. T2DM had resolved (withdrawal of pharmacological treatment) in 60% of the LGBP group and 75.8% of the LSG group. Reduced use of pharmacological therapy was noted in 31.42% of the LGBP group and 15.15% of the LSG group. Percentage excess weight loss and BMI lost were 56.35% and 29.75% in the LGBP group and 60.11% and 29.80% in the LSG group, respectively. During short-term follow-up, the impact on regulation of HbA1c blood level of LGBP or LSG is important. At 1 year after surgery, LSG seems to be as effective as LGBP for the management of T2DM in severely obese patients.

Bariatric surgery is booming in France and there is increasing interest in developing new surgical techniques. It is essential to manage such surgery in a multidisciplinary fashion: rigorous coordination is required along with adaptability to the local care available. Organization into centers of excellence is encouraged, and good communication between the hospital medicosurgical team and the private practitioners are highly recommended. Multidisciplinary meetings for therapeutic decisions are invaluable because they allow the direct exchange of information between the hospital staff and private practitioners. The selection of one member of the hospital team as liaison for each patient can facilitate the organization of postsurgical follow up Long-term follow-up of these patients is mandatory but often very difficult to maintain beyond one year. Organized coordination between hospital and private practitioners should improve this follow-up., (Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.)

Background: The TANTALUS system (MetaCure Ltd.) is a minimally invasive implantable gastric stimulation modality that does not exhibit malabsorptive or restrictive characteristics. The device applies gastric contractility modulation (GCM) signals to the stomach antrum. The signals are delivered in synchronization to the native electrical activity of the stomach during meals. Retrospective analysis of previous studies indicated that type 2 diabetes mellitus (T2DM) subjects on oral medication with hemoglobin A1c (HbA1c) between 7.5% and 9.5% are the population with most potential benefit from the treatment. The current study includes subjects enrolled prospectively within that range of HbA1c., Aim: To prospectively investigate the potential effect of the TANTALUS system on glycemic control and weight in overweight subjects with T2DM., Methods: In this European multicenter, open-label study, 13 T2DM obese (6 male, 7 female, BMI 37.2 +/- 1.0 kg/m(2), range 30.4-44.0 kg/m(2)) subjects treated with oral antidiabetic medications but with poor glycemic control (HbA1c > or = 7%, range 7.3-9.5%) were implanted laparoscopically with the TANTALUS system., Results: Thirteen subjects that had completed 3 months of treatment showed a significant reduction in HbA1c from 8.0 +/- 0.2% to 6.9 +/- 0.1% (p < 0.05), whereas fasting blood glucose decreased from 175 +/- 6 mg/dL to 127 +/- 8 mg/dL (p < 0.05). The glycemic improvement was accompanied by reduction in weight from 104.4 +/- 4.4 kg to 99.7 +/- 4.8 kg, and in waist circumference from 122.3 +/- 3.2 cm to 117.0 +/- 3.0 cm., Conclusions: Interim results with the TANTALUS system suggest that this stimulation regime can potentially improve glucose levels and induce moderate weight loss in obese T2DM subjects on oral antidiabetic therapy with poor glycemic control. Further evaluation is required to determine whether this effect is due to induced weight loss and/or due to direct signal-dependent mechanisms.

Background: One limit of the Roux-en-Y gastric bypass (GBP) is the preclusion of exploring the bypassed stomach with conventional endoscopy and radiological studies. In this study, we explored the feasibility, safety, and weight progression of a new bariatric procedure that eliminates this inconvenience., Methods: Eleven 40- to 50-kg Yorkshire pigs underwent laparoscopic sleeve gastrectomy and Roux-en-Y duodeno-jejunal bypass (SG-DJBP). Weight was monitored at postoperative days 15 and 30 and after 3 months; weight progression was compared with an identical group that underwent a sham procedure or GBP. At autopsy, surgical site was evaluated at microscopic and macroscopic level., Results: Mean operating time was 66 +/- 5.76 min. All the survivors tolerated the procedure well, except one subject that experienced a gastric leak from the stapler line. The SG-DJBP had a had significantly slower weight gains than the sham group (P = 0.005). The absence of histological abnormalities in the duodenal wall was confirmed at autopsy., Conclusion: SG-DJBP is feasible and produces effects of weight progression comparable to those of GBP. Being a combination of previously standardized procedures, we are confident to propose this procedure as a bariatric alternative in humans. Long-term follow-up will be required to establish the efficacy on weight loss in humans.

The aim of this study is to look for correlation between a physiological variable (skin conductance, SCL) and cognitive variables (reaction time, RT and productivity score) obtained in a memory task. Subjects were 17 females, including 7 patients and 10 controls. Patients were recruited among women who went to a clinic for alimentary disorders because of obesity and volunteered for this study; controls were normal women of comparable age without any alimentary problem. Tonic variations of SCL were recorded by a computerized polygraph during the execution of the cognitive task, which consisted of a computerized presentation of frequent, everyday used words evenly divided according to an alimentary/nonalimentary content and to a high/low imagery quality. The acquisition session was followed by an immediate recognition session where subjects were asked to identify the previously presented words among an equal number of similar words not included in the acquisition list. The two session series (acquisition and recognition) were repeated three times to evaluate the learning curve and habituation. This same procedure was separately performed with high imagery alimentary/nonalimentary words and with another list of low imagery alimentary/nonalimentary words. During the recognition tasks, both RT and productivity scores were recorded. A correlation analysis between cognitive and physiological variables was carried out to explore how subjects with different attitudes to food react in cognitive and somatic terms when exposed to verbal stimuli concerning this topic and to neutral verbal stimuli. Results show that obese patients have a different emotional activation in front of these verbal stimuli where both the cognitive activity and the somatic responses are affected by their involvement with the verbal stimuli. On the contrary, the imagery effect does not seem to be influenced by the content and by the idiosyncratic reactions to it of the specific groups of subjects.

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Background: Experience was gained management of intra-gastric migration of adjustable gastric banding.Methods: From July 1996 to January 2003, 4236 patients who underwent laparoscopic adjustable gastric banding were proposed for routine follow-up. Gastrograms were performed in case of band adjustment. Radiological controls and endoscopy were performed according to symptoms.Results: A total of 45 cases of band migration (1.6%) were diagnosed during follow-up. All but one of the migrated bands were removed laparoscopically either by a dissection outside the stomach or through a short gastrotomy. Mortality was 0% and morbidity 8% (n = 4).Conclusion: The risk of an intragastric band migration remains low in the literature but could grow on account of the longer follow-up of patients. The retrieval of the band is the gold standard and must be planned promptly or delayed according to symptoms. [ABSTRACT FROM AUTHOR]

Introduction: La carence en vitamine D (Vit D), fréquente en cas d’obésité, peut s’associer à une augmentation du risque cardiovasculaire. Les procédures de chirurgie bariatrique risquent d’aggraver des carences pré-existantes. Nous avons évalué la prévalence, les co-déficits et les conséquences de la carence en Vit D chez des patients consultant pour demande de chirurgie bariatrique. Matériels et méthodes: Notre analyse rétrospective porte sur 268 patients (fonction rénale normale, absence de traitement vitamino-calcique) consultant pour demande de chirurgie bariatrique depuis le 01/01/2009. Leur bilan a comporté examen clinique, HGPO, et dosages de 25OH-Vit D, parathormone (PTH), calcium, phosphore, albumine, phosphatases alcalines, magnésium, fer sérique, ferritine, folates, Vit B12, Vit A, sélénium, zinc. Résultats: Notre effectif de 268 sujets (74 % femmes) présente les caractéristiques suivantes : âge, 40,4±12,9 années ; IMC, 43,1±6,0kg/m2; tour de taille, 128,0±1,4cm. Une carence en 25OH-Vit D (taux < 10ng/ml) existe chez 9,4 % et une insuffisance (taux entre 10 et 30 ng/ml) chez 81,7 % des sujets. Le taux de 25OH-Vit D est significativement corrélé aux paramètres anthropométriques (IMC, r =−0,24, p=0,0007 ; tour de taille, r =−0,24, p=0,0011 ; masse grasse r =−0,20, p=0,0072) et à la glycémie à jeun (r =−0,23, p=0,0017). Dans un modèle de régression linéaire multiple, on observe une association significative entre 25OH-Vit D et masse grasse (p=0.006) et glycémie à jeun (p=0.045). Concernant le métabolisme phosphocalcique, il existe une corrélation négative entre le taux de 25OH-Vit D et la PTH (r =−0,25, p=0,016) et une tendance pour une corrélation positive avec la phosphorémie (r=0,19, p=0,07) et négative avec les phosphatases alcalines (r =−0,12, p=0,09). Le taux de 25OH-Vit D est positivement corrélé à celui de Vit A, une autre vitamine liposoluble (r =−0,26, p=0,0005) et de zinc, qui dépend de l’absorption des graisses (r =−0,17, p=0,01). Discussion: Nos résultats sont en faveur d’un lien indépendant entre 25OH-Vit D, adiposité et glycémie. Les perturbations du bilan phospho-calcique font suspecter un retentissement osseux potentiel. [Copyright &y& Elsevier]

Résumé Introduction La gastrectomie en manchon ( sleeve gastrectomy ) utilisée dans le traitement des obésités morbides diéto-résistantes entraîne une perte de poids importante qui comprend aussi une perte de masse musculaire. Il est donc logique de proposer une activité physique adaptée à ces sujets pour protéger leur masse maigre et les redynamiser. Nous avons voulu déterminer si l’exercice améliore aussi la perte de poids majeure entraînée par le geste chirurgical. Matériels et méthodes Deux groupes d’obèses appariés pour l’IMC initial et l’âge ont été comparés. Le premier est constitué de sujets ne réalisant qu’une gastrectomie en manchon, le second des sujets réalisant en postopératoire un entraînement en endurance douce. Résultats Les deux courbes de perte de poids s’écartent significativement (Anova p = 0,037) sur une observation de 30 mois postopératoires. La perte de poids à 30 mois est plus importante dans le groupe « sleeve + LIPOXmax » (en % du poids initial −35,78 ± 3,93 vs −26,20 ± 2,26 p = 0,039 ; en poids brut −55,13 ± 9,06 kg vs −31,07 ± 3,28 p = 0,012). Conclusion Le groupe sleeve + LIPOXmax présente une meilleure moyenne de perte de poids après 30 mois postopératoires, devançant l’autre groupe sleeve de +4,87 kg, ce qui plaide en faveur de l’existence d’un effet additif des deux stratégies. Summary Introduction Sleeve gastrectomy is a major therapy of morbid obesity, but recent reports suggest that its effects on weight loss are improved when patients increase their muscular activity. We present the first longitudinal study of sleeve associated or not with regular exercise prescribed and followed over 30 months. Methods Two groups of obese patients matched for baseline BMI and age were compared. The first group was treated by sleeve gastrectomy alone and patients did not increase their muscular activity. The second group practiced 3 × 45 min/week endurance exercise targeted at the level of maximal lipid oxidation (LIPOXmax) after sleeve gastrectomy. Results Results show a significant difference between the two weight loss curves (ANOVA P = 0.037). Weight loss at 30 months was higher in the group practicing exercise (expressed in % of initial weight −35.78 ± 3.93 vs. −26.20 ± 2.26 P = 0.039; expressed in crude weight: −55.13 ± 9.06 kg vs. −31.07 ± 3.28 P = 0.012). These results need to be confirmed on a larger sample but they are consistent with the hypothesis that the long lasting, moderate, and slightly progressive weight-reducing action of LIPOXmax endurance training is observed after sleeve gastrectomy and synergistically adds its effect to that of surgery. [ABSTRACT FROM AUTHOR]