Intra-gastric balloon therapy and weight reduction

Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure’s outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients’ records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.

Irisin is a myokine with potential anti-obesity properties that has been suggested to increase energy expenditure in obese patients. However, there is limited clinical information on the biology of irisin in humans, especially in morbidly obese patients undergoing bariatric surgery. We aimed to assess the association of circulating irisin concentrations with weight loss in obese patients undergoing bariatric surgery. This was a pilot, single-centre, longitudinal observational study. We recruited 25 morbidly obese subjects who underwent Roux-en-Y gastric bypass surgery (RYGBP), and blood samples from 12 patients were taken to measure serum irisin concentrations before, and one and nine months after surgery. Their clinical characteristics were measured for one year. The preoperative serum irisin concentration (mean 1.01 ± 0.23 μg/mL, range 0.73–1.49) changed bidirectionally one month after RYGBP. The mean concentration at nine months was 1.11 ± 0.15 μg/mL (range 0.92–1.35). Eight patients had elevated irisin levels compared with their preoperative values, but four did not. Elevations of irisin levels nine months, but not one month, after surgery, were associated with lower preoperative levels (p = 0.016) and worse weight reduction rates (p = 0.006 for the percentage excess weight loss and p = 0.032 for changes in body mass index). The preoperative serum irisin concentrations were significantly correlated with the percentage of excess weight loss for one year (R2 = 0.612; p = 0.04) in our study. Our results suggest that preoperative circulating irisin concentrations may be at least in part associated with a weight loss effect of bariatric surgery in morbidly obese patients. Further large-scale clinical studies are needed to ratify these findings.

This mixed-methods study, using retrospective and prospective data, aimed to explore inhibitors and facilitators of preoperative weight loss in obese patients with colorectal cancer and the potential impact of preoperative weight loss support on SSIs. Patients with a body mass index (BMI) of ≥ 25 kg/m2 were eligible to participate in the weight loss support program. Patient demographic, history, surgical, and outcomes variables were abstracted from the records. Five (5) nurses who provided weight loss support participated in a focus group interview method to explore weight loss inhibitory and promotional factors. Descriptive statistics and qualitative analysis methods were used to examine the data. Twenty-six (26) patients participated in the program for a mean of 45.5 days (SD ± 25.3). Body weight decreased from 79.8 kg (SD ± 15.6) to 75.7 kg (SD ± 14.3), and BMI decreased from 30.4 kg/m² (SD ± 4.7) to 29.4 kg/m² (SD ± 5.0) (P < .05). The average weight loss percentage was 4.9% (SD ± 3.4). In 14 patients, the weight loss percentage was 5% or more. SSIs occurred in 5 of 26 patients (19.2%). Additionally, 4 of 26 patients (15.4%) who had 8.8% or more weight loss did not manifest SSIs. Previous weight loss before the preoperative surgery visits, lack of motivation for weight loss, and time and duration required for weight loss were identified as inhibitory factors, whereas history of successful weight loss experience, knowledge acquisition, family support, and reduced knee and lower back pain were identified as promotional factors for weight loss. Patients in this program lost weight prior to colorectal surgery. Research to further explore the safety and effects of preoperative weight loss in obese patients with colorectal cancer as well as inhibitory and promotional factors for participation and success is needed.

BACKGROUNDOver one-third of Americans carry the diagnosis of obesity, many also with obesity-related comorbidities. This can place patients at increased risk of operative and postoperative complications. The intragastric balloon has been shown to aid in minor weight loss, however its weight recidivism in patients requiring short interval weight loss has not been well studied.AIMTo evaluate weight loss, ability to undergo successful elective surgery after intragastric balloon placement, and weight management after balloon removal.METHODSThis study is a retrospective review of patients in a single academic institution undergoing intragastric balloon placement from 2019-2023 to aid in weight loss prior to undergoing elective surgery. Clinical outcomes including weight loss, duration of balloon placement, successful elective surgery, weight regain post-balloon and post-procedure complications were assessed. Exclusion criteria included those with balloon in place at time of study.RESULTSThirty-three patients completed intragastric balloon therapy from 2019-2023 as a bridge to elective surgery. All patients were required to participate in a 12-month weight management program to be eligible for balloon therapy. Elective surgeries included incisional hernia repair, umbilical hernia repair, inguinal hernia repair, and knee and hip replacements. The average age at placement was 53 years ± 11 years, majority (91%) were male. The average duration of intragastric balloon therapy was 186 days ± 41 days. The average weight loss was 14.0 kg ± 7.4 kg and with an average percent excess body weight loss of 30.0% (7.9%-73.6%). Over half of the patients (52.0%) achieved the goal of 30-50 lbs (14-22 kg) weight loss. Twenty-one patients (64%) underwent their intended elective surgery, 2 patients (6%) deferred surgery due to symptom relief with weight loss alone. Twenty-one of the patients (64%) have documented weights in 3 months after balloon removal, in these patients the majority (76%) gained weight after balloon removed. In patients with weight regain at 3 months, they averaged 5.8 kg after balloon removal in the first 3 months, this averaged 58.4% weight regain of the initial weight lost.CONCLUSIONIntragastric balloon placement is an option for short-term weight management, as a bridge to elective surgery in patients with body mass index (BMI) > 35. Patients lost an average of 14 kg with the balloon, allowing two-thirds of patients to undergo elective surgery at a healthy BMI. However, most patients regained an average of 58% of the original weight lost after balloon removal. The intragastric balloon successfully serves as a tool for rapid weight loss, though patients must be educated on the risks including weight regain.

The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia. Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60months after RYGB. After 36, 48, and 60months, approximately 50% of patients had BMI >30kg/m(2). As for %EWL, 60-month results were poor for 17% of patients (%EWL <50%), good for 40% of patients (%EWL 50-75%), very good for 24% of patients (%EWL from >75-90%), and excellent for 19% of patients (%EWL >90%). The four most significant predictors of BMI change 60months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age. After 60months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

Background: Bariatric surgery is an effective treatment option for severely obese patients who fail to achieve significant weight loss through conventional methods. Laparoscopic sleeve gastrectomy (LSG) and gastric bypass (GBP) have gained popularity due to favorable outcomes and low complications. Aim: The aim of the study was to investigate and compare the impact of LSG and GBP procedures on anthropometric and body composition parameters among severely obese Indian patients. Materials and Methods: A prospective longitudinal study was conducted to compare the impact of LSG ( n = 38) and GBP (Roux-En-Y GBP, Mini GBP, and Sleeve Gastrectomy with Duodeno-Jejunal Bypass) ( n = 38) surgery on anthropometric and body composition parameters, followed up at 3-, 6-, and 12-months postsurgery. Results: A significant reduction in body mass index (BMI) and body weight was observed at 12 months versus baseline with comparable weight loss in both the groups. The percentage of excess weight loss and total weight loss at month 3 and the percent of excess BMI loss at months 3 and 12 were significantly higher in GBP group versus LSG group. Significant reduction in neck, waist, and hip circumference, waist-to-height ratio, fat percentage, and fat-free mass (kg) with a significant rise in total body water percentage and muscle mass percentage from baseline was noted in both groups at all-time points. Conclusion: LSG and GBP procedures have comparable effects on anthropometric and body composition parameters in Indian obese patients. The study provides valuable insights into the potential effectiveness of both bariatric procedures as viable options for the management of obesity in the Indian population.

Preoperative weight loss is not beneficial in obese patients undergoing cervical or lumbar fusion-a national cohort study of 57,961 patients.

Disclosure: M. Shaheen: None. P. Duran: None. D. Pan: None. F. Ramirez: None. M. Nemeth: None. M. Lee: None. T.C. Friedman: None.Obesity represents a significant public health challenge in the United States, disproportionately affecting under-resourced minority populations. The Los Angeles County Department of Health Services (LAC-DHS) primary serves indigent, minority patients of whom a substantial proportion are obese and manage related medical conditions. While Medical group visits have been employed effectively for managing chronic conditions, their efficacy as an intervention for obesity remains underexplored. The study evaluated the efficacy of medical group visits compared to dietitian-led visits (standard of care) in a safety net health care setting using a 12-month randomized trial. A total of 290 adults with average age of 48.5 ± 10.6 years (83.1% female) were recruited from LAC-DHS Martin Luther King Jr. Outpatient Obesity Clinic and randomized into two groups: medical group visits (n=218) and individualized dietitian-led visits (n=72). Changes from baseline in weight (lbs), Body Mass Index (BMI), hemoglobin A1c (HbA1c), total cholesterol, HDL, LDL, triglyceride, quality of life (Physical Component Summary [PCS] and Mental Component Summary [MCS]) and food intake were analyzed using Mann Whitney U test and Chi square test with statistical significance set at p-value < 0.05. At baseline, there were no significant differences in demographic characteristics and other variables between the groups (p>0.05). However, medical group visits resulted in significantly greater reductions in weight (lbs), BMI, HbA1c, total cholesterol, and triglyceride levels (p<0.05). The Medical group showed greater improvements in weight loss, BMI reduction, lower levels of total cholesterol, HbA1c, and triglyceride compared to the dietitian-led group (p<0.05). About 75% of the medical group lost ≥5 Lbs compared to 50% in the dietitian-led group (p=0.001). No significant differences were observed between groups in food intake or quality of life indicators (p>0.05). Within-group analysis indicated that weight loss correlated with reduced levels of LDL and non-HDL cholesterol levels in the dietitian-led group (p<0.05) and with lower HbA1c, triglyceride, and improved mental health score (MCS) in the medical group (p<0.05). The results indicated that the medical group visits were more effective for weight loss among obese patients in an inner-city setting demonstrating significant improvements in weight loss, BMI, lipid profile and HbA1c levels compared to the dietitian-led group. Grants: R24DA017298, U54MD007598, S21MD000103, UL1TR001881Presentation: Sunday, July 13, 2025

BackgroundTo study the predictive value of baseline radiographs and low-field (0.2T) MRI scans for the symptomatic outcome of clinically significant weight loss in obese patients with knee osteoarthritis.MethodsIn this study we hypothesize that imaging variables assessed with radiographs and MRI scans pre-treatment can predict the symptomatic changes following a recommended clinically significant weight reduction Patients were recruited from the Department of Rheumatology, Frederiksberg Hospital, Denmark. Eligibility criteria were: age >18 years; primary osteoarthritis according to ACR; BMI > 28 kg/m2; motivation for weight loss. Subjects were randomly assigned to either intervention by low-energy diet (LED) for 8 weeks followed by another 24 weeks of dietary instruction or control-group. MRI scans and radiographs were scored for structural changes and these parameters were examined as independent predictors of changes in osteoarthritis symptoms after 32 weeks. The outcome assessor and statistician were blinded to group allocation.ResultsNo significant correlations were found between imaging variables and changes in Western Ontario and McMaster Universities Index of Osteoarthritis (Spearman's test, r < 0.33 and P > 0.07).Only the LED group achieved a weight loss, with a mean difference of 16.3 kg (95%CI: 13.4-19.2;P < 0.0001) compared to the control group. The total WOMAC index showed a significant difference favouring LED, with a group mean difference of - 321.3 mm (95%CI: -577.5 to -65.1 mm; P = 0.01). No significant adverse events were reported.ConclusionStage of joint destruction, assessed on either radiographs or low-field MRI (0.2T), does not preclude a symptoms relief following a clinically relevant weight loss in elderly obese female patients with knee osteoarthritis.

PurposeThe aim of the present study was to investigate the effect and safety of a multiphase modified ketogenic diet (MMKD) compared to beinaglutide treatment or lifestyle modification (LM) alone on weight loss in obese patients in China.Patients and MethodsThe present study was conducted in adults with obesity who did not have diabetes with two phases as follows: a 4-week run-in phase to guide diet and exercise, followed by a 12-week intervention phase aiming to lose weight. All participants performed aerobic and resistance exercise, and they were free to select any one of three weight-loss strategies as follows: LM group, 12 weeks of hypocaloric balanced diet (HBD); MMKD group, two cycles of a multiphase diet with each cycle comprised of 2 weeks of ketogenic diet (KD), 2 weeks of transition diet and 2 weeks of HBD; and beinaglutide group, 12 weeks of HBD plus daily injection of beinaglutide (0.4 mg per day). Body weight, body composition and metabolic variables were measured before and after the 12 weeks of treatment.ResultsAll intervention strategies had significant weight loss, and the MMKD led to greater weight loss than LM (difference, −3.7 kg; 95% confidence interval [CI], −6.1 to −1.4; P = 0.001) but not beinaglutide (difference, −1.5 kg; 95% CI, −4.3 to 1.3; P = 0.587). Waist circumference (WC), fat mass, body fat percentage (BFP) and visceral fat area (VFA) were also significantly decreased, and the MMKD had a greater effect on these parameters than LM or beinaglutide. In addition, significant reductions in blood pressure and homoeostatic model assessment of insulin resistance (HOMA-IR) were observed in all three groups, but the MMKD resulted in the most significant improvement in insulin resistance. Almost no adverse events, except for two cases of dizziness, were observed in the MMKD group, which was significantly fewer events than the other two groups.ConclusionThese findings demonstrated that the MMKD is an effective and safe treatment for weight loss, thus providing an additional option for obese Chinese patients.

Bariatric surgery is effective in treating different components of metabolic syndrome including obesity, type 2 diabetes mellitus (T2DM), and hyperlipidemia. But there is no consensus on the ideal biliopancreatic and Roux limb length. This study aimed to explore the effect of biliopancreatic limb and Roux limb lengths during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures on weight loss and T2DM control.We studied the clinical records of 58 patients with metabolic syndrome, T2DM, and body mass index (BMI) 32 to 50 kg/m2 who underwent LRYGB in our hospital. The short limb group (Group A) underwent LRYGB with a limb length of 160 to 200 cm (n = 31) and the long limb group (Group B) underwent LRYGB with a limb length of 210 to 240 cm (n = 27) were compared.The occurrence of acute or chronic internal hernia in Group B was higher than that in Group A (P = .026). Twelve months after surgery, patients from the 2 groups were also observed with reduction in BMI, percent excess weight loss (EWL), preoperative FPG, and HbA1c as compared with these indicators before surgery. However, the differences of these indicators between 2 groups were not significant at the time point of before and 3, 6, 12 months after surgery.LRYGB had significant effects on weight loss and diabetes control in obese T2DM patients. However, there was no significant difference in the short term on weight loss and diabetes control in the patients receiving different limb lengths.

Bariatric surgery is a significant investment for the patient and weight loss team. In some cases, this includes a requirement for pre-operative weight loss despite the lack of evidence for a correlation with successful outcomes. We sought to determine whether weight loss on a short, immediate pre-operative diet, as well as across the medical weight loss program, would correlate with 1-year outcomes of patients undergoing laparoscopic sleeve gastrectomy (LSG). All patients having a LSG between March 2013 and March 2016 were reviewed. Demographics and biometrics [weight, body mass index (BMI)] were collected at initial, day of surgery and follow-up (2weeks, 6weeks, 4months, and 1year). Pre-operative weight loss was determined both cumulative (initial to day of surgery) and for the pre-operative diet (2weeks). Weight loss and percent excess weight loss (%EWL) were calculated and correlated at all time points. A total of 127 patients were reviewed for this study. The mean %EWL at 1-year follow-up was 47 ± 18%. Weight loss achieved on a 2-week pre-operative diet did not correlate with weight outcomes at 1-year follow-up (r = 0.134, p = 0.40); however, cumulative pre-operative weight loss had a modest correlation (r = 0.443, p < 0.01). Post-operative %EWL at 4months had the best correlation with longer term weight loss (r = 0.730, p < 0.01). Pre-operative performance is not a good predictor for 1-year outcomes in LSG. Better correlation was observed in %EWL at post-surgery visits. Following the patient's trajectory post-operatively may provide a window for intervention to improve weight loss.

Intra-gastric balloon (IGB) therapy is the most established endoscopic treatment of obesity, but there is a paucity of literature on long-term efficacy. This study aims to evaluate the short- and long-term weight loss efficacy of IGB. Double-blinded RCT with 6-month IGB vs with sham endoscopy, in body mass index (BMI) 27-35 patients. Anthropometric, fasting glucose, and lipid profile measurement as early outcomes (up to 2years) and 10-year follow-up. Primary outcomes were total body weight loss (kg) and BMI. Secondary outcomes were new-onset diabetes mellitus, other new comorbidities, and willingness for further intervention. Initial RCT recruited 99 patients (50 IGB vs 49 sibutramine group). Forty-nine patients (26 IGB vs 23 control group) participated in a 10-year review (follow-up rate of 51.6%). Total body weight loss at 6 (9.75 vs 7.48kg, p = 0.03), 12 (6.52 vs 4.42kg, p = 0.05), 18 (5.42 vs 3.57, p = 0.32), and 24months (4.07 vs 2.93kg, p = 0.56) favored the IGB group. Total weight loss (TWL) at 10years (0.03 vs - 2.32kg, p = 0.05) and %TWL (- 0.16 ± 12.8% vs - 2.84 ± 5.6%, p = 0.39) were not significantly different between groups. Follow-up BMI (30.97 ± 1.6 vs 30.38 ± 1.8kg/m2, p = 1.00) was similar. At 10years, new-onset diabetes mellitus, sleep apnoea, metabolic syndrome, and arthralgia were not significant (p > 0.05). Twenty-three (81%) IGB group vs 13 (56%) control expressed a willingness for further intervention (p < 0.01). IGB delivers weight loss to 2years and is superior to control. However, new comorbidity development is not significantly different at 10years. Patient that received IGB therapy were subsequently more willing for further bariatric metabolic intervention.

Extremes of body mass index and mortality among Asian peritoneal dialysis patients.

Plasma brain-derived neurotrophic factor in women after bariatric surgery: a pilot study