Summary How the impact of the COVID‐19 stay‐at‐home orders is influencing physical, mental and financial health among vulnerable populations, including those with obesity is unknown. The aim of the current study was to explore the health implications of COVID‐19 among a sample of adults with obesity. A retrospective medical chart review identified patients with obesity from an obesity medicine clinic and a bariatric surgery (MBS) practice. Patients completed an online survey from April 15, 2020 to May 31, 2020 to assess COVID‐19 status and health behaviours during stay‐at‐home orders. Logistic regression models examined the impact of these orders on anxiety and depression by ethnic group. A total of 123 patients (87% female, mean age 51.2 years [SD 13.0]), mean BMI 40.2 [SD 6.7], 49.2% non‐Hispanic white (NHW), 28.7% non‐Hispanic black, 16.4% Hispanic, 7% other ethnicity and 33.1% completed MBS were included. Two patients tested positive for severe acute respiratory syndrome coronavirus 2 and 14.6% reported symptoms. Then, 72.8% reported increased anxiety and 83.6% increased depression since stay‐at‐home orders were initiated. Also 69.6% reported more difficultly in achieving weight loss goals, less exercise time (47.9%) and intensity (55.8%), increased stockpiling of food (49.6%) and stress eating (61.2%). Hispanics were less likely to report anxiety vs NHWs (adjusted odds ratios 0.16; 95% CI, 0.05‐0.49; P = .009). Results here showed the COVID‐19 pandemic is having a significant impact on patients with obesity regardless of infection status. These results can inform clinicians and healthcare professionals about effective strategies to minimize COVID‐19 negative outcomes for this vulnerable population now and in post‐COVID‐19 recovery efforts.

Objective This study aimed to compare outcomes of treatment strategies for weight regain after bariatric surgery. Methods This is a retrospective analysis of 207 individuals treated for post‐bariatric weight regain at an academic center from January 1, 2014, through November 25, 2019. Percentage body weight loss was compared after 3, 6, 9, and 12 months of treatment among an intensive lifestyle modification (ILM) group, a non–glucagon‐like‐1 receptor agonist (GLP‐1‐RA)‐based weight‐loss pharmacotherapy (WLP) group, and a GLP‐1‐RA‐based WLP group (the latter two groups in conjunction with ILM). Results The percentage body weight loss was significantly different between groups after 3 months (1.4% vs. 2.2% vs. 4.5% [P < 0.001] for ILM, non–GLP‐1‐RA‐based WLP, and GLP‐1‐RA‐based WLP groups, respectively), 6 months (0.8% vs. 2.9% vs. 6.7% [P < 0.001]), and 9 months (−1.6% vs. 5.6% vs. 6.9% [P = 0.007]). There was a significant difference in the percentage of individuals achieving ≥5% weight loss after 3, 6, and 9 months, with most occurring in the GLP‐1‐RA‐based WLP group. In a multiple regression analysis including bariatric surgery type, treatment group was the only significant predictor of percentage weight change. Conclusions GLP‐1‐RA‐based WLP therapies were found to be more effective for treating post‐bariatric weight regain than non–GLP‐1‐RA‐based WLP or ILM, regardless of surgery type.

After bariatric surgery, people frequently do not achieve a healthy weight and/or regain weight. There is limited outcomes data on anti-obesity medications in patients with prior bariatric surgery. GLP-1RAs promote weight loss by decreasing gastric motility and appetite, yet post-prandial levels of GLP-1 are elevated after bariatric surgery. We evaluated weight outcomes in patients with prior bariatric surgery seen in an academic medical center’s weight management program. We compared the following groups: intensive lifestyle modification (ILM) vs. any GLP-1 RA (GLP-1) vs. any non-GLP-1 RA weight loss agents (non-GLP-1) vs. combination of weight loss agents including GLP-1 RA (GLP-1 combination). We included patients with a history of bariatric surgery, at least two clinic visits, and no anti-obesity medications at the initial visit. Data was extracted from the Electronic Medical Record and confirmed by manual chart review. All patients were counseled on lifestyle modification for weight loss. The two GLP-1-based treatment groups had significantly greater % weight loss at 3- and 6-months compared to the ILM group (Figure). In multivariable regression model, adjusting for baseline age and sex, surgery type did not (p=0.2 and p=0.97 for 3- and 6-mo analyses) influence outcome. GLP-1 RA therapies (alone or in combination) are effective for weight loss in patients with prior bariatric surgery, regardless of surgery type. Disclosure C. Gazda: None. J. Almandoz: None. I. Lingvay: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk A/S, Sanofi, TARGET PharmaSolutions, Valeritas, Inc. Other Relationship; Self; Novo Nordisk A/S. J. Clark: None.

Introduction: Parathyroid carcinoma is rare and represents &lt;1% of patients diagnosed with hyperparathyroidism (1). Clinical Cases: We present two cases of incidentally diagnosed parathyroid carcinoma during parathyroidectomy for primary hyperparathyroidism. A 69-year-old female was referred for hypercalcemia of 10.7 mg/dL (normal range 8.4-10.2). She had bone pain, fatigue, and mild depression. She was taking triamterene-hydrochlorothiazide, vitamin D 2000 international units daily, and 1 caltrate daily. Her thiazide diuretic was discontinued, and a repeat calcium was 9.5 mg/dL with a PTH of 79 pg/mL (normal range 14-64). Vitamin D and renal function were normal. A 24 hour urine calcium was elevated at 706 mg/24 hours (normal range 100-321). A bone density revealed osteopenia. Based on the high urine calcium, a thyroid ultrasound was completed and showed an enlarged right parathyroid gland. Intraoperatively, the surgeon found a superior parathyroid gland adherent to the local soft tissues with recurrent laryngeal nerve entrapment. The right superior parathyroid and right thyroid lobe were resected. Pathology demonstrated an infiltrating parathyroid carcinoma. Postoperative monitoring has included: calcium, creatinine, PTH and neck ultrasound every six months without evidence of recurrence. A 79-year-old man was referred for an approximate 18-month history of hypercalcemia. He had a prior kidney stone and constipation. He was not on calcium supplementations or thiazides. On lab testing calcium was 11.0 mg/dl with prior levels of 11.7 mg/dl. PTH was 246 pg/ml and vitamin D was 20.1 ng/ml (normal range 30-80). Imaging was obtained for parathyroid localization. A neck ultrasound and nuclear medicine study showed a right inferior parathyroid adenoma. A bone density revealed osteoporosis. Intraoperatively, the surgeon found a bilobed parathyroid extending intrathyroidal and adherent to the recurrent laryngeal nerve. The right inferior parathyroid, right thyroid lobe, and isthmus were resected. Pathology was consistent with parathyroid carcinoma. The patient had recurrent laryngeal nerve damage with persistent hoarseness postoperatively. Clinical Lessons: Patients with parathyroid carcinoma typically present with symptomatic hypercalcemia with mean levels of 13.5-14 mg/dL and mean PTH values 8.7 times the upper limit of normal (1). Given the rarity of the condition, there are no guidelines for surveillance (1). These cases highlight atypical, mild, and early presentations of an unusual and typically aggressive disease and serve as an example of how to monitor for recurrence. Reference: 1- Stack BC, Bodenner DL. Medical and Surgical Treatment of Parathyroid Diseases An Evidence-Based Approach. Switzerland: Springer, Cham; 2017.http://link.springer.com/chapter/10.10 07/978-3-319-26794-4_31#enumeration. Accessed November 3, 2019.

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