Background Negative lifestyle behaviors are associated with an increased risk of adverse outcomes from coronavirus disease (COVID-19). This study aimed to assess lifestyle changes affecting weight, sleep, mental health, physical activity, and dietary habits prospectively from before COVID-19 to during lockdown. Methods A total of 297 Saudi women, aged 19–30 years (mean age, 20.7 ± 1.4 years), were interviewed at two time points, before and during the quarantine. The data collected included anthropometrics, sociodemographic data, clinical history, food frequency questionnaire responses, Pittsburgh Sleep Quality Index scores, Global Physical Activity Questionnaire (GPAQ) responses, and Perceived Stress Scale measures. In addition, during quarantine, COVID-19 and nutrition-related information and Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores were collected. Multivariate multinomial logistic regression analysis was used to examine the indicators of weight gain and loss from before COVID-19 (baseline) until during lockdown. Results Although approximately half of the participants did not report a weight change, 30% revealed weight loss and 18%, weight gain. The variables associated with increased weight gain were self-quarantine since COVID-19 started (OR: 5.17, 95% CI: 1.57–17.01, p = 0.007), age (OR: 1.53, 1.03–2.28, p = 0.04), and stress at baseline and during lockdown (OR: 1.15, 1.03–1.29, p = 0.01; OR: 1.10, 1.01–1.19, p = 0.03, respectively). The variables associated with a reduced risk of weight gain were the GPAQ score during lockdown (OR: 0.16, 0.04–0.66, p = 0.01), coffee consumption (OR: 0.36, 0.19–0.67, p = 0.01), and total sleep time (OR: 0.70, 0.51–0.97, p = 0.03). Conclusion While most young Saudi women experienced no weight change during the COVID-19 lockdown, one-third lost weight and a significant proportion gained weight. Factors associated with weight, such as stress, sleep hours, physical activity, and coffee consumption, highlight the need to carefully consider those at risk during future circumstances that may require lockdowns. These factors could also aid in implementing policies for future lockdowns and support those most at risk of gaining weight.

Background: Obesity surgery is effective for obesity and type 2 diabetes (T2DM). However, many patients do not achieve sustained diabetes remission following surgery. Liraglutide, a GLP-1 analogue, improves glycaemia and reduces body weight. Our aim was to evaluate the safety and effectiveness of Liraglutide 1•8 mg in patients with persistent or recurrent T2DM after surgery. Methods: In this double-blind, placebo-controlled trial, adults with HbA1c >48 mmol/mol (>6•5%) at least one year after surgery were randomised 2:1 to once-daily subcutaneous Liraglutide 1•8 mg or Placebo, together with a reduced-calorie diet and increased physical activity. The primary outcome was the change in HbA1c from baseline to 26 weeks. EudraCT 2014-003923-23 and ISRCTN 13643081. Findings: Between February 2016 and November 2018, we assigned 80 patients to receive Liraglutide (n=53) or Placebo (n=27). Seventy-one (89%) participants completed the study up to week 26 (complete-cases population). A multivariable linear regression analysis taking baseline HbA1c and type of surgery into account as covariates showed that Liraglutide was associated with a difference in HbA1c change of-13•3 mmol/mol or-1•22%, 95% CI-19•7 to-7•0, p<0•001) vs Placebo at 26 weeks. Liraglutide was associated with a difference in the change of weight of-4•23 kg [95% CI-6•81 to-1•64, p<0•001) vs Placebo. No significant influence of type of surgery was noted. Interpretation: This is the first randomised controlled trial of adjunctive Liraglutide treatment in patients with diabetes mellitus after metabolic surgery. The results support the use of Liraglutide therapy in this clinical context. Funding: JP Moulton Charitable Foundation 3 surgery. We have previously shown that the acute peripheral administration of the GLP-1 RA Exendin-4 in rodent models of RYGB has additive effects to the already enhanced endogenous GLP-1 secretion as demonstrated by an additional reduction in food intake 11. Indeed, data from retrospective non-randomised studies in humans support this hypothesis: the administration of GLP-1 RAs in patients with and without T2DM and a suboptimal response to metabolic surgery was associated with weight loss and glycaemic improvements 12-15. This RCT was therefore designed to investigate the safety and efficacy of pharmacological administration of the GLP-1 RA Liraglutide on glycaemic control in patients with persistent or recurrent T2DM after RYGB or VSG surgery. Methods Study population This was a prospective randomised double-blinded placebo-controlled clinical trial. Eighty patients with obesity and persistent or recurrent T2DM that had undergone RYGB or VSG surgery at least 12 months before randomisation were recruited from the

Objective: The aim of this study was to examine the clinical efficacy and safety of the duodenal-jejunal bypass liner (DJBL) while in situ for 12 months and for 12 months after explantation. Summary Background Data: This is the largest randomized controlled trial (RCT) of the DJBL, a medical device used for the treatment of people with type 2 diabetes mellitus (T2DM) and obesity. Endoscopic interventions have been developed as potential alternatives to those not eligible or fearful of the risks of metabolic surgery. Methods: In this multicenter open-label RCT, 170 adults with inadequately controlled T2DM and obesity were randomized to intensive medical care with or without the DJBL. Primary outcome was the percentage of participants achieving a glycated hemoglobin reduction of ≥20% at 12 months. Secondary outcomes included weight loss and cardiometabolic risk factors at 12 and 24 months. Results: There were no significant differences in the percentage of patients achieving the primary outcome between both groups at 12 months [DJBL 54.6% (n = 30) vs control 55.2% (n = 32); odds ratio (OR) 0.93, 95% confidence interval (CI): 0.44–2.0; P = 0.85]. Twenty-four percent (n = 16) patients achieved ≥15% weight loss in the DJBL group compared to 4% (n = 2) in the controls at 12 months (OR 8.3, 95% CI: 1.8–39; P = .007). The DJBL group experienced superior reductions in systolic blood pressure, serum cholesterol, and alanine transaminase at 12 months. There were more adverse events in the DJBL group. Conclusions: The addition of the DJBL to intensive medical care was associated with superior weight loss, improvements in cardiometabolic risk factors, and fatty liver disease markers, but not glycemia, only while the device was in situ. The benefits of the devices need to be balanced against the higher rate of adverse events when making clinical decisions. Trial Registration: ISRCTN30845205. isrctn.org; Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership reference 12/10/04.

Objective:To assist healthcare providers in evidence-based clinical decision-making for the management of overweight and obese adults in Saudi Arabia.Methods:The Ministry of Health, Riyadh, Kingdom of Saudi Arabia assembled an expert Saudi panel to produce this clinical practice guideline in 2015. In collaboration with the methodological working group from McMaster University, Hamilton, Canada, using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, which describes both the strength of recommendation and the quality of evidenceResults:After identifying 11 questions, corresponding recommendations were agreed upon as guidance for the management of overweight and obese adults. These included strong recommendations in support of lifestyle interventions rather than usual care alone, individualized counseling interventions rather than generic educational pamphlets, physical activity rather than no physical activity, and physical activity in addition to diet rather than diet alone. Metformin and orlistat were suggested as conditional recommendations for the management of overweight and obesity in adults. Bariatric surgery was recommended, conditionally, for the management of obese adults (body mass index of ≥40 or ≥35 kg/m2 with comorbidities).Conclusions:The current guideline includes recommendation for the non-pharmacological, pharmacological, and surgical management of overweight and obese adults. In addition, the panel recommends conducting research priorities regarding lifestyle interventions and economic analysis of drug therapy within the Saudi context, as well as long term benefits and harms of bariatric surgery.