In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity -European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

Physical activity is a cornerstone in the medical management of obesity and could be important for weight loss following bariatric surgery. This review aims to describe the evolution of physical activity following massive weight loss induced by bariatric surgery, and to identify the relationship between physical activity and amount of weight loss. A literature search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self-assessment of physical activity was used in all the studies. Objective measures (pedometry) were used in two studies. The time frame for physical activity assessment varied: before surgery in two publications, after surgery in nine, and longitudinal pre- to post-operative evolution in nine. The latter nine publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss. In conclusion, observational evidence of self-reported physical activity suggests that physical activity increases after bariatric surgery and that physical activity is associated with surgically induced weight loss. However, these findings warrant further evaluation using objective measures of physical activity and testing in controlled trials.

OBJECTIVE:To investigate associations of body composition assessed by bioimpedance analysis and anthropometric indicators of fat repartition with carotid structure and function. DESIGN: Cross-sectional epidemiological study. SUBJECTS: A total of 1014 middle-aged apparently healthy adults participating in the SU.VI.MAX study. MEASUREMENTS: Body composition (fat mass, fat-free mass) was assessed by bioimpedance analysis and anthropometric indicators of fat repartition (waist circumference (WC); waist-hip-ratio (WHR)) were simultaneously collected. Carotid ultrasound examination included measurements of intima-media thickness (IMT) at the common carotid arteries (CCA) and assessment of atherosclerotic plaques in extracranial carotid arteries. Carotid-femoral pulse-wave velocity (PWV) was used as a marker of aortic stiffness. RESULTS: In multivariate analyses adjusted for major known cardiovascular risk factors in addition to age, gender and height, fat-free mass, fat mass (FM), and WC were positively associated with CCA-IMT and lumen diameter. No significant association was found with occurrence of carotid plaques. PWV was only associated with WC. Associations of CCA-IMT and PWV with WC were not significant anymore after further adjustment on body mass index (BMI) or FM. CONCLUSION: WC was the only measurement positively associated with both early atherosclerosis markers such as CCA-IMT and arterial stiffness. Although this association depends on overall adiposity, as assessed by the BMI, it emphasizes the importance of WC in clinical practice and prevention programs as a screening tool for individuals at risk for cardiovascular disease.

Background: Few studies suggest that the combined increase in plasma triglycerides (TG) and in waist circumference (WC), termed 'hypertriglyceridemic waist' (HTGW), is an interesting marker of risk for cardiovascular disease (CVD). Objective: Using cutoffs used for defining HTGW, we examined the prospective association of HTGW with CVD risk in a French cohort of men. Design: Men were participants in the SU.VI.MAX study, an intervention trial testing the impact of an antioxidant supplementation on chronic diseases. Data were collected in 1994-1996 in 3430 men followed up for 7.5 years. Cutoffs used for defining HTGW were WC X90 cm and TG X2 mmol/l. We assessed the relative risk (RR) (95% confidence interval (CI)) of CVD in groups defined according to both WC and TG levels. Results: In this population, 41.2% of the subjects were classified as low WC/low TG, 43.2% as high WC/low TG, 3.5% as low WC/high TG and 12.1% as HTGW. During follow-up, 122 subjects had a CVD event. In this group, HTGW prevalence was 26.2%. After adjustment for age, RR (95% CI) for CVD for the HTGW group showed the highest association with CVD risk: 2.13 (1.21-3.76), using low WC/ low TG as the reference group. Conclusion: HTGW was associated with the risk of CVD after 7.5 years of follow-up in a low-risk middle-aged men population. This marker may be used as a useful clinical tool to screen for men at risk of CVD.

Background: The A risk allele of rs9939609 of the fat mass-and obesity-associated gene (FTO) increases body fat mass. Objective: To examine whether FTO rs9939609 affects obese individuals' response to a high-fat, low-carbohydrate (CHO) (HF) or low-fat, high-CHO (LF), hypo-energetic diet and whether the effect of the FTO variant depends on dietary fat and CHO content. Design: In a 10-week, European, multi-centre dietary intervention study 771 obese women and men were randomized to either LF (20-25% of energy (%E) from fat, 60-65%E from CHO) or HF (40-45%E from fat, 40-45%E from CHO), hypo-energetic diet (measured resting metabolic rate multiplied by 1.3-600 kcal day À1 ). Body weight, fat mass (FM), fat-free mass (FFM), waist circumference (WC), resting energy expenditure (REE), fasting fat oxidation as % of REE (FatOx), insulin release (HOMA-b) and a surrogate measure of insulin resistance (HOMA-IR) were measured at baseline and after the intervention. In all, 764 individuals were genotyped for FTO rs9939609. Results: For A-allele carriers the drop-out rate was higher on HF than LF diet (in AT, P ¼ 0.002; in AT/AA combined, P ¼ 0.003). Among those individuals completing the intervention, we found no effect of FTO rs9939609 genotype on Dweight, DFM, DFFM, DWC or DFatOx. However, participants with TT had a smaller reduction in REE on LF than on HF diet (75 kcal/24 h; interaction: P ¼ 0.0055). These individuals also showed the greatest reduction in HOMA-b and HOMA-IR (interaction: P ¼ 0.0083 and P ¼ 0.047). Conclusion:The FTO rs9939609 may interact with the macronutrient composition in weight loss diets in various ways; carriers of the A allele on LF diet appear to have a lower risk for drop out, and TT individuals have a smaller decrease in REE and greater decrease in HOMA-b and HOMA-IR on LF than on HF diet.

Objective: Weight gain is a risk factor for metabolic syndrome (MS). However, it is not known whether weight fluctuations (WF) have a deleterious effect upon MS risk. In the present study, we investigated this association in subjects participating in the SU.VI.MAX cohort. Methods: MS status was assessed at baseline (1994/1995) and at the end of follow-up (2001/2002) using the National Cholesterol Education Program-Adult Treatment Panel III criteria. WF were estimated with four weight measures during followup. Odds ratio (OR, 95% confidence interval (CI)) for incident MS cases was evaluated according to four WF groups (no WF and tertiles of WF) in 3553 middle-aged subjects. Results: The OR (95% CI) for MS was 2.06 (1.20-3.52) for the third WF tertile compared to the first tertile. This association was independent of confounding variables, especially relative weight change during follow-up. Subjects without WF had a 2.72-fold increase (1.64-4.53) for MS risk compared to the first tertile of WF. For MS components taken separately, similar associations were found for raised blood pressure, low high-density lipoprotein-cholesterol and increased waist circumference. Conclusion: Our results showed that WF was an independent risk factor for MS after 7 years of follow-up. Moreover, subjects without WF were also at risk for MS, due to the highest weight gain during follow-up. These results support the benefits of weight stability and emphasize the importance of weight gain prevention starting from early adulthood.

These prospective data suggest that less sedentary behaviour may partly counteract some of the negative effects of increasing body weight on glucose-insulin homoeostasis.

Objective:Some characteristics of the built environment have been associated with obesity in youth. Our aim was to determine whether individual and environmental socio-economic characteristics modulate the relation between youth overweight and spatial accessibility to physical activity (PA) facilities and to food outlets.Design:Cross-sectional study.Subjects:3293 students, aged 12±0.6 years, randomly selected from eastern France middle schools.Measurements and methods:Using geographical information systems (GIS), spatial accessibility to PA facilities (urban and nature) was assessed using the distance to PA facilities at the municipality level; spatial accessibility to food outlets (general food outlets, bakeries and fast-food outlets) was calculated at individual level using the student home address and the food outlets addresses. Relations of weight status with spatial accessibility to PA facilities and to food outlets were analysed using mixed logistic models, testing potential direct and interaction effects of individual and environmental socio-economic characteristics.Results:Individual socio-economic status modulated the relation between spatial accessibility to PA facilities and to general food outlets and overweight. The likelihood of being overweight was higher when spatial accessibility to urban PA facilities and to general food outlets was low, but in children of blue-collar-workers only. The odds ratio (OR) (95% confidence interval) for being overweight of blue-collar-workers children compared with non-blue-collar-workers children was 1.76 (1.25–2.49) when spatial accessibility to urban PA facilities was low. This OR was 1.86 (1.20–2.86) when spatial accessibility to general food outlets was low. There was no significant relationship of overweight with either nature PA facilities or other food outlets (bakeries and fast-food outlets).Conclusion:These results indicate that disparities in spatial accessibility to PA facilities and to general food outlets may amplify the risk of overweight in socio-economically disadvantaged youth. These data should be relevant for influencing health policies and urban planning at both a national and local level.