Metabolic surgery: A clinical update

Wilson, Rickesha; Aminian, Ali; Tahrani, Abd A

doi:10.1111/dom.14235

Cited by 19 publications

(23 citation statements)

References 198 publications

(195 reference statements)

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“…We have shown previously that patients with IIH have an increased risk of cardiovascular disease compared to women with similar BMI (5). Previous studies showed that bariatric surgery is associated with reduction in CVD and mortality in patients with obesity (24). This further emphasises the importance of not delaying bariatric surgery unnecessarily in women with IIH.…”

Section: Discussionmentioning

confidence: 80%

“…Although bariatric surgery in IIH:WT had high upfront costs (23) it was more cost-effective with time, both saving money and improving quality of life at the 5, 10 and 15 year time horizons considered (24). This analysis provides further evidence in terms of considering different types of weight loss methods, supporting bariatric surgery as a management option to be considered in women with active IIH.…”

Section: Discussionmentioning

confidence: 84%

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Association of Amount of Weight Lost After Bariatric Surgery With Intracranial Pressure in Women With Idiopathic Intracranial Hypertension

et al. 2022

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Background and ObjectivesThe idiopathic intracranial hypertension randomized controlled weight trial (IIH:WT) established that weight loss through bariatric surgery significantly reduced intracranial pressure when compared with a community weight management intervention. This substudy aimed to evaluate the amount of weight loss required to reduce intracranial pressure and to explore the effect of different bariatric surgical approaches.MethodsIIH:WT was a multicenter randomized controlled trial. Adult women with active idiopathic intracranial hypertension and a body mass index ≥35 kg/m2 were randomized to bariatric surgery or a community weight management intervention (1:1). This per-protocol analysis evaluated the relationship between intracranial pressure, weight loss, and the weight loss methods. A linear hierarchical regression model was used to fit the trial outcomes, adjusted for time, treatment arm, and weight.ResultsSixty-six women were included, of whom 23 had received bariatric surgery by 12 months; the mean age was 31 (SD 8.7) years in the bariatric surgery group and 33.2 (SD 7.4) years in the dietary group. Baseline weight and intracranial pressure were similar in both groups with a mean weight of 119.5 (SD 24.1) and 117.9 (SD 19.5) kg and mean lumbar puncture opening pressure of 34.4 (SD 6.3) and 34.9 (SD 5.3) cmCSF in the bariatric surgery and dietary groups, respectively. Weight loss was significantly associated with reduction in intracranial pressure (R2 = 0.4734, p ≤ 0.0001). Twenty-four percentage of weight loss (weight loss of 13.3 kg [SD 1.76]) was associated with disease remission (intracranial pressure [ICP] ≤ 25 cmCSF). Roux-en-Y gastric bypass achieved greater, more rapid, and sustained ICP reduction compared with other methods.DiscussionThe greater the weight loss, the greater the reduction in ICP was documented. Twenty four percentage of weight loss was associated with disease remission. Such magnitude of weight loss was unlikely to be achieved without bariatric surgery, and hence, consideration of referral to a bariatric surgery program early for those with active idiopathic intracranial hypertension may be appropriate.Trial RegistrationClinicalTrials.gov Identifier: NCT02124486; ISRCTN registry number ISRCTN40152829; doi.org/10.1186/ISRCTN40152829.Classification of EvidenceThis study provides Class II evidence that weight loss after bariatric surgery results in reduction in intracranial pressure in adult women with idiopathic intracranial hypertension. This study is Class II because of the use of a per-protocol analysis.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 84%

Association of Amount of Weight Lost After Bariatric Surgery With Intracranial Pressure in Women With Idiopathic Intracranial Hypertension

et al. 2022

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“…Bariatric metabolic surgery (BMS) is the most effective obesity treatment resulting in sustained weight loss with a significant impact on obesity complications 20 . The Royal College of Obstetricians and Gynaecologists guidelines recommended that BMS may be an option for women with PCOS and severe obesity (BMI ≥ 40 or ≥35 kg/m 2 with a high‐risk obesity complication) if standard weight‐loss strategies have failed 21 .…”

Section: Bariatric Metabolic Surgerymentioning

confidence: 99%

How to manage weight loss in women with obesity and PCOS seeking fertility?

Hazlehurst

Singh

Bhogal

et al. 2022

Clinical Endocrinology

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Obesity exacerbates the phenotype of polycystic ovarian syndrome (PCOS) including infertility as well as reducing the efficacy and access to fertility treatments. Weight management is, therefore, a key component of treatment for women with PCOS and coexistent obesity. Many women with PCOS describe significant difficulty losing weight and treatment options are limited. The first‐line treatment is lifestyle interventions though the weight loss and any impact on fertility are limited. No one dietary strategy can be preferentially recommended based on current evidence. While very low energy diets can result in significant weight loss the evidence for impact on fertility is limited. Pharmacotherapy, including a range of treatments can result in marked weight loss and there is some evidence of improved rates of conception including spontaneous and in response to assisted reproduction treatment. As with pharmacotherapy, data regarding bariatric surgery is largely from nonrandomized studies and though the significant weight loss is anticipated to improve fertility the available data prevents firm conclusions. Clinicians and patients must consider the magnitude of weight loss to be targeted as well as the anticipated fertility treatment required and the timeline of treatment when deciding upon the personalized weight loss strategy. Clinicians and patients should be confident in targeting the most appropriate treatment early in the patient's management to avoid unnecessary delays.

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“…Together, these result in decreased risk of several conditions including diabetes, cardiovascular diseases, obstructive sleep apnoea, infertility, and some types of cancer, and in decreased use of medications [15e18]. In recognition that bariatric surgery is more than being simply restrictive and malabsorptive and goes beyond weight loss, it has been termed metabolic surgery [19]. Bariatric surgery has become a common procedure: the International Federation for the Surgery of Obesity and Metabolic Disorders Worldwide Survey of 2018 reported 634,897 bariatric operations were performed globally in 2016 [20].…”

Section: Introductionmentioning

confidence: 99%