The latest medical research on Bariatric Surgery

Obesity, a global health problem, is causally implicated in the development of cardiovascular disease. Bariatric surgeries are effective treatment options for obesity; however, the effectiveness of different bariatric surgeries on cardiac structure and function is not fully understood. We undertook a systematic review and network meta-analysis to comprehensively assess this effectiveness.

PubMed, Web of Science, and EMBASE were searched from their inception until November 11, 2023. Studies that compared bariatric surgeries vis-à-vis non-surgical treatment, placebo, and other bariatric surgeries, as well as reported changes in left ventricular mass or its index (LVM or LVMI) or left ventricular ejection fraction (LVEF), were summarized.

Total 19 studies (17 cohort studies and 2 randomized controlled trials) and 2012 adults were meta-analyzed. Patients receiving gastric bypass had appreciably lowered LVM (weighted mean difference [WMD]: -43.86 g, 95% confidence interval [CI] -61.09 to -26.63, p < 0.01) and LVMI (standardized mean difference: -0.67, 95% CI -1.03 to -0.32, p < 0.01) compared with other bariatric surgeries. No significant improvement in LVEF was noted across all surgeries. The drop in body mass index was most pronounced for biliopancreatic diversion with duodenal switch (WMD -16.33 kg/m2, 95% CI -21.60 to -11.05, p < 0.01).

Our findings of this network meta-analysis indicated that gastric bypass proved best for the improvement in cardiac structure, and there was no obvious improvement in cardiac function for all bariatric surgeries. Further studies are required to better understand the differing effectiveness of bariatric surgeries on cardiac structure and function and the underlying molecular mechanisms.

To describe pathways to eating disorder (ED) development that have been evaluated in people with overweight and obesity.

Four databases were searched to identify studies testing ED development models in adolescents (10-19 years) or adults (>19 years) with overweight and obesity. Explanatory variables were thematically grouped into constructs to describe pathways to each ED outcome.

Of 2226 studies screened, 46 (10 adolescent; 36 adult) were included. Study samples were predominantly female, ranging from 22 to 2236 participants and mean age 12.3 to 56.0 years. In total, 207 explanatory variables were grouped into 18 constructs to summarize 107 pathways that were identified. The most common ED outcome was binge eating (n = 24 studies), followed by global ED psychopathology (n = 10 studies). Across pathways to ED development, negative affect was the most proposed construct, followed by preoccupation with weight/shape and weight stigma.

Pathways to ED development in people with overweight and obesity are complex and may include more than 18 different explanatory factors of which negative affect, preoccupation with weight/shape, and weight stigma are the most common. More research on adolescents, males, and the spectrum of ED in diverse populations is required for early identification and intervention.

Behavioral weight management interventions (BWMIs) are an evidence-based strategy for addressing childhood obesity. Targeting eating behavior traits (EBTs; individual tendencies determining food intake/occasions) could play a pivotal role in improving the effectiveness of these behavioral interventions. The present study describes a systematic review and meta-analysis of the impact of BWMIs on eating behavior traits in children with overweight or obesity.

Seven databases were searched, and eligible studies included randomized controlled trials reporting EBT outcomes following BWMIs delivered to children with overweight or obesity (<18 years of age). Random effects meta-analyses were conducted to compare EBT outcomes for intervention and control groups. Synthesis without meta-analysis (SWiM) was applied for EBTs where meta-analysis was not feasible.

The review identified eight trials characterizing the impact of BWMIs on 15 EBTs. Meta-analyses of data from three trials at intervention completion and post-intervention (average of 28 weeks [±8]) revealed positive short-term increases in dietary restraint (SMD random effect 0.42 [95% CI 0.13, 0.70]). However, these effects were not sustained at follow-up. Improvements in emotional eating, external eating, food responsiveness, and enjoyment of food were shown in studies which could not be pooled quantitatively.

BWMIs in children living with overweight/obesity are beneficial for the improvement of some EBTs at intervention completion including dietary restraint, emotional eating, external eating, food responsiveness, and enjoyment of food. However, this remains a relatively unexplored area and more research is needed to strengthen understanding of the multifaceted impact of child BWMIs on a comprehensive range of EBTs.