Abstract P084: Influence Of Amount And Rapidity Of Weight Loss On The Risk Of Subsequently Regaining Weight And Drop-out From Treatment Among Patients With Severe Obesity Dieting In Hospital Without Bariatric Surgery

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Tomohide Yamada ◽  
Kazuo Hara ◽  
Takashi Kadowaki
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Severe Obesity ◽  
Cohort Analysis ◽  
Antidepressant Medication ◽  
Drop Out ◽  
Rapid Weight Loss ◽  
Obese Patients ◽  
Duration Of Hospitalization ◽  
Severely Obese

Although many obese patients with type 2 diabetes lose weight by dieting, most subsequently regain it. We performed a retrospective cohort analysis to assess the influence of the amount and rapidity of weight loss during hospitalization on the risk of subsequently regaining weight and stopping treatment in patients with severe obesity who dieted without bariatric surgery. A total of 131 severely obese patients (48±14 years old; BMI: 41.7±8.8; 75% with diabetes) received inpatient treatment that included diet, exercise, behavioral modification (charting weight four times daily), and educational seminars, and were followed after discharge. Regaining weight and drop-out were defined as returning to baseline body weight and failing to keep outpatient appointments, respectively. Patients lost an average of 5.3±3.0kg (4.9±2.4%) in hospital (mean: 19 days). Over the median 2-year follow-up period, unadjusted analysis showed that patients with >3% weight loss in hospital had significantly less risk of regaining weight than patients losing≤3%. The risk decreased further with greater weight loss (>7% loss; hazard ratio (HR):0.06; 95% confidence interval:0.007-0.47). Adjusted analysis revealed that >5% weight loss was associated with significantly less risk of regaining weight after adjustment for age, sex, BMI, smoke, diabetes, insulin, sulfonylurea, antidepressant medication, and duration of hospitalization (>7% loss; HR 0.04(0.004-0.36, p=0.004), 7%≥loss>5%; HR 0.3(0.11-0.85, p=0.02)). No significant relation was observed between weight loss and drop-out. Among patients with >3% weight loss during hospitalization, rapid weight loss (>3% within 7 days) did not increase the risk of subsequently regaining weight compared with patients showing slower weight loss. In conclusion, achieving >5% weight loss during comparatively brief hospitalization predicts subsequent maintenance of lower weight. Experiencing success in hospital might increase the motivation of obese patients.

Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease

2019 ◽  
Vol 34 (7) ◽  
pp. 3197-3203 ◽  
Author(s):  
Camila Ortiz-Gomez ◽  
David Romero-Funes ◽  
David Gutierrez-Blanco ◽  
Joel S. Frieder ◽  
Maria Fonseca-Mora ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Chronic Kidney Disease ◽  
Weight Loss ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Rapid Weight Loss ◽  
Obese Patients ◽  
Severely Obese

Differential impact of bariatric surgery-induced weight loss on upper leg tissue composition in severely obese patients

2011 ◽  
Vol 35 (2) ◽  
pp. 188
Author(s):  
A. Auclair ◽  
J. Martin ◽  
M. Bastien ◽  
N. Bonneville ◽  
S. Marceau ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Obese Patients ◽  
Tissue Composition ◽  
Differential Impact ◽  
Severely Obese

scholarly journals Utilising a milk-based meal replacement programme in a bariatric patient with poorly controlled type 2 diabetes mellitus

2019 ◽  
Vol 2019 ◽  
Author(s):  
Michelle Maher ◽  
Mohammed Faraz Rafey ◽  
Helena Griffin ◽  
Katie Cunningham ◽  
Francis M Finucane
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Glycaemic Control ◽  
Severe Obesity ◽  
Meal Replacement ◽  
Agonist Therapy ◽  
Severely Obese ◽  
Skimmed Milk

Summary A 45-year-old man with poorly controlled type 2 diabetes (T2DM) (HbA1c 87 mmol/mol) despite 100 units of insulin per day and severe obesity (BMI 40.2 kg/m2) was referred for bariatric intervention. He declined bariatric surgery or GLP1 agonist therapy. Initially, his glycaemic control improved with dietary modification and better adherence to insulin therapy, but he gained weight. We started a low-energy liquid diet, with 2.2 L of semi-skimmed milk (equivalent to 1012 kcal) per day for 8 weeks (along with micronutrient, salt and fibre supplementation) followed by 16 weeks of phased reintroduction of a normal diet. His insulin was stopped within a week of starting this programme, and over 6 months, he lost 20.6 kg and his HbA1c normalised. However, 1 year later, despite further weight loss, his HbA1c deteriorated dramatically, requiring introduction of linagliptin and canagliflozin, with good response. Five years after initial presentation, his BMI remains elevated but improved at 35.5 kg/m2 and his glycaemic control is excellent with a HbA1c of 50 mmol/mol and he is off insulin therapy. Whether semi-skimmed milk is a safe, effective substrate for carefully selected patients with severe obesity complicated by T2DM remains to be determined. Such patients would need frequent monitoring by an experienced multidisciplinary team. Learning points: Meal replacement programmes are an emerging therapeutic strategy to allow severely obese type 2 diabetes patients to achieve clinically impactful weight loss. Using semi-skimmed milk as a meal replacement substrate might be less costly than commercially available programmes, but is likely to require intensive multidisciplinary bariatric clinical follow-up. For severely obese adults with poor diabetes control who decline bariatric surgery or GLP1 agonist therapy, a milk-based meal replacement programme may be an option. Milk-based meal replacement in patients with insulin requiring type 2 diabetes causes rapid and profound reductions in insulin requirements, so rigorous monitoring of glucose levels by patients and their clinicians is necessary. In carefully selected and adequately monitored patients, the response to oral antidiabetic medications may help to differentiate between absolute and relative insulin deficiency.

Restored insulin inhibition on insulin secretion in nondiabetic severely obese patients after weight loss induced by bariatric surgery

2003 ◽  
Vol 27 (4) ◽  
pp. 463-468 ◽  
Author(s):  
J A Pereira ◽  
B M Claro ◽  
J C Pareja ◽  
E A Chaim ◽  
B D Astiarraga ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Insulin Secretion ◽  
Obese Patients ◽  
Severely Obese ◽  
Insulin Inhibition

Abstract 16319: Large Weight Loss Improves Left Ventricular Geometry but Not Myocardial Function 6 Months After Bariatric Surgery (the Fatwest Study)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lisa M Grymyr ◽  
Saied Nadirpour ◽  
Eva Gerdts ◽  
Johannes Hjertaas ◽  
Bjørn Nedrebø ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Heart Rate ◽  
Weight Loss ◽  
Systolic Function ◽  
Wall Stress ◽  
Left Ventricular ◽  
Obese Patients ◽  
Large Weight Loss ◽  
Lv Mass ◽  
Severely Obese

Background: Bariatric surgery causes rapid and large weight loss and improves cardiovascular risk profile, yet the effect on left ventricular (LV) systolic function has been less explored. Methods: In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study 98 severely obese patients (44±10 years, 72% women, preoperative body mass index [BMI] 41.8±4.8 kg/m 2 , 36% with hypertension) underwent echocardiography before and 5.9 months after gastric bypass surgery. We assessed changes in LV geometry and systolic function by biplane ejection fraction (EF), midwall shortening (MWS) and mitral annular systolic velocity (s′). LV hypertrophy was defined based on LV mass/height 2.7 . Myocardial O 2 demand was derived from the LV mass-wall stress-heart rate product. Results: Patients experienced on average a 10 kg/m 2 reduction in BMI, and a significant drop in heart rate and blood pressure (all p<0.001). LV mass (-12 g) and myocardial O 2 demand improved significantly (all p<0.01). However, LV EF (60 vs. 61%), s’ (8.5 vs. 8.3cm/s) and MWS (16.1 vs. 15.7%) remained unchanged, and 45% of patients had low MWS 6 months after surgery (Figure). In multivariable regression analyses, LV mass reduction was predicted by weight loss and female sex, independent of changes in blood pressure and heart rate (R 2 0.24, p <0.001) while lower myocardial O2 demand was explained by improvement in its three components, particularly lower LV end-systolic wall stress (R 2 0.9, p<0.001). Conclusion: In severely obese patients with normal EF, bariatric surgery induces a significant reduction in BMI, LV mass and myocardial O 2 demand, but no improvement in LV myocardial systolic function 6 months after surgery.

scholarly journals Erratum to: ESR1, FTO, and UCP2 Genes Interact with Bariatric Surgery Affecting Weight Loss and Glycemic Control in Severely Obese Patients

2011 ◽  
Vol 22 (1) ◽  
pp. 194-194
Author(s):  
Tsan-Hon Liou ◽  
Hsin-Hung Chen ◽  
Weu Wang ◽  
Shu-Fen Wu ◽  
Yi-Chih Lee ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Glycemic Control ◽  
Obese Patients ◽  
Severely Obese
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