BACKGROUND: Over two-thirds of the United States population is considered overweight or obese. Bariatric surgery is often used when conservative weight loss measures fail. The majority of bariatric surgeries are performed on women of childbearing age. Women who become pregnant following bariatric surgery have a decreased occurrence of gestational diabetes, hypertensive disorders and macrosomia, but they also have an increased risk of small for gestational age infants (SGA), with the greatest risk of SGA infants following malabsorptive and mixed bariatric surgery procedures. STUDY: A gap in the literature exists regarding the risks of SGA and intrauterine growth restriction (IUGR) following Roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy (SG), the two most common procedures in the United States in 2014. This study will be a multi-center retrospective cohort study that will identify the risk of IUGR following RYGB and SG. CONCLUSION: This study will improve our understanding of the effects on pregnancy following RYGB and SG. The most innovative, and hardest, part of this study will be the collection of data on as many SG women as possible. This will be the biggest hurdle because SG is a relatively new procedure, so the prevalence of pregnancy following SG is low. PUBLIC HEALTH SIGNIFICANCE: A better understanding of the effects of the most common bariatric procedural types on pregnancy is important given the prevalence of bariatric surgery among women of childbearing age. It will allow bariatric surgeons to better council their patients on a surgery type for those that may be considering pregnancy afterwards, and enable obstetricians to have a better understanding of the risks associated with their patient’s pregnancy.

Introduction: Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. Methods: Retrospective cohort including patients ≥ 18 years old with BMI ≥ 35 kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥ 60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. Results: Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed. 29% less EWL% per each extra year of life (P = .019), and. 93% more EWL% per each extra HOMA-IR point (P = .004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P = .050), and 2% more chance of success per each additional HOMA-IR point (P = .038). Conclusions: There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes. / Revisión por pares

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥ 30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery. / Revisión por pares

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The prevalence of obesity is increasing globally. Obesity is characterized by increased fat mass and is a risk factor for type 2 diabetes (T2D). Obesity is associated with hyperglycaemia, hyperinsulinemia, insulin resistance and chronic inflammation. Currently, the most effective and durable treatment for obesity and its comorbidities is bariatric surgery. Bariatric surgery changes food intake, energy balance and the composition of gut microbiota. Bariatric surgery can lower blood glucose and put T2D into remission. It was unknown if bariatric surgery-induced changes in the gut microbiota was an independent yet sufficient factor to lower blood glucose. Fecal microbiota transplantation (FMT) was performed on conventional (specific-pathogen-free, SPF) and germ-free (GF) mice using fecal material obtained from patients before surgery and 12 months after bariatric surgery. We tested FMT into mice from the same patients before and after vertical sleeve gastrectomy (VSL) and biliopancreatic diversion with duodenal switch (BPD/DS). FMT did not alter body weight, fat mass, glucose tolerance or glucose transporter mRNA expression in all intestine segments in SPF mice. FMT lowered blood glucose during an oral glucose load in GF mice receiving bacteria after VSL and BPD/DS bariatric surgery. Post-BPD/DS surgery FMT decreased Glut1 transcript level in the ileum and increased Glut1 transcript level in the TA muscle of GF mice, but did not change GLUT1 protein levels. Post-BPD/DS surgery FMT also decreased goblet cell count, villus height and crypt depth in the ileum of GF mice. We conclude that changes in the gut microbiota caused by bariatric surgery is a standalone factor that can lower blood glucose and alter gut morphology. / Thesis / Master of Science (MSc) / Type 2 diabetes is a chronic disease that involves high blood sugar (i.e. glucose), which can damage many parts of the body leading to serious complications. Diabetes is a growing global problem and is the seventh leading cause of death. Obesity is one of the largest factors leading to type 2 diabetes. Bariatric surgery reduces obesity and is to date the most effective method to lower blood glucose and reverse type 2 diabetes. Bariatric surgery alters gut anatomy and the types of bacteria that inhabit the gut. Gut bacteria can change obesity and blood glucose levels, but it was not known if the bacterial community present after bariatric surgery was a factor that is sufficient to lower blood glucose. We found that transferring gut bacteria from humans after bariatric surgery into mice lowers the blood glucose and alters the gut barrier structure where food is absorbed. It is not yet clear how this happens, but these findings show that a change in gut microbes is a standalone factor that can alter host blood glucose. Finding the glucose lowering factor in bacteria may be a new treatment to combat type 2 diabetes.

Bariatric surgery is becoming a more common solution for weight loss in individuals with severe obesity. Much attention has been placed on negative surgery outcomes, specifically on psychosocial predictors of post-surgical weight regain and development of psychopathology. Literature on obesity suggests that eating in response to emotional cues is related to the obesity epidemic. The current review identifies all research in the literature that focuses on emotionality and emotional characteristics in bariatric surgery patients and the predicted negative impact on the surgery process from pre-surgical evaluation to post-surgical follow-up. The review was conducted following PRISMA guidelines for systematic reviews. Six articles were identified in the literature meeting all review criteria, specifically focusing on emotionality in bariatric surgery patients. Results suggest high rates of emotional instability, impulsivity, and difficulty in identifying emotions in bariatric surgery patients, which could have adverse effects on the bariatric surgery process. Authors suggest that these components of emotionality may lead to negative effects following surgery, specifically concerning post-surgical dietary restrictions and weight regain. These findings suggest that further research needs to be done in the area of emotionality and bariatric surgery. Authors infer that high rates of emotional instability, impulsivity, and inability to identify emotions may have significant implications for screening and intervention; however, limitations in these studies indicate a need for further research on emotionality in bariatric surgery patients, particularly the impact of emotionality on surgery outcomes.

Adult overweight and obesity is a life-threatening health concern worldwide. Bariatric surgery is a successful treatment for severely obese individuals however, there is a moderate risk for weight regain. This study evaluated perception of food, supportive resistance resources, and nutrition knowledge, which play important roles in successful weight loss post bariatric surgery. Participants completed a three-part questionnaire at three time intervals: prior to surgery, 2 months post-surgery, and 5 months post-surgery. Results show that bariatric patients’ eating behavior significantly changes post bariatric surgery, but a disordered perception of food remains. Bariatric surgery patients believe support from significant others and family are most important and physical activity will help prevent weight regain. Results indicate that bariatric patients’ nutrition knowledge decreases over time and additional nutrition education may be needed within the first-year post-surgery. More research should be conducted in the area of bariatric surgery and how to prevent weight regain.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.