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Bariatric surgery tops GLP-1 drugs and lifestyle changes in sustained weight loss efficacy
An extensive review of medical research from 2020 to 2024 has conclusively demonstrated that bariatric surgery, also referred to as metabolic or weight-loss surgery, yields the most substantial and longest-lasting weight loss results when compared to other interventions such as GLP-1 receptor agonists and lifestyle modifications. This significant finding was unveiled at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting.
According to the research, lifestyle modifications, encompassing diet and physical exercise, typically lead to an average weight reduction of 7.4%. However, the study notes that this weight is often regained within approximately 4.1 years. In contrast, more intensive interventions like GLP-1 receptor agonists and surgical procedures have shown greater efficacy. The studies analysed involved thousands of participants across various clinical and randomised trials.
The research highlighted the effectiveness of GLP-1 semaglutide, which, with five months of weekly injections, resulted in a 10.6% reduction in body weight. A more pronounced effect was observed with tirzepatide, where nine months of treatment led to a 21.1% weight loss. Nevertheless, approximately half of this weight was regained within a year after cessation of treatment with either drug. If treatment was sustained, patients receiving tirzepatide stabilised at a 22.5% weight loss after 17-18 months, while those on semaglutide reached a plateau at 14.9% during the same timeframe.
More profound outcomes were observed with metabolic and bariatric surgeries such as gastric bypass and sleeve gastrectomy. These procedures showed a total weight loss of 31.9% and 29.5% respectively, one year post-operation. Remarkably, a weight loss of around 25% was maintained for up to a decade following the surgery.
“Metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity,” explained Marina Kurian MD, a co-author of the study and bariatric surgeon at NYU Langone Health. She further emphasised the underutilisation of such surgeries, advocating for their consideration earlier in the treatment process rather than as a last resort.
In 2022, approximately 280,000 metabolic and bariatric procedures were conducted in the U.S., representing just about 1% of the eligible population based on Body Mass Index (BMI) criteria. This is in the context of a prevailing obesity rate of 42.4% among Americans, as reported by the U.S. Centers for Disease Control and Prevention (CDC). Obesity is known to compromise the immune system, enhance chronic inflammation, and escalate the risk of numerous health issues including cardiovascular diseases, stroke, type 2 diabetes, and certain types of cancer.
Dr. Ann Rogers, ASMBS President-elect and Professor of Surgery at Penn State College of Medicine, who was not involved in the study, highlighted the importance of surgical interventions in combating obesity. “While new drug treatments show great promise and could lead to more successful outcomes, particularly with better affordability and insurance coverage, we are still not fully utilising the most effective tool we have—metabolic and bariatric surgery, which is safer and more effective than ever,” she stated.
The study comprised a systematic review of various research studies that explored weight loss through lifestyle changes, GLP-1s (Semaglutide or tirzepatide), or metabolic and bariatric surgery. The review of GLP-1s was based on four randomised clinical trials conducted between 2021 and 2024. Lifestyle interventions were examined across eight studies, while surgical approaches were evaluated through a review of 35 studies, including two randomised trials, covering approximately 20,000 patients in total.
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Bridging the gap: From obesity research to effective clinical practice
Recent advances in obesity research have considerably deepened our understanding of the condition’s underlying causes and the optimal strategies for its management. Despite these advances, a significant disparity exists in the application of this knowledge within clinical settings. This challenge has been meticulously outlined in the American Heart Association’s (AHA) scientific statement, “Implementation of Obesity Science Into Clinical Practice,” published in the Association’s leading journal, Circulation.
The statement asserts that obesity remains a critical public health issue, both in the United States and globally, affecting nearly all populations and imposing severe strains on healthcare systems. Obesity is a significant risk factor for heart disease, thus hindering progress in reducing heart disease rates. “Obesity is undeniably a critical public health concern in the U.S. and around the world, affecting nearly all populations and straining our health care systems. As a major risk factor for heart disease, obesity has significantly hindered progress in reducing heart disease rates. Despite advancements in understanding the complexities of obesity and newer treatment options, major gaps remain between obesity research and real-world implementation in clinical practice,” explains Deepika Laddu, Ph.D., FAHA, chair of the statement writing committee and senior research scientist at Arbor Research Collaborative for Health in Ann Arbor, Michigan.
The evidence strongly favours intensive lifestyle therapy, which is markedly more effective for weight loss than brief advice from healthcare professionals. However, the more common approach involves offering general educational information rather than directing patients toward specific classes, programmes, or tangible resources that facilitate lifestyle changes. One study highlighted that only 16% of healthcare professionals were knowledgeable about evidence-based lifestyle treatments for obesity, including diet and nutrition, physical activity, and intensive behavioural therapy referral. The barriers to effective weight management are further exacerbated by socioeconomic, racial, and ethnic disparities, with people of diverse backgrounds and those covered by Medicare or Medicaid less likely to be referred to or have weight management programs covered by their insurance.
Globally, the prevalence of obesity has been on the rise for around 30 years. Current estimates from the U.S. Centers for Disease Control and Prevention indicate that more than 40% of U.S. adults aged 20 and older are living with obesity. Research has elucidated the multifactorial causes of obesity, which include sociological and physiological determinants. Treatments have evolved to include more effective strategies for lifestyle modifications, medication therapy, and bariatric (weight-loss) surgery. Despite these advancements, each treatment approach faces its own set of challenges.
“Significant strides have been made in advancing the science to help us understand obesity, yet there remains a considerable gap between what we know and what happens in the doctor’s office,” Laddu observes. She emphasises the need for healthcare professionals and systems to better incorporate cutting-edge knowledge about obesity into practical applications so that more individuals can access appropriate support and treatment. This might include adopting new technologies and telemedicine, making referrals to community-based weight management programmes, providing social support, and enhancing the reach and access to treatments.
The statement discusses the FDA-approved Glucagon-like peptide-1 (GLP-1) agonists, such as high-dose semaglutide and tirzepatide, which are associated with an average weight loss of more than 10% at six months in clinical studies. Despite a large portion of the adult U.S. population meeting the BMI criteria for obesity and being eligible for these medications, a relatively small percentage currently use them. The historical lack of insurance coverage and high costs were significant barriers until recent policy changes by the Centers for Medicare and Medicaid Services allowed for the coverage of anti-obesity medications like semaglutide.
Weight loss surgery, or bariatric surgery, has seen improvements in safety, expertise, and understanding of its health benefits. A comprehensive review of studies on weight loss surgeries indicated that patients undergoing these procedures experienced lower risks of cardiovascular disease and reductions in other obesity-associated conditions such as Type 2 diabetes and high blood pressure. However, ensuring that the populations most in need have access to bariatric surgery remains a challenge due to cost, resource availability, and social support factors.
The statement further elaborates on the need for a comprehensive approach to obesity care, highlighting strategies to improve integration of obesity science into clinical practice and to develop solutions that manage obesity at the community level. The importance of education for healthcare professionals on the complex origins and clinical consequences of obesity is discussed, alongside the necessity for health policy changes to make obesity treatment more affordable, particularly for high-risk patients.
Specific approaches are highlighted in the statement to help bridge the gap between the science about obesity and clinical care, such as:
- To reach and successfully impact populations in need, healthcare professionals may consider how social determinants of health, including insurance type, household income, race and ethnicity, environment, health literacy, access to health-promoting resources, and social supports all influence the likelihood of successful patient treatment.
- Education for healthcare professionals explaining the complex origins and clinical consequences of obesity is discussed. Such training should emphasise information about diagnosis, prevention, and treatment of obesity. Despite the high prevalence of obesity around the world, there is a lack of education programmes centred on obesity for medical professionals.
- Further evaluation of health policy changes that healthcare systems and insurance plans can implement and scale in order to make obesity treatment affordable for patients, especially those at high risk for adverse outcomes such as cardiovascular disease.
- A framework for delivering obesity care into clinical practice settings is reviewed, as well as efforts by some professional societies for developing interventions that make obesity treatment more accessible.
“The statement emphasises the importance of a comprehensive approach across different levels of health care delivery and public policy, along with the adoption of feasible, evidence-based strategies in clinical settings,” said Laddu. “It also underscores the need for future research and policy changes to improve current patient care models and ensure equitable access to obesity-related care for people in underrepresented groups.”
The scientific statement also provides possible solutions for how to help people in their day-to-day lives, including interventions with digital technology and access through telemedicine. However, more research is needed in obesity science and treatment. Limited understanding of the cost-effectiveness of obesity prevention and the long-term health outcomes for established therapies has hindered the implementation of obesity science into clinical settings. Cross-collaborative obesity science research between stakeholders and health economists may serve as the bridge to developing and scaling cost-effective prevention programmes.
Further research into Food Is Medicine approaches in health care, such as medically tailored meals and produce prescriptions, to prevent and treat cardiovascular disease and other diet-related diseases are also being explored in several settings including the Association’s Health Care by FoodTM initiative.
This scientific statement was prepared by a dedicated volunteer group on behalf of various AHA councils, highlighting the critical need for increased awareness and informed healthcare decisions regarding obesity. While it outlines current knowledge and research needs, it refrains from making specific treatment recommendations, which are covered in the AHA’s official guidelines. This comprehensive approach underscores the necessity of closing the gap between advanced obesity research and its practical application in healthcare.
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Digital health platform reduces hospital stay for surgery patients
A recent study has highlighted the significant benefits of a digital health platform named Pip Care in enhancing the postoperative recovery process for patients undergoing surgery. The research, published in the Journal of Medical Internet Research, demonstrates the platform’s ability to reduce hospital stays through effective engagement with patients and integration of personalised recovery strategies.
Pip Care is designed to support patients throughout their perioperative journey by offering personalised care plans and connecting them with certified health coaches. These coaches collaborate with the patients’ surgical teams to provide tailored guidance and daily recovery tasks. The platform’s objective is to foster patient adherence to recovery plans, thus improving surgical outcomes.
The study was conducted in collaboration between UPMC and the University of Pittsburgh School of Medicine. Researchers invited patients scheduled for elective surgeries at an academic medical centre over a period from November 22, 2022, to March 27, 2023, to participate in the platform from approximately two to four weeks pre-surgery to four weeks post-surgery. Out of 283 patients approached, 172 (60.8%) enrolled in the study. A notable 83.1% of these participants engaged in one or more health coaching sessions, with 97.2% proceeding to surgery, surpassing the industry’s typical 90% to 93% surgical adherence rates. Post-surgery, 70.3% continued to engage with the platform.
The platform maintained an impressive 82% weekly engagement rate, with patients frequently attending multiple health coaching sessions. Feedback gathered from 95 survey submissions revealed high levels of satisfaction, with many patients affirming that the coaching significantly aided their perioperative experience.
A comparative analysis between 128 patients using the Pip Care platform and 268 non-users undergoing the same procedures at the same hospital showed that platform users experienced a 24% reduction in postoperative hospital stay. Specifically, the average stay for Pip Care users was 2.4 days compared to 3.1 days for those not using the service. However, both groups recorded similar rates of return to emergency departments within 30 days post-operation.
Dr. Aman Mahajan, MD, PhD, Peter and Eva Safar Professor and Chair of the Department of Anesthesiology and Perioperative Medicine at the University of Pittsburgh School of Medicine, emphasised the challenge of ensuring adherence to perioperative care plans. He noted, “Ensuring that patients follow through with their prescribed perioperative care plans is crucial for their health and recovery outcomes, but achieving this adherence is often challenging.” Dr. Mahajan hailed the integration of this hybrid digital-telemedicine platform as a significant advancement in clinical care, offering ease of use for both patients and clinicians while enhancing patient outcomes and satisfaction with surgical procedures.
This study contributes to the growing body of evidence supporting digital healthcare’s role in improving the continuity of care in surgery. For instance, a 2022 study from the University of Alabama Birmingham indicated that telehealth interventions had substantially reduced no-show rates among surgical patients. The American College of Surgeons has endorsed telehealth, recognising its potential to enhance access to surgical care, especially for patients in remote or underserved areas, and to empower patients in their health care journeys by facilitating active participation in virtual consultations.
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Bariatric surgery associated with over 50% reduction in cancer risk for individuals with obesity
Bariatric surgery could considerably decrease the risk of cancers related to obesity, such as those of the breast, colon, liver, pancreas, ovaries, and thyroid, in patients with obesity.
“Bariatric surgery, which includes sleeve gastrectomy, gastric bypass, and gastric band procedures, is the principal method for significant weight loss in individuals with obesity,” stated Dr. Vibhu Chittajallu, a gastroenterology fellow at Case Western Reserve University and University Hospitals Cleveland Medical Center, during a Digestive Disease Week media briefing. He highlighted that these procedures offer benefits beyond weight loss, such as enhancements in patients’ mental and physical well-being.
Chittajallu further added, “Emerging evidence suggests that the substantial weight reduction linked with bariatric surgery may also provide a protective shield against the development of cancers associated with obesity. My team and I decided to delve deeper into this trend.”
Chittajallu and his team used TriNetX, a database involving 47 U.S. healthcare institutions and over 107 million patients, to conduct a retrospective study from 2002 to 2022. They singled out adults with a Body Mass Index (BMI) over 35 who underwent bariatric surgery, comparing them with patients with obesity who didn’t have the surgery. The study accounted for risk factors like smoking history, alcohol use, heart disease, hormone therapies, and cancer-screening tests, including 55,789 individuals in each group.
The researchers also used the International Agency for Research on Cancer to identify cancers with “sufficient” evidence of a connection to obesity. This included esophageal adenocarcinoma, multiple myeloma, and cancers of the kidney, colon, rectum, stomach, liver, gallbladder, pancreas, ovary, endometrium, breast, and thyroid.
The results revealed that after ten years, the cumulative occurrence of obesity-related cancer was 4% (n = 2,206) in the bariatric surgery group and 8.9% (n = 4,960) in the nonsurgical control group (HR = 0.482; 95% CI, 0.459-0.507).
Chittajallu pointed out that the bariatric surgery group consistently exhibited lower numbers of new cases for all types of obesity-related cancers, including those of the breast, colon, liver, pancreas, ovaries, and thyroid.
“Although more research is required to fully understand the impact of bariatric surgery on cancer risk,” Chittajallu concluded, “our findings indicate that bariatric surgery is a promising area to investigate.”
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Bariatric surgery may reduce cancer risk in patients with obesity and type 2 diabetes
Research findings derived from a Swedish Obese Subjects (SOS) study, published in Diabetes Care, found that in people with obesity and type 2 diabetes (T2D), bariatric surgery may play a role in cancer prevention. “Durable” remission of T2D is often achieved after weight-loss surgery, further associating it with a reduced cancer risk.
The study examined long-term outcomes after bariatric surgery versus usual care in people with obesity. Researchers examined outcomes of 701 patients with obesity and T2D at baseline. A total of 393 of these patients (mean age, 48.6 years) underwent bariatric surgery while 308 patients (mean age, 50.5 years) received conventional obesity treatment. The investigators analysed cancer events, reported in the Swedish National Cancer Register, over the median follow-up of 21.3 years.
In patients treated with bariatric surgery, the incidence rate for first-time cancer during the follow-up period was 9.1 per 1,000 person-years (95% CI, 7.2–11.5). In contrast, the incidence rate for first-time cancer in patients treated with usual obesity care was 14.1 per 1,000 person-years (95% CI, 11.2–17.7). The incidence rate for first-time cancer diagnosis was significantly lower in the patients treated with bariatric surgery (adjusted hazard ratio [HR], 0.63; 95% CI, 0.44–0.89; P =.008).
Compared with the control group, bariatric surgery was associated with a significantly reduced incidence of cancer in women, (HR, 0.58; 95% CI, 0.38–0.90; P =.016). However, with bariatric surgery in men, there was no similar association (HR, 0.79; 95% CI, 0.46-1.38; P =.0413). Diabetes remission at 10 years follow-up was also associated with a reduction in cancer incidence (HR, 0.40; 95% CI, 0.22–0.74; P =.003).
The ascertainment of diabetes diagnoses was a limitation of the study, which were based on a single time point measurement and/or the use of a diabetes medication. Additionally, the majority of participants in the surgery group had received vertical banded gastroplasty or banding, which is rarely used today. High postoperative mortality following bariatric surgery was reported during the original SOS study.
“In conclusion, with increasing rates of obesity and diabetes worldwide, a greater emphasis on cancer prevention strategies is needed,” the researchers wrote. “Bariatric surgery may greatly reduce the risk of cancer among patients with obesity and diabetes. Durable diabetes remission seems imperative for cancer prevention in patients with obesity and diabetes.”
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