Combating Obesity: Updates On Non-Dietary Weight Loss Interventions

December 11, 2018

Three new studies from Obesity Week 2018 offered highlights of different surgical interventions for obese patients.

Recent advances in our understanding of surgical treatments for obesity have led to significant advances in this area of medicine. Three recent abstracts presented at Obesity Week 2018 address this cutting edge field. In the first study, authors found that bariatric surgery may be most appropriate and successful in obese patients with disordered eating habits. In the second study, researchers from the Cleveland Clinic discovered a nearly 50% reduction in in-hospital mortality in congestive heart failure patients after weight reduction surgery. In the third study, researchers in Dayton, Ohio found that left gastric artery embolization may represent a safe and effective procedure for weight loss in morbidly obese patients.

Click through the slides above for details on the 3 studies as well as take home points for clinical practice.

Study 1. Alison Field, ScD, from Brown University and colleagues sought to determine if different appetite behaviors, disordered eating, family history, CV markers, or hormones involved in glucose metabolism affect weight change in patients after bariatric surgery.

Methods and Results. Data was used from the Longitudinal Assessment of Bariatric Surgery study which collected data on 2456 adults following first-time bariatric surgery. Primary outcomes included weight and weight change from 30 days to 7 years and 4 different subtypes were identified. Class 4 subjects weighed an average of 25% less (males) and 30.3% less (females) vs baseline weight at 3 years post bariatric surgery. Class 2 and 3 subjects had significantly larger 3-year weight loss vs class 4 and weight loss in class 1 was not significantly different vs class 4.

Take Home Points. Of the 4 subtypes, class 2 experienced the most weight change at 3 years and pre-surgery information may help predict weight change trajectories after surgery. Also, men and women with early onset obesity lost an average of 25% and 30% less, respectively.

For more information: Field AE, Inge TH, Belle SH, et al. Association of obesity subtypes in the longitudinal assessment of bariatric surgery study and 3-year postoperative weight change. Obesity (Silver Spring). 2018;26:1931-1937.

Study 2. While several studies suggest bariatric surgery improves CV risk factors, the impact of the surgery on hard CV events has not been well studied. It is still unknown whether bariatric surgery has a protective effect on post-operative cardiac complications, such as HF. Ali Aminian, MD, and colleagues from the Cleveland Clinic aimed to determine if bariatric surgery conferred HF benefit in obese patients.

Methods and Results. The study comprised of 2810 patients with CHF who also underwent bariatric surgery and were matched 1:5 with CHF patients who had no history of bariatric surgery. Mortality rates after CHF were significantly lower in patients with a history of bariatric surgery vs control groups. Length of stay in a hospital was also significantly shorter in bariatric surgery group vs control groups.

Take Home Points. When asked on what is responsible for the decrease in mortality, author Ali Aminian, MD, stated, "It's fascinating because we don’t exactly know the underlying mechanism for this. We can assume the surgery improved the risk factors for heart failure or improved the function of organs overall.”

For more information: Aminian A, Aleassa EM, Khorgami Z, et al. Bariatric surgery decreases mortality of congestive heart failure: A nationwide study. Paper presented at: Obesity Week 2018; November 2018; Nashville, TN.

Study 3. Obesity predisposes patients to a variety of maladies and bariatric surgery remains the most effective weight reduction surgery for morbidly obese patients. However, high rates of reoperation and other complications make investigation into alternatives an attractive option. Mubin Syed, MD, and fellow researchers in Ohio sought to determine the safety and efficacy of left gastric artery (LGA) embolization for weight loss.

Methods and Results. The pilot study, GET LEAN, looked at 4 morbidly obese patients undergoing LGA embolization. The average weight loss at 6 months was 20.3 lbs and the average excess body weight loss at 6 months was -17.2%. There were 3 minor complications, superficial gastric ulcerations that healed by 30 days, and it did not require hospitalization.

Take Home Points. LGA embolization appears to be safe and effective at reducing appetite and weight in morbidly obese patients. While this procedure is still under investigation, the FDA approved it for use in patients with certain anatomic variants. LGA embolization may become a good alternative to large operative procedures for weight loss in select obese patients. Physicians should tailor weight loss strategies to individual patients and include options that are realistic and safe on a case-by-case basis.

For more information: Patel S, Shaikh A, Syed M. Bariatric embolization: Promising results for GET LEAN study at six months. Interventional News Web site. https://interventionalnews.com/bariatric-embolization-promising-results-for-get-lean-study-at-six-months/. Published July 3, 2017. Accessed December 11, 2018.

Perspective. “The presented abstracts highlight the importance of surgical and interventional techniques for weight loss in morbidly obese patients. The burden of disease, mortality, morbidity, lost work, and enormous cost of obesity warrant continued study aimed at developing sustainable solutions that can be tailored to individual patients."

Combating Obesity: Updates On Non-Dietary Weight Loss Interventions

Gregory M. Weiss, MD