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One-anastomosis gastric bypass is an alternative to the “gold-standard” Roux-en-Y gastric bypass. This technique appears to be safe and efficient, but controversy remains regarding the long-term theoretical risk of subsequent biliary reflux and its possible complications, such as cancer. The aim of the present narrative review was to summarize some of the current thoughts on biliary reflux. Research has established that exposure to chronic bile reflux in humans and rats (outside the “bariatric surgery” box) induce esophageal intestinal metaplasia and esophageal adenocarcinoma. Although one-anastomosis gastric bypass can theoretically induce chronic biliary reflux, the incidence of biliary reflux and risk of cancer have not been prospectively evaluated. Clarification of this controversial issue is urgently needed.

Importance A healthy lifestyle is associated with a reduced risk of cardiovascular disease in adults with obesity. Little is known about the associations between a healthy lifestyle and the risk of other obesity-attributable diseases in this population. Objective To examine the association between healthy lifestyle factors and the incidence of major obesity-related diseases in adults with obesity compared with those with normal weight. Design, Setting, and Participants This cohort study evaluated UK Biobank participants aged 40 to 73 years and free of major obesity-attributable disease at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis. Exposures A healthy lifestyle score was constructed using information on not smoking, exercising regularly, no or moderate alcohol consumption, and eating a healthy diet. For each lifestyle factor, participants scored 1 if they met the criterion for a healthy lifestyle and 0 otherwise. Main Outcomes and Measures The risk of outcomes according to the healthy lifestyle score in adults with obesity compared with those with normal weight were examined using multivariable Cox proportional hazards models with Bonferroni correction for multiple testing. The data analysis was performed between December 1, 2021, and October 31, 2022. Results A total of 438 583 adult participants in the UK Biobank were evaluated (female, 55.1%; male, 44.9%; mean [SD] age, 56.5 [8.1] years), of whom 107 041 (24.4%) had obesity. During a mean (SD) follow-up of 12.8 (1.7) years, 150 454 participants (34.3%) developed at least 1 of the studied diseases. Compared with adults with obesity and 0 healthy lifestyle factors, individuals with obesity who met all 4 healthy lifestyle factors were at lower risk of hypertension (HR, 0.84; 95% CI, 0.78-0.90), ischemic heart disease (HR, 0.72; 95% CI, 0.65-0.80), arrhythmias (HR, 0.71; 95% 0.61-0.81), heart failure (HR, 0.65; 95% CI, 0.53-0.80), arteriosclerosis (HR, 0.19; 95% CI, 0.07-0.56), kidney failure (HR, 0.73; 95% CI, 0.63-0.85), gout (HR, 0.51; 95% CI, 0.38-0.69), sleep disorders (HR, 0.68; 95% CI, 0.56-0.83), and mood disorders (HR, 0.66; 95% CI, 0.56-0.78). The lifestyle profiles associated with the lowest risks included a healthy diet and at least 1 of the 2 healthy behaviors of physical activity and never smoking. Compared with adults with normal weight, those with obesity were at higher risk of several outcomes, irrespective of the lifestyle score (adjusted HRs ranged from 1.41 [95% CI, 1.27-1.56] for arrhythmias to 7.16 [95% CI, 6.36-8.05] for diabetes for adults with obesity and 4 healthy lifestyle factors). Conclusion and Relevance In this large cohort study, adherence to a healthy lifestyle was associated with reduced risk of a wide range of obesity-related diseases, but this association was modest in adults with obesity. The findings suggest that although a healthy lifestyle seems to be beneficial, it does not entirely offset the health risks associated with obesity.

IntroductionPatients with one-anastomosis gastric bypass (OAGB) can develop gastroesophageal reflux disease (GERD). The nature of this GERD (acid or biliary) remains unclear.ObjectiveTo assess the nature of GERD via impedance pH testing in patients presenting with reflux post OAGB.MethodsRetrospective analysis of a prospectively collected database of 43 patients with OAGB backgrounds who developed postoperative GERD and were investigated with impedance pH monitoring between 2006 and 2019.ResultsMean age was 52.48 ± 9 years. Mean body mass index (BMI) prior to OAGB was 46.82 kg/m2. None of these patients had clinical GERD before surgery. The median time interval between surgery and investigation with 24-h impedance pH monitoring was 64 (56) months. The mean BMI at the time of investigations was 32.67 ± 6.9 kg/m2. The type of reflux was acid in 13 (30.2%), non-acid (biliary) in 12 (27.9%), and mixed (acid and biliary) in 5 (11.6%) patients. However, it remained not confirmed in 13 (30.2%). Median DeMeester score was 48.95 (27.67) in patients with acid, 2.8 (7.4) in patients with biliary, and 28.7 (5.6) in patients with mixed reflux. Median percent of time spent with pH < 4 was 9.65 (8) in patients with acid, 0.6 (1.75) in patients with biliary, and 7.7 (3.9) in patients with mixed reflux.ConclusionAcid reflux seems to be as common as bile reflux in patients presenting with GERD after OAGB. In case of revisional surgery for severe GERD post OAGB, 24-h impedance pH monitoring could be essential to determine the surgical procedure of choice.

We report the case of a 36-year-old woman who developed non-diabetic ketoacidosis following a low carbohydrate diet in order to lose weight while actively breast feeding her newborn. She was admitted in intensive care unit because of severe metabolic acidosis. She rapidly recovered after refeeding process. Lactation ketoacidosis, a special condition that occurs in non-diabetic breastfeeding women, is rare and life-threatening. This report highlights the importance of nutritional education of lactating women in the post-partum period.

C-reactive protein (CRP) is associated with the risk of cardiovascular disease (CVD); whether the effects are modified by diabetes status still is unclear. This study investigated these issues and assessed the added value of CRP to predictions. Participants were drawn from representative samples of adults living in England and Scotland. Cox proportional hazards regression models were used to relate baseline plasma CRP with all-cause and CVD mortality during follow-up in men and women with and without diabetes. The added value of CRP to the predictions was assessed through c-statistic comparison and relative integrated discrimination improvement. A total of 25,979 participants (4.9% with diabetes) were followed for a median of 93 months, during which period there were 2,767 deaths (957 from CVD). CRP (per SD log(e)) was associated with a 53% (95% CI 43-64) and 43% (38-49) higher risk of cardiovascular and all-cause mortality, respectively. These associations were log linear and did not differ according to diabetes status (both P ≥ 0.08 for interaction), sex, and other risk factors. Adding CRP to conventional risk factors improved predictions overall and separately by diabetes status but not for CVD mortality, although such improvements only were marginal based on several discrimination statistics. The association between CRP and CVD was similar across diabetes status, and the effects are broadly similar across levels of other conventional risk factors.

Since 2007, single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has been proposed as an alternative to Roux-en-Y gastric bypass (RYGB) in the treatment of obesity. We conducted a multicentre randomised trial, with the hypothesis that SADI-S could be more effective than RYGB at 2-year follow-up. This multicentre, open-label, individually randomised superiority trial was conducted in France; patients were recruited from 22 bariatric institutions, mostly public academic hospitals. Key inclusion criteria were patients with a BMI ≥40 kg/m2 or ≥35 kg/m2 with obesity-related comorbidities (type 2 diabetes, hypertension, dyslipidaemia, sleep apnoea, or osteoarthrosis), and a candidate for SADI-S or RYGB gastric bypass as a primary surgery or after a sleeve gastrectomy. Main key exclusions included previous bariatric surgery (other than sleeve gastrectomy), inflammatory bowel disease, type 1 diabetes, and untreated Helicobacter pylori infection. Participants were randomly assigned (1:1) to SADI-S or RYGB, stratified by centre, failure of sleeve gastrectomy, and presence of type 2 diabetes. The primary endpoint was percentage excess weight loss (%EWL) at 2 years (%EWL=[(weight at 2 years – initial weight)/(initial weight – ideal weight)] × 100). The study is registered with ClinicalTrials.gov, NCT03610256 and is completed. Between Nov 8, 2018, and Sept 29, 2021, a total of 381 patients were randomly assigned (intention-to-treat population) and included in the primary analysis (SADI-S: 190, RYGB: 191). Mean age was 44·4 years (SD 10·64), mean BMI was 46·2 kg/m2 (6·40), 265 (70%) were female, and 79 (21%) had a primary sleeve gastrectomy. 43 (12%) of 370 participants were lost to follow-up. At 2 years, the mean %EWL was statistically significantly higher in the SADI-S group compared with the RYGB group (–76·0% [SD 26·7] vs –68·1% [28·7], confirming the superiority of SADI-S (mean difference –6·72% [95% CI –12·64 to –0·80], p=0·026). The primary outcome was missing for 78 (20%) of 381 participants, with 46 (59%) of 78 participants in the SADI-S group and 32 (41%) of 78 in the RYGB group, p=0·09. The number of serious adverse events related to the surgical technique in the safety population, including all operated patients, was 40 in the SADI-S group including three anastomotic leaks and eight severe diarrhoea compared with 35 in the RYGB group including five internal hernia and five severe abdominal pain cases of which two required diagnostic laparoscopy. SADI-S showed superior weight loss compared with RYGB at 2 years, with a similar safety profile. French Ministry of Health (Direction Générale de l'offre de Soin – DGOS).

Introduction: This study assesses explicit weight bias (EWB) among French medical students and its association with demographic factors and educational tools. Methods: A cross-sectional study assessed EWB among 1,635 students from two universities between June and September 2024. The Anti-Fat Attitudes Questionnaire measured three dimensions: dislike, fear of fat, and belief in weight controllability (willpower). Academic and demographic data were collected, with scores adjusted for sex. Two educational tools were evaluated: a podcast addressing weight bias (“Augusta’s Oath”) and a clinical rotation in the nutrition department. Results: On a 1 to 9 scale where higher scores indicate stronger weight bias, medical students showed a moderate overall score (2.7 ± 1.1), with low levels of dislike toward individuals with obesity (1.9 ± 1.2), moderate belief in weight controllability (willpower, 3.1 ± 1.9), and high levels of personal fear of gaining weight (4.2 ± 2.1), indicating a persistent presence of EWB. Men exhibited higher EWB than women. Students who listened to the podcast had significantly lower willpower scores than those of non-listeners (2.6 ± 1.5 vs. 3.1 ± 1.7; p < 0.01) and were half as likely to score above 4, i.e., explicitly expressing bias (59/470; 12% vs. 279/1,164; 24%; OR: 0.50, 95% CI: [0.33; 0.74]; p < 0.01). Nutrition rotations were also associated with slightly lower willpower scores (2.8 ± 1.7 vs. 3.0 ± 1.7, p < 0.01). Neither educational exposure was associated with dislike or fear scores. Conclusion: EWB, especially fear of getting fat and willpower beliefs, is prevalent among French medical students. Educational podcasts show promise in reducing specific biases, offering tools to combat weight stigma in medical education.

Purpose One-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to conventional short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB). The objective of this study is to compare the aforementioned procedures in terms of efficacy on GERD symptoms. Materials and Methods Retrospective analysis between October 2012 and June 2020. Results Fifty-two patients underwent OAGB revision to S-BPL-RYGB ( n  = 21) or L-BPL-RYGB ( n  = 31) secondary to GERD. Investigation with pH impedance prior to revision was performed in 15 patients showing biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2. Patients with AR had a revision to S-BPL-RYGB, whereas patients with BR underwent L-BPL-RYGB. Among the patients without pH metry results ( n  = 37), S-BPL-RYGB was performed for associated disabling digestive disorders or nutritional deficiencies. GERD was treated in 68% of patients with L-BPL-RYGB versus 95% of patients after S-BPL-RYGB. Patients, whose decision for revisional procedure was based on the results of pH impedance testing, did not reveal refractory GERD. Conclusion L-BPL-RYGB seems appropriate in patients with BR, whereas conversion to S-BPL-RYGB should be preferred if AR is present. Graphical Abstract

In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus can pose an additional technical challenge. A 58-year-old patient with total situs inversus underwent Roux-en-Y gastric bypass (RYGB) surgery in our department. The main difficulty was the realization of a mirrored RYGB. Laparoscopic RYGB in a patient with situs inversus totalis is feasible but requires significant concentration and three-dimensional coordination to perform the mirrored procedure.