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Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity.
Aminian, A, Fathalizadeh, A, Tu, C, Butsch, WS, Pantalone, KM, Griebeler, ML, Kashyap, SR, Rosenthal, RJ, Burguera, B, Nissen, SE
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2021;17(1):208-214
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Plain language summary
A growing body of evidence indicates that patients with obesity are disproportionately affected with a severe form of SARS-CoV-2 infection and may experience resultant higher mortality. The aim of this study was to determine the association of prior metabolic surgery with severity of SARSCoV-2 infection in patients with severe obesity. This study is a retrospective, matched-cohort analysis of a prospective, observational, institutional review board–approved clinical registry of all patients tested for SARS-CoV-2 infection. The study population included a total of 363 patients, including 33 individuals who had metabolic surgery and 330 matched patients who tested positive. Results indicate that a history of metabolic surgery is associated with lower severity of SARSCoV-2 infection in patients with severe obesity, as manifested by lower risks of hospital and ICU admission. Authors conclude that prior metabolic surgery with subsequent weight loss and improvement of metabolic abnormalities could potentially reduce morbidity from SARS-CoV-2 infection.
Abstract
BACKGROUND Obesity is a risk factor for poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). OBJECTIVES To investigate the relationship between prior metabolic surgery and the severity of COVID-19 in patients with severe obesity. SETTING Cleveland Clinic Health System in the United States. METHODS Among 4365 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 8, 2020 and July 22, 2020 in the Cleveland Clinic Health System, 33 patients were identified who had a prior history of metabolic surgery. The surgical patients were propensity matched 1:10 to nonsurgical patients to assemble a cohort of control patients (n = 330) with a body mass index (BMI) ≥ 40 kg/m2 at the time of SARS-CoV-2 testing. The primary endpoint was the rate of hospital admission. The exploratory endpoints included admission to the intensive care unit (ICU), need for mechanical ventilation and dialysis during index hospitalization, and mortality. After propensity score matching, outcomes were compared in univariate and multivariate regression models. RESULTS The average BMI of the surgical group was 49.1 ± 8.8 kg/m2 before metabolic surgery and was down to 37.2 ± 7.1 at the time of SARS-CoV-2 testing, compared with the control group's BMI of 46.7 ± 6.4 kg/m2. In the univariate analysis, 6 (18.2%) patients in the metabolic surgery group and 139 (42.1%) patients in the control group were admitted to the hospital (P = .013). In the multivariate analysis, a prior history of metabolic surgery was associated with a lower hospital admission rate compared with control patients with obesity (odds ratio, 0.31; 95% confidence interval, 0.11-0.88; P = .028). While none of the 4 exploratory outcomes occurred in the metabolic surgery group, 43 (13.0%) patients in the control group required ICU admission (P = .021), 22 (6.7%) required mechanical ventilation, 5 (1.5%) required dialysis, and 8 (2.4%) patients died. CONCLUSION Prior metabolic surgery with subsequent weight loss and improvement of metabolic abnormalities was associated with lower rates of hospital and ICU admission in patients with obesity who became infected with SARS-CoV-2. Confirmation of these findings will require larger studies.
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Obesity: tackling the causes of the causes
The BMJ Opinion provides comment and opinion written by The British Medical Journal's international community of readers, authors, and editors.
2021
Abstract
This article analyses the responsibility of society systems’ structures towards the obesity epidemic - and how strongly a shift in the government responses is required to tackle this issue. Our “obesogenic” environments hinder the population from accessing healthy lifestyle and dietary patterns, while portraying obesity as an individual’s lack of personal willpower. By challenging the current views on obesity, this article proposes that new policies must be created to eliminate inequalities and to provide long-term solutions to the root causes of obesity, deeply entrenched across all aspects of society.
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Episode 27: Clinical Conversations: Behavioral Interventions in Lifestyle Change
The Obesity Medicine Association (OMA) is the largest organization of physicians, nurse practitioners, physician assistants, and other health care providers working with patients affected by obesity. Obesity: A Disease is the official Obesity Medicine Association (OMA) FREE podcast exploring the many facets of the disease of obesity.
2021
Abstract
In this podcast episode, OMA Clinical Education Director, Nicholas Pennings, interviews Ariana Chao, PhD, CRNP, about the role of behavioural interventions in obesity. The topics covered include: - the fundamental roles that health practitioners play when providing support with obesity; - how to address negative self-talk with patients; - the impact of intensive behavioural therapy and goal setting on the development of the disease; - the importance of group support when it comes to patients’ long-lasting commitment to lifestyle and dietary interventions.
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Nutrition, immunity and COVID-19
BMJ Nutrition, Prevention & Health aims to present the best available evidence of the impact of nutrition and lifestyle factors on the health of individuals and populations. The journal will present robust research on the key determinants of health including the social, economic, and physical environment, as well as lifestyle and behaviour. It will explore dietary factors, exercise and healthcare interventions and technologies, which aim to maintain and improve health and wellbeing and to prevent illness and injury.
2021
Abstract
Written and published during the SARS-CoV-2 pandemic, this article provides an in-depth overview of how the immune system works, while analysing the factors that negatively impact its optimal functioning (i.e., micronutrients deficiency, ageing, obesity). The study focuses on assessing the role that specific nutrients play in supporting the immune system response, with a particular interest in the antiviral defences. Moreover, the interconnection between the gut probiotic bacteria and the immune system is also analysed - and how a healthy microbiota seems to be protective against respiratory tract infections.
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The Current Landscape of Obesity Services: a Report from the All-Parliamentary Group on Obesity
"With the number of people with obesity projected to rise significantly in the coming years, action must be taken to treat patients with severe and complex obesity now, as well as strengthening prevention programmes and childhood obesity programmes to reverse this escalating trend." From the Chair of the All-Parliamentary Group on Obesity.
2021
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This report from the All-Party Parliamentary Group on Obesity is part of an inquiry into the current landscape of obesity services. It is designed to highlight barriers and opportunities for government, commissioners and other stakeholders to improve equitable access to obesity prevention and treatment programmes.
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Navigating Obesity in Immune Dysfunction
KARA FITZGERALD, ND completed a post-doctorate in nutritional biochemistry/laboratory science with Richard Lord, Ph.D. Author: Case Studies in Integrative and Functional Medicine, contributing author: Laboratory Evaluations for Integrative and Functional Medicine; IFM’s Textbook for Functional Medicine. She lectures globally on functional medicine; is on faculty at IFM and practices in Connecticut.
2021
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This blog post discusses the management of obesity in clinical practice. The benefits of using a personalised approach are highlighted while other factors are taken into consideration when supporting obese patients - too little versus too much physical activity, and their equal contribution to respiratory tract infection risk for example. The crucial role of weight loss is analysed and discussed, along with the importance of working with a team of different healthcare practitioners, who practice patient-lead healthcare.
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Oral hygiene and COVID-19 is there a link? with Dr. Victoria Sampson
EMS is one of the leading manufacturers of precision medical devices for dental prophylaxis, orthopaedics, and urology.
2021
Abstract
Dr. Victoria Sampson is an award-winning functional dentist whose findings have been published in both the British Dental Journal and Nature in April 2020. Through her work, she unveils the staggering statistics that link poor oral health and gum disease to increased risk of obesity, cardiovascular disease, and severe Covid-19 development. Through this interview, we learn how periodontal disease causes systemic inflammation, producing high levels of inflammatory markers which are also elevated in Covid-19 and cardiovascular disease.
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Do These Microbes Make Me Look Fat?
Metagenics Institute is a trusted, peer-to-peer, evidence-based educational resource for nutrition and personalized medicine. Its mission is to transform healthcare by inspiring and educating practitioners, and their patients, about personalized lifestyle medicine.
2021
Abstract
This article reflects upon the epidemic of obesity, analysing the role that socioeconomic factors, dietary patterns, lifestyle, environmental toxins, and genetics are playing in metabolic disorders development. Moreover, it presents us with some compelling food for thought regarding the impact that a healthy/unhealthy gut can play in obesity and cardiovascular disease development, and how microbiome research is showing promising results in the field.
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Impact of Obesity on Outcomes of Pregnancy in Women With Heart Disease
The Journal of the American College of Cardiology (JACC) publishes original peer-reviewed clinical and experimental reports on all aspects of cardiovascular disease. Topics covered include coronary artery and valve disease, congenital heart defects, vascular surgery, cardiomyopathy, drug treatment, new diagnostic techniques, findings from the laboratory, and large multicenter studies of new therapies.
2021
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This study examined the correlation between maternal obesity and the development of cardiac events (e.g. heart failure, arrhythmias, cardiac death/arrest, stroke, aortic dissection, thromboembolic events, preeclampsia, and postpartum hemorrhage) during pregnancy in women with pre-existing cardiovascular diseases. The authors found that obesity leads to an increased risk of maternal cardiovascular complications, and define it as a modifiable risk factor that should be addressed and prevented.
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Vitamin D Mitigates COVID-19, Say 40+ Patient Studies (listed below) – Yet BAME, Elderly, Care-homers, and Obese are still ‘D’ deficient, thus at greater COVID-19 risk - WHY?
The British Medical Journal (BMJ) is a global healthcare knowledge provider with a vision for a healthier world. It shares knowledge and expertise to improve healthcare outcomes. They publish more than 70 medical and allied science journals.
2021
Abstract
In this article, the author addresses the need for vitamin D supplementation to better respond to the Covid-19 pandemic. The article highlights the urge to proactively educate the population and to supplement this steroid hormone widely, especially within high risk groups such as the BAME (Black, Asian, and Minority Ethnic communities), the elderly, the Carehomers, and the obese.