Bariatric Journal

A study examining historical data from the UK, where sugar was rationed after World War II, found that limiting sugar intake during early life—both in utero and throughout infancy—significantly lowered the risk of developing type 2 diabetes and hypertension in adulthood. Additionally, this sugar restriction appeared to delay the onset of these conditions. By leveraging a unique historical perspective, the researchers were able to isolate sugar consumption from other potential confounding factors, leading them to conclude that early-life sugar restriction could be an effective strategy for promoting long-term health.

A recent study revealed that restricting sugar intake starting in utero reduces the risk and delays the onset of type 2 diabetes and hypertension in adulthood. Adults who experienced early-life sugar rationing in the UK for at least 19 months (including in utero) had a 38% lower risk of type 2 diabetes (HR 0.62, 95% CI 0.55-0.69) and a 21% lower risk of hypertension (HR 0.79, 95% CI 0.74-0.85) compared to those who never experienced rationing, reported Tadeja Gracner, PhD, from the University of Southern California, at the ObesityWeek annual meeting. These findings were also published in Science.

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The researchers noted that in-utero exposure alone accounted for about a third of the overall reduction in risk for type 2 diabetes and hypertension, relative to those exposed both in utero and up to age 1. Moreover, adults who were exposed to sugar rationing from prenatal stages through their first year experienced delays of about four years in type 2 diabetes diagnosis and two years in hypertension diagnosis. John Clark, MD, PhD, from Sharp Rees-Stealy Medical Group, commented that while the study cannot confirm causation, the clarity of the longitudinal data makes this a compelling addition to the evidence connecting early-life sugar exposure with chronic diseases.

Despite dietary guidelines advising that sugar should constitute less than 10% of an adult’s total energy intake and that children under two should avoid added sugars entirely, 70% of pregnant people reportedly consume above this threshold, averaging about 20 teaspoons per day. Similarly, 61% of infants and 98% of toddlers regularly consume added sugars, with baby foods often containing high levels of sugar. Gracner highlighted that the first 1,000 days of life are crucial for optimal development, and research supports the association between high sugar intake and increased chronic disease risk, as well as a stronger preference for sweetness in adulthood.

Leveraging historical UK data from 1942 to 1953, when sugar was rationed at 6.5% of total daily energy intake, the researchers were able to isolate sugar consumption from other factors. When rationing ended in 1953, sugar intake almost doubled, providing a clear contrast in dietary patterns. Using data from the UK Biobank, the study analyzed type 2 diabetes and hypertension risk among 60,183 adults born before and after the rationing period. Those born from October 1951 to June 1954, who experienced rationing in their early lives, had consistently lower disease risk and delayed onset compared to those born afterward.

For adults exposed only to prenatal sugar rationing, the risk reduction was 16% for type 2 diabetes (HR 0.84, 95% CI 0.75-0.95) and 6% for hypertension (HR 0.94, 95% CI 0.88-1.00), with delayed diagnoses by 1.46 years for diabetes and 0.53 years for hypertension. Additionally, those exposed to sugar rationing both prenatally and through their first year of life saw a 31% reduced obesity risk compared to non-rationed peers (HR 0.69, 95% CI 0.60-0.80).

The researchers concluded that early-life sugar restriction could be a powerful tool for long-term health. This historical study adds depth to the hypothesis that sugar consumption significantly influences the development of chronic diseases, with rationing data offering an unusually clear view of this association in humans.

Understanding Gastric Bypass Surgery: Comprehensive Overview

Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is one of the most well-established weight-loss surgeries. It’s primarily aimed at patients with severe obesity (BMI over 40, or 35 with obesity-related health conditions) and is often considered when other methods, such as diet, exercise, and medications, haven’t provided the needed results. Gastric bypass works by altering the digestive system to restrict food intake and reduce nutrient absorption, ultimately leading to substantial and long-term weight loss.

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How Gastric Bypass Works

In a gastric bypass procedure, the surgeon creates a small stomach pouch and reroutes part of the small intestine. Here’s a breakdown of the key steps:

1. Creating a Smaller Stomach Pouch: The stomach is divided, forming a small pouch about the size of an egg. This pouch can hold only a small amount of food, limiting how much you can eat at once.

2. Bypassing Part of the Small Intestine: The surgeon connects the new stomach pouch directly to the middle portion of the small intestine, bypassing the first segment (the duodenum). This reduces calorie and nutrient absorption, promoting weight loss.

Together, these changes significantly reduce food intake and absorption, which leads to a decrease in body weight and, often, improvement in weight-related conditions like diabetes, hypertension, and sleep apnea.

Types of Gastric Bypass Procedures

1. Roux-en-Y Gastric Bypass: This is the most common form, where the stomach and intestine are restructured as described above.

2. Mini-Gastric Bypass: A simpler variation, it involves creating a longer and narrower stomach pouch, which is then attached further down the small intestine. It’s generally faster to perform but may have different risks and benefits.

Benefits of Gastric Bypass Surgery

1. Significant Weight Loss: Patients can lose around 60-80% of their excess weight within a year or two after surgery.

2. Improvement in Health Conditions: Conditions like type 2 diabetes, high blood pressure, high cholesterol, and obstructive sleep apnea often improve dramatically.

3. Improved Quality of Life: Beyond physical health, many patients experience better mobility, energy, and self-confidence.

4. Longevity Benefits: Studies show that gastric bypass may lead to a longer lifespan for patients with obesity by reducing the risk of serious health conditions.

Potential Risks and Complications

1. Nutrient Deficiencies: Because it alters the digestive tract, gastric bypass can lead to deficiencies in vitamins and minerals, including iron, calcium, and B12. Lifelong supplementation is often necessary.

2. Dumping Syndrome: This is a common side effect where food moves too quickly from the stomach to the intestine, causing symptoms like nausea, sweating, and diarrhea, especially after eating high-sugar foods.

3. Surgical Risks: As with any major surgery, risks include infection, bleeding, and blood clots.

4. Ulcers and Gastrointestinal Issues: Patients may be prone to developing ulcers, particularly if they use NSAIDs or smoke. Some may also experience acid reflux or bowel obstructions.

5. Psychological Adjustment: Rapid weight loss and lifestyle changes can impact mental health, requiring support from counseling or therapy.

The Process: From Preparation to Recovery

1. Pre-Surgery Preparation: Before surgery, patients undergo a thorough health evaluation, including blood tests, imaging, and consultations with specialists. Pre-operative guidelines may include a specific diet, lifestyle changes, and sometimes weight loss to prepare for the procedure.

2. The Surgery: Gastric bypass is performed laparoscopically (minimally invasive) in most cases, with patients under general anesthesia. It typically takes 2-4 hours, followed by a hospital stay of about 2-3 days.

3. Recovery and Aftercare: Recovery involves a phased diet, starting with liquids, then progressing to pureed, soft, and eventually solid foods over several weeks. Regular follow-ups with the healthcare team are essential to monitor weight loss, address potential deficiencies, and support adjustments to the new lifestyle.

Long-Term Considerations

Gastric bypass is not a “quick fix” and requires commitment to lifelong lifestyle changes. Patients need to:

• Follow a Nutrient-Dense Diet: Prioritize high-protein, low-sugar foods to sustain energy levels and avoid dumping syndrome.

• Stay Hydrated: Dehydration is common post-surgery, so patients are encouraged to sip water throughout the day.

• Take Lifelong Supplements: Multivitamins and other specific supplements are essential to avoid deficiencies.

• Attend Regular Check-Ups: Regular appointments help manage any complications and ensure nutrient levels remain adequate.

• Embrace Physical Activity: While diet is key, regular exercise helps maintain weight loss and improves overall health.

Who is a Good Candidate for Gastric Bypass?

Gastric bypass is typically recommended for individuals who:

• Have a BMI of 40 or higher, or 35 and higher with obesity-related health conditions.

• Are between the ages of 18 and 65, though this can vary depending on individual health conditions and risks.

• Have tried other weight-loss methods without sufficient results.

• Understand the commitment to lifestyle changes required for success.

Gastric Bypass Surgery Success Stories and Patient Outcomes

Studies have shown that gastric bypass patients can achieve significant weight loss that is often maintained for many years. Additionally, nearly 80% of patients experience remission or significant improvement in type 2 diabetes, and up to 90% see improvements in hypertension and other weight-related issues. However, success rates depend on each person’s adherence to dietary, activity, and follow-up guidelines.

Conclusion

Gastric bypass is a powerful tool for weight loss and health improvement in individuals struggling with obesity. However, it requires a strong commitment to lifestyle changes and regular medical follow-up. For those who meet the criteria and are prepared for the challenges, it can be life-changing—helping them achieve a healthier weight, improve related health conditions, and regain quality of life.

SIBO After Bariatric Surgery

If you've undergone bariatric surgery, whether it's gastric bypass, sleeve gastrectomy, or another procedure, you may be at an increased risk of developing small intestinal bacterial overgrowth (SIBO). SIBO is a condition where there is an abnormal increase in the number and/or type of bacteria present in the small intestine.

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The Link Between Bariatric Surgery and SIBO

Bariatric surgeries work by restricting the amount of food you can consume or by reducing the absorption of nutrients. While these changes help with weight loss, they can also disrupt the delicate balance of gut bacteria, leading to SIBO.

Some of the ways bariatric surgery can contribute to SIBO include:

1. Altered Gut Anatomy: Procedures like gastric bypass and duodenal switch involve rerouting the intestines, which can create "blind loops" where bacteria can accumulate.

2. Decreased Stomach Acid: Reduced stomach acid production, a common side effect of bariatric surgery, can allow more bacteria to survive and thrive in the small intestine.

3. Nutrient Malabsorption: Decreased absorption of nutrients, such as iron and vitamin B12, can create an environment that favors the overgrowth of certain bacteria.

Symptoms of SIBO After Bariatric Surgery

Recognizing the symptoms of SIBO is crucial for getting the right treatment. Common symptoms include:

- Bloating and gas

- Abdominal pain or discomfort

- Diarrhea or constipation

- Unintentional weight loss

- Nutrient deficiencies (e.g., vitamin B12, iron)

If you experience any of these symptoms after your bariatric surgery, it's important to speak with your healthcare provider.

Diagnosing and Treating SIBO

To diagnose SIBO, your healthcare provider may order a breath test or a small intestinal aspirate and culture. These tests can help determine the type and amount of bacteria present in your small intestine.

Once SIBO is diagnosed, the treatment typically involves a combination of antibiotics, dietary changes, and probiotics. Your healthcare provider will work with you to develop a personalized treatment plan based on your specific needs and the type of SIBO you have.

Preventing SIBO After Bariatric Surgery

While SIBO is a common complication after bariatric surgery, there are steps you can take to help prevent it:

1. Follow your healthcare provider's dietary recommendations, which may include limiting certain carbohydrates and increasing your intake of fiber-rich foods.

2. Take probiotics and digestive enzymes as directed by your healthcare provider.

3. Maintain good oral hygiene and avoid unnecessary antibiotic use, as these can disrupt the gut microbiome.

4. Stay hydrated and exercise regularly to support overall digestive health.

Addressing SIBO after bariatric surgery is crucial for your long-term health and well-being. By working closely with your healthcare provider, you can manage your symptoms, restore gut health, and continue your journey to improved health and wellness.

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The UK's Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning about the potential side effects of weight-loss drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RAs), urging healthcare professionals to inform patients of these risks.

Meanwhile, the House of Lords food, diet, and obesity committee has declared a public health emergency due to the high rates of obesity and diet-related diseases in the UK. The committee advocates for a comprehensive approach to address this crisis, including a tax on unhealthy foods, a ban on junk food advertising, and greater regulation of the food system. While weight-loss drugs are acknowledged as a potential tool, the committee emphasizes the need for broader societal interventions to combat the root causes of obesity.

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Background Information on GLP-1RAs

GLP-1 receptor agonists (GLP-1RAs) are used to treat type II diabetes and obesity. Approved options in the UK include dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide. Specific brands, such as Wegovy (semaglutide), are also approved to reduce cardiovascular risk in patients with heart disease. Another product, Mounjaro (tirzepatide), combines GLP-1RA with a GIP RA.

Growing interest in GLP-1RAs for weight loss has led to their use outside intended conditions, although benefits and risks for these applications remain unstudied. GLP-1RAs licensed for weight management are effective for patients with obesity or weight-related health issues but are intended only for those who meet these criteria.

Reports of adverse reactions include gastrointestinal symptoms, especially at treatment initiation or following dose increases. Severe cases of dehydration have led to hospitalizations, particularly in individuals who may not meet prescribing criteria but have used these drugs for unapproved weight-loss purposes. By October 2024, the MHRA received reports of gastrointestinal issues in users of GLP-1RAs for weight management, with 68 cases resulting in hospitalization. Limitations in reporting data mean the actual frequency of such reactions remains uncertain.

Adverse Drug Reaction Reporting

Healthcare professionals are encouraged to continue reporting ADRs through the Yellow Card scheme. Include detailed information, such as the patient’s medical history, co-medications, treatment dates, and any signs of misuse. This data supports the safe and effective use of GLP-1RAs.

Information for Patients

• Prescription Use Only: GLP-1RAs are prescription medicines intended for medical supervision. They should only be prescribed by qualified healthcare professionals.

• Risks and Benefits: Be aware that the risks and benefits of using GLP-1RAs for weight loss outside licensed indications have not been thoroughly studied.

• Common Side Effects: The most frequent side effects are gastrointestinal (nausea, vomiting, diarrhea, constipation), affecting over 1 in 10 users. These can persist for several days and may cause dehydration, which, in severe cases, could lead to complications like kidney damage.

• Staying Hydrated: To avoid dehydration, stay hydrated by drinking plenty of fluids, especially if you experience gastrointestinal side effects like vomiting or diarrhea.

• Serious but Rare Side Effects: Less common but serious side effects include gallstone disease, pancreatitis, and severe allergic reactions.

• Avoiding Counterfeit Products: If you receive a private prescription, ensure it’s filled by a legitimate pharmacy to avoid the risk of counterfeit products.

• Reading and Following Instructions: Always follow the dosage and instructions provided in the Patient Information Leaflet. If you experience any side effects, consult a healthcare professional.

Guidance for Healthcare Professionals

• Informing Patients of Side Effects: Educate patients at the start of their treatment and when increasing doses on the common gastrointestinal side effects of GLP-1RAs, which affect over 1 in 10 patients. While often mild, these effects can occasionally lead to severe dehydration and even hospitalization.

• Hypoglycemia Awareness: Recognize that hypoglycemia can develop in non-diabetic patients using GLP-1RAs for weight management. Ensure patients understand the signs and symptoms of hypoglycemia and encourage them to seek medical advice immediately if they experience these symptoms.

• Warning Against Falsified Medications: Advise patients of the risks associated with obtaining GLP-1RAs from unregistered sources, as some counterfeit versions contain insulin.

• Potential for Misuse: Be mindful of reports of unauthorized use of GLP-1RAs, including aesthetic weight loss, and consider the implications of such misuse in patient counseling.

• Adverse Drug Reaction Reporting: Report any suspected adverse drug reactions (ADRs) through the Yellow Card scheme to improve the safety and understanding of GLP-1RAs in real-world use.

Source: https://shorturl.at/ebTJ6

The British Assosciation of Aesthetic Plastic Surgeons and the British Bariatric and Metabolic Surgery Society have issued a joint declaration last year on surgical health tourism due to increasing complication rates. 

In the report, it was pointed out that the increasing number of people going abroad for aesthetic and bariatric surgery has increased the rates of serious complications and even death. Aesthetic and Bariatric Surgery Associations stated that they published this joint declaration to draw attention to patient safety and health.

Both associations warned about the risks of health tourism. Against this, economic pressures and advertising bombardment are leading to an increasing number of British patients choosing to travel abroad for surgery. Health professionals point out that an increasing number of patients are presenting with complications following operations performed outside the UK. The management of these complications has the potential to place a heavy burden on the already strained NHS budget. Therefore, a measure could be introduced to ensure that these costs are paid by the patient.

Also the recent YouTube video "Türkiye'deki güzellik sektörünün karanlık tarafı" (The dark side of the beauty market in Turkey) by DW Türkçe explores the dark side of Turkey's booming aesthetic surgery industry, specifically highlighting the dangers faced by British citizens seeking cosmetic procedures there.

The video investigates the cases of Morgan Ribeiro, a young woman who tragically died after a botched gastric sleeve surgery in Istanbul, and Sara Platt, who endured numerous complications after a tummy tuck and breast augmentation. Both women had been lured to Turkey by advertisements for affordable procedures, but ultimately fell victim to unscrupulous clinics and unqualified surgeons. The video also examines the role of medical tourism agencies in facilitating these procedures, raising concerns about their lack of transparency and accountability. The report concludes by advocating for stricter regulations in the industry and increased awareness among potential patients of the risks involved.

Dangers of Unregulated Clinics

Unregulated clinics pose significant risks to patients seeking medical care. These clinics often operate without proper licensing, oversight, or adherence to medical standards, leading to harmful consequences. In this chapter, we delve into the potential dangers associated with these establishments and provide examples from various sources to illustrate our points.

Substandard Conditions

Unregulated clinics often have substandard conditions that can compromise patient safety and care. These conditions may include:

* Lack of proper sanitation, leading to the spread of infections and diseases

* Outdated or malfunctioning medical equipment, increasing the risk of complications during procedures

* Inadequate staff training, resulting in poor patient care and potentially life-threatening mistakes

In the video, a journalist visits an unregulated cosmetic surgery clinic, where they find dirty instruments, rusty equipment, and unqualified staff, posing significant risks to patients undergoing procedures.

Unqualified Staff

Unregulated clinics may employ unqualified or inadequately trained staff, which can result in improper diagnoses, incorrect treatments, and patient harm:

* Unlicensed practitioners may administer treatments or perform procedures outside their scope of expertise

* Inadequately trained staff may not recognize or respond appropriately to patient complications or emergencies

A former patient of an unregulated clinic shares their story of receiving treatment from an unlicensed practitioner who misdiagnosed their condition, leading to unnecessary and harmful treatments.

Performed Procedures

Unregulated clinics may perform procedures without proper oversight or adherence to medical standards, increasing the risk of complications and poor outcomes, such as:

* Performing unnecessary or inappropriate procedures, potentially causing harm and increasing healthcare costs

* Failing to obtain informed consent or provide adequate pre- and post-procedure instructions

* Lack of follow-up care or inadequate response to patient complications

The video shows undercover footage from an unregulated clinic, where practitioners are seen performing invasive procedures without proper equipment, safeguards, or patient consent.

Unregulated clinics put patients at risk by operating without proper oversight, licensing, or adherence to medical standards. By cutting corners in areas such as staff training, facility maintenance, and procedure performance, unregulated clinics expose patients to potential harm, substandard care, and poor outcomes. It is crucial for both patients and regulatory bodies to ensure that medical clinics are held to the highest standards, to protect public health and safety.

What We Offer to Our Patients?

1-When you decide to walk with us in your fight against obesity, you will be consulted by a UK citizen bariatric surgeon and informed in full detail.

2-Selection of the operation is completely tailored to you in the light of international criteria. Using the ACS NSQIP Surgical Risk Calculator, the most appropriate and lowest risk method is selected for you. Complication and risk estimates for all possible methods, detailed scientific analyses on targeted success rates are presented to you as a report.

3-The method to be applied to you is decided together in medical consultation, and all your postoperative examination and surgery reports, including images such as endoscopy, ultrasound, leak test, etc. are delivered to you. We would also like to inform you that our practice of delivering the surgery video to the patient without editing is a standard.

4- Your surgery is performed by internationally accredited surgeons who are world-renowned in the field of bariatric surgery. Follow-up processes are also carried out by a team with SRC International Accreditation.

5-The medical history, medications and embolism risks of all bariatric surgery candidates are evaluated at the time of surgery decision. If necessary, changes in medications or the use of blood thinners are decided in communication with your GP.

6-After the surgery, your regular and mandatory controls are carried out by our bariatric dietitians even if you do not request it. In order to avoid any vitamin and mineral deficiency, your regular blood tests will be followed up in co-operation with your GP.

7- In case you need any support in the UK, the necessary support is provided by local bariatric surgery specialists and other consultants. 

Your health is your most valuable asset, cost should never be your priority when deciding on surgery abroad. You can contact us to reach UK quality health service with much more reasonable package prices compared to UK figures.

Sources: Fly to Cure Healthcare 🇬🇧

As obesity rates continue to rise worldwide, the medical community is increasingly focusing on finding effective, minimally invasive solutions for weight management. Traditional surgical approaches, while effective, are not suitable for everyone due to the risks, recovery times, and certain health requirements. To bridge this gap, Endoscopic Sleeve Gastroplasty (ESG) has emerged as a promising option for those looking for less invasive weight-loss procedures.

Recently, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) endorsed ESG as an effective method for managing obesity, especially for patients who cannot or prefer not to undergo traditional surgery. This endorsement follows a comprehensive review of ESG, reflecting its rising acceptance as a valuable addition to obesity care. Let’s dive into what ESG is, why it’s significant, and how the IFSO’s review supports its role in obesity treatment.

What is Endoscopic Sleeve Gastroplasty (ESG)?

ESG is a minimally invasive, endoscopic procedure designed to reduce the stomach’s volume, limiting food intake and helping individuals lose weight. Unlike traditional bariatric surgery, ESG does not require any cuts or large incisions. Instead, the procedure is performed using an endoscope—a flexible tube equipped with a camera and suturing device—that enters the stomach through the mouth.

Once inside the stomach, the surgeon uses specialized tools to create a series of sutures along the stomach wall, reducing its overall size and forming a sleeve-like structure. This reshaping of the stomach reduces the amount it can hold, helping patients feel full after consuming smaller portions of food. Since ESG preserves the natural anatomy of the digestive system, it also reduces the risks associated with more invasive surgeries.

The IFSO Review and Endorsement of ESG

The recent endorsement of ESG by IFSO is based on a systematic review conducted by the IFSO Bariatric Endoscopy Committee. This review collected and analyzed data from various studies on ESG, with the aim of evaluating its safety, effectiveness, and role within obesity care. The review included findings from numerous case studies, cohort studies, and even a randomized controlled trial, encompassing a total of over 15,000 patients.

The review’s findings provided evidence supporting ESG as a valuable option for weight loss, particularly for individuals with obesity who either cannot undergo or choose not to have more invasive procedures. Here are some of the key findings and conclusions from this IFSO-backed review:

1. Significant Weight Loss Outcomes: The review found that ESG led to meaningful and sustained weight loss across different study groups. Patients generally experienced a significant percentage of excess weight loss (EWL) and total body weight loss (TBWL) over periods extending up to five years. For example, average TBWL values remained between 14-18% over 24 to 36 months, indicating durable results.

2. Safety Profile: The review demonstrated that ESG has a favorable safety profile, with a serious adverse event rate of only 1.25%. This low rate of complications underscores ESG’s position as a safer alternative to more invasive weight-loss surgeries, especially for patients who might have higher surgical risks.

3. Quality of Evidence: Although most of the studies included in the review were observational, limiting the level of evidence, the findings from a randomized controlled trial (RCT) included in the review offered more robust support for ESG’s efficacy and safety. The RCT reinforced ESG’s status as a reliable option for weight management, providing a higher level of scientific evidence to back the positive outcomes observed in other study types.

Why ESG is an Important Development in Obesity Treatment

The IFSO’s endorsement of ESG signals a shift toward accepting less invasive methods as part of mainstream obesity treatment. Here’s why ESG’s position in obesity care is so important:

• Alternative for High-Risk Patients: Many patients with obesity have health conditions that make them poor candidates for surgery. ESG provides a viable alternative for these patients, offering significant weight loss without the high risks associated with surgical interventions.

• Options for Those with Lower BMI: Some individuals with a BMI below the threshold for traditional surgery still struggle with obesity-related health conditions, but they may not qualify for traditional metabolic and bariatric surgery (MBS). ESG fills this gap, providing an option for patients with class I and II obesity who may still benefit from medical intervention.

• Reduced Healthcare Burden: Because ESG can often be performed as an outpatient procedure, it reduces the time patients need to spend in healthcare facilities, lowers the risk of complications, and generally has a shorter recovery period compared to surgery. This can help reduce healthcare costs and increase accessibility for patients who need treatment.

Detailed ESG Outcomes from the IFSO Review

The IFSO review looked at weight loss outcomes and complication rates for ESG over time. Here are some of the specific results from the review:

1. Weight Loss:

• 6 Months: Patients typically lost an average of 15.66% of their total body weight.

• 12 Months: At the one-year mark, average weight loss increased to approximately 17.56%.

• 18-24 Months: Patients continued to lose weight over time, with results peaking around 18 months at nearly 16.25%.

• Long-Term Results: Even at 36 to 60 months, weight loss remained stable, with mean weight loss percentages staying between 14-15%.

2. Safety and Complications:

• The review showed that serious complications were uncommon, with a rate of only 1.25%.

• Mild side effects, such as nausea or abdominal discomfort, were more common but generally resolved quickly.

3. Quality of Evidence:

• While observational studies were the primary source of data, a single RCT in the review provided a more moderate level of evidence for ESG’s safety and effectiveness. The RCT’s findings aligned with those of other studies, reinforcing the reliability of ESG as a weight-loss tool.

How ESG Compares to Other Weight-Loss Procedures

Compared to traditional bariatric surgeries like the gastric bypass or sleeve gastrectomy, ESG offers several distinct advantages:

• Lower Risk: ESG has a much lower rate of complications than many traditional surgeries, as it doesn’t involve cutting or stapling parts of the stomach or intestines.

• Quicker Recovery: Most patients can return to daily activities within a few days after ESG, whereas recovery from surgical options can take several weeks.

• Reversibility: While not commonly reversed, ESG is theoretically reversible by removing the stitches, which is not an option with more permanent procedures like sleeve gastrectomy.

However, ESG may also have limitations in comparison to traditional surgeries:

• Less Drastic Weight Loss: While ESG is effective, the amount of weight loss may be slightly less than with traditional surgeries, especially for those with higher BMI levels.

The Future of ESG in Obesity Management

The IFSO endorsement of ESG is a pivotal development in the field of obesity treatment, as it highlights the potential for ESG to become a standard, widely accepted option within the broader spectrum of obesity care. As more studies are conducted, and additional RCTs build upon the existing data, the medical community will gain an even clearer picture of ESG’s long-term benefits and limitations.

The IFSO’s endorsement encourages healthcare providers to consider ESG not as an alternative to surgery but as a complementary option. It opens up the possibility of using ESG as part of a multidisciplinary obesity treatment plan, giving doctors more tools to help patients achieve sustainable weight loss.

Key Takeaways for Patients Considering ESG

If you’re considering ESG as a weight-loss option, here are some essential points to discuss with your healthcare provider:

1. Eli…

This podcast summarizes key information from the article published on the website of Dr. Murat Ustun, a leading bariatric surgeon in Turkey. The article focuses on Endoscopic Sleeve Gastroplasty (ESG), a minimally invasive procedure for weight loss.

What is ESG?

ESG is a non-surgical procedure where an endoscope is inserted through the mouth into the stomach. Special sutures are then used to reduce the stomach's volume, helping patients feel full faster and consume less food.

Who is ESG suitable for?

The procedure is generally suitable for individuals with a Body Mass Index (BMI) between 30 and 40 who have struggled to lose weight through traditional methods like diet and exercise. It can also be an alternative for patients who are high-risk for open surgical procedures.

Procedure and Advantages:

Performed under general anesthesia, the procedure takes approximately 1-2 hours. Recovery is generally quick with a low risk of complications, highlighting the advantages of ESG as a minimally invasive procedure.

The article emphasizes the benefits of ESG over gastric balloons:

“Although the basic mechanism of both is to reduce stomach volume, there are significant differences between them and gastric balloons. First, in a gastric balloon, a foreign body made of silicone or polypropylene, i.e., a gastric balloon, is placed into the stomach and filled with serum. In endoscopic sleeve gastroplasty, volume restriction is achieved only by placing sutures.”

The article highlights the comfort and long-term effectiveness of ESG compared to the temporary nature of gastric balloons.

Expected Weight Loss and Long-Term Care:

Patients can expect to lose 15-20% of their excess weight within the first six months. However, maintaining this weight loss requires commitment to lifestyle changes, including:

* Eating smaller portions regularly

* Adopting a healthy and balanced diet

* Engaging in regular physical activity

* Attending periodic health check-ups

* Seeking support from nutritionists and psychologists if needed

Risks and Reversibility:

While generally low, risks associated with ESG include nausea, vomiting, temporary abdominal pain, and rare occurrences of infection, bleeding, or suture opening. Importantly, ESG is reversible, as the sutures can be removed endoscopically if needed, restoring the stomach to its original size.

ESG in Turkey and Cost:

The article notes that Dr. Murat Ustun pioneered ESG in Turkey in 2014 and continues to perform the procedure with a team of gastroenterologists and bariatric surgeons. The cost of ESG in Turkey ranges from 7,000 to 10,000 USD, making it more expensive than traditional bariatric surgery methods due to the specialized equipment required.

Conclusion:

ESG is presented as a promising non-surgical alternative for weight loss, especially for individuals with a BMI between 30 and 40. The procedure boasts several advantages, including minimal invasiveness, quick recovery, and reversibility. However, long-term success depends heavily on patients adopting and maintaining healthy lifestyle changes.

For more information: www.apolloendosleeve.com