Obesity arises from intertwined and reciprocal diet-microbiome-host pathways that reshape energy balance, insulin sensitivity, and inflammation. This review synthesizes mechanistic links between microbial functions and metabolic control, charts lifestyle-related lifecourse dynamics from birth to older age, examines how GLP-1-based therapies may perturb gut ecology and metabolite output and surveys AI/ML frameworks for multi-omics integration. Plant-based, fiber-rich dietary patterns generally enrich saccharolytic guilds, boost SCFAs production, and modulate bile acid signaling, whereas Westernized patterns favor bile-tolerant, amino acid-fermenting consortia and proinflammatory metabolites. Preclinical data suggest that incretin-based therapies remodel the microbiome-metabolome axis, but human causal mediation remains unproven and observed changes may partly reflect weight loss or metabolic improvement. Function-centered metrics outperform phylum-level ratios for translation. Harmonized longitudinal cohorts and explainable ML-derived microbial and metabolomic signatures are now pivotal to identify responder subtypes and actionable microbe-metabolite targets, enabling precision nutrition alongside pharmacotherapy across the lifespan.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disorder worldwide, affecting approximately one-third of the population and increasing the risk of severe hepatic and cardiovascular complications. Growing evidence indicates that MASLD is a systemic disease in which epigenetic changes-including DNA and RNA methylation as well as histone modifications-drive its progression by integrating metabolic and inflammatory signals across organs. This review introduces the concept of "networked epigenome cascades" and highlights how epigenetic alterations in extrahepatic metabolic organs contribute to insulin resistance (IR) and systemic inflammation. MASLD is thereby reframed as a disorder of systemic epigenomic miscommunication rather than a liver-only disease. We further discuss preclinical and emerging interventions, with an emphasis on natural compounds that modulate epigenomic regulation, while noting the uncertainties that remain regarding their translational potential for MASLD. By positioning the epigenome as a central mechanism, this review underscores its promise for biomarker development and mechanistically targeted interventions, although robust validation in humans is still required.
INTRODUCTION:Convenience stores are a key food source in many communities but often provide limited healthy options. This systematic review examines the impact of healthy eating interventions in convenience stores on diet-related outcomes across high-income countries. METHODS:This systematic review was conducted using seven databases and gray literature sources. Eligible studies were published between January 2005 and June 2024. Eligible studies evaluated healthy eating strategies or interventions in convenience stores and reported diet-related outcomes. This study was registered with PROSPERO (CRD2024538968) and reported according to PRISMA guidelines. RESULTS:Twenty-eight studies met the inclusion criteria: 20 intervention studies, four observational studies, and four gray literature reports. Interventions included changes to the availability, positioning, pricing, and signage of healthy foods. Most studies reported improvements in purchasing and consumption of healthy foods, especially fruits and vegetables. Multicomponent approaches were most effective, particularly those that use availability, positioning, and signage strategies to concurrently incentivize healthy foods and disincentivize unhealthy foods. However, study quality varied, with many showing moderate to high risk of bias. CONCLUSION:Healthy eating strategies in convenience stores show promise for improving diet-related outcomes. The results from this review provide policy makers with evidence to justify the implementation of population-level policies that support improved availability, positioning, and signage on healthy foods in convenience store settings to improve dietary-related behaviors. Future research that uses high-quality scientific evaluation designs and cost-effectiveness assessments would further enhance the evidence base and case for policy action.
Bariatric surgery (BS) has short- and medium-term benefits in improving metabolic syndrome (MetS) components, but its long-term impact remains incompletely characterized. This systematic review and meta-analysis aimed to quantify the long-term effects of BS (≥ 5 years) on fasting blood glucose (FBG), HDL cholesterol, triglycerides (TG), waist circumference (WC), and systolic and diastolic blood pressure (SBP and DBP). A comprehensive literature search was conducted across relevant databases. Eligible studies included randomized controlled trials and observational cohorts reporting pre- and postsurgical metabolic outcomes after at least 5 years of follow-up. Random-effects meta-analyses and meta-regressions were performed. Fifty-four articles (49 cohorts and five RCTs), including 37,840 baseline participants, were analyzed. BS was associated with significant improvements across all outcomes, with effect sizes varying by study design. Pooled estimates ranged from -22.97 to -44.68 mg/dL for FBG, +10.25 to +11.94 mg/dL for HDL, -54.11 to -59.59 mg/dL for TG, -20.55 cm for WC, -7.82 to -9.76 mmHg for SBP, and -4.80 to -6.48 mmHg for DBP. Meta-regression showed stronger effects in patients with higher baseline values. BS provides sustained, long-term improvements in all major MetS components. However, these findings are primarily driven by studies on Roux-en-Y gastric bypass, whereas long-term data on sleeve gastrectomy remain limited. High-quality longitudinal evidence on sleeve gastrectomy is needed to improve the generalizability of these results to contemporary surgical practice.
BACKGROUND:Efforts to control the global obesity epidemic are increasingly focusing on preventing childhood obesity. A wide range of interventions has been implemented; however, such interventions raise important ethical issues. AIM:This study aims to determine systematically the spectrum of ethical issues that are raised by interventions to prevent or treat childhood obesity. METHODS:A systematic review in PubMed was conducted for publications describing and/or assessing ethical issues raised by childhood obesity interventions. Data were analyzed and synthesized using qualitative content analysis. RESULTS:Our literature search retrieved 4637 publications of which 62 were included in the final analysis. When the ethical issues presented by the 11 different types of childhood obesity interventions were identified, it is clear that the discussion of ethical issues regarding interventions to prevent or treat childhood obesity has important gaps. However, two key overarching themes emerged across the different interventions: a lack of evidence of effectiveness and risk of harmful side effects. CONCLUSION:The obesity epidemic is a growing, yet largely neglected, global public health crisis. Despite there being an ethical obligation to address this crisis, it is ethically problematic that efforts to reduce childhood obesity rates have primarily focused on individual behavior. Evidence demonstrates that these lifestyle interventions are not only largely ineffective but also cause harm. A fundamental shift towards more system-level actions is needed.
Psychiatric disorders are highly prevalent among individuals living with obesity and contribute to treatment resistance, poor adherence, and adverse health outcomes. Yet, obesity management often remains fragmented, with limited integration between endocrinology, psychiatry, and behavioral health. This Perspective advocates for a mental health framework for obesity care. We emphasize the need for future investigations to test the clinical relevance of behavioral phenotyping as a complementary approach to pharmacotherapy, including GLP-1 receptor agonists, to enhance treatment personalization. By reframing obesity as a disease deeply intertwined with mental health, we emphasize the need for multidisciplinary care models that incorporate psychological assessment, stigma reduction, and patient-centered nutrition counseling. Advancing this framework will require closer collaboration between medical and mental health disciplines and greater investment in neurobehavioral research to improve long-term outcomes in obesity care.
BACKGROUND:Obesity is a major public health challenge worldwide, driving chronic disease and health care costs. Primary health care (PHC) is a key setting for prevention, early identification, and management of obesity, yet implementation of evidence-based interventions remains limited. Identifying the barriers and enablers that influence adoption of obesity care in PHC is critical to strengthen delivery. OBJECTIVE:This scoping review will systematically map and synthesize barriers and enablers to implementing obesity interventions in PHC, considering behavioral, nutritional, pharmacological, digital, and organizational approaches, across both adult and pediatric populations. METHODS:The review will follow the Joanna Briggs Institute (JBI) methodology and be reported according to PRISMA-ScR guidelines. Searches will be conducted in PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect, complemented by gray literature from OpenGrey, ResearchGate, Google Scholar, and organizational websites. Eligible sources will include peer-reviewed and gray literature published between 2019 and 2025 in English, French, German, Italian, Portuguese, Spanish, or Turkish. Two reviewers will independently screen, extract, and analyze data, with discrepancies resolved by consensus. Data will be synthesized descriptively and thematically, supported by NVivo, and results presented in tables, thematic maps, and conceptual diagrams. Expected Results Anticipated barriers include time constraints, limited provider training, stigma, scarce resources, and inadequate reimbursement models. Enablers are expected to include supportive health policies, training, patient engagement strategies, and team-based care models. CONCLUSIONS:This review will synthesize implementation factors affecting obesity care in PHC, informing scalable strategies and policy to improve obesity management worldwide.
Recent studies suggest that health literacy (HL) may play an important role in management of individuals living with severe obesity (BMI ≥ 40 kg/m2), but to date, there has been no attempt to synthesize characteristics and outcomes of these studies. To explore the prevalence of low HL in people with severe obesity, and how HL may impact on health outcomes and management of severe obesity, six databases and two independent journals were searched. Seventeen studies were included in this review, mostly undertaken in high income countries, among females and candidates of bariatric surgery. Low HL ranged from 3.7% to 57.9% in cohorts studied, possibly explained by the heterogeneity of HL tools (i.e., seven different validated tools). Eight studies found higher HL to lead to better treatment outcomes (e.g., weight loss, attending appointments). Thematic synthesis of qualitative studies identified a lack of access to health information and support from healthcare providers (domains of HL) as barriers in improving health in patients with severe obesity. There is notable gap in interventional studies on improving HL in people with severe obesity. Overall, HL seems to be an important predictor of health outcomes in management of severe obesity. Further research is needed to assess the impact of HL on a broader range of health outcomes in nonsurgical patients with severe obesity.
ABSTRACT Introduction Cardiovascular (CV) outcomes of Glucagon‐like peptide‐1 (GLP‐1)–based medicines among people with overweight and obese (OW/OB) population have been investigated by meta‐analyses of randomized controlled trials (RCTs), but an overall summary is lacking. Methods PubMed, EMBASE, Epistemonikos, and Cochrane databases were searched till May 2024 for meta‐analyses of RCTs that assessed CV outcomes of GLP‐1–based medicines among people with OW/OB. GRADE approach was used to assess strength of associations. Results Nine studies with 58 unique meta‐analyses were included. Fifteen (25.9%) associations were statistically significant. Five high certainty evidence demonstrated beneficial effects of GLP‐1 RAs on any CV events ( N = 1), major adverse cardiac events (MACE) ( N = 2), and myocardial infarction (MI) ( N = 2), whereas two associations on revascularization ( N = 1) and CV events ( N = 1) were supported by moderate certainty. Four associations demonstrated inverse effects of tirzepatide on MACE ( N = 1; moderate) and hypertension ( N = 3; low). Remaining four demonstrated higher risk of arrhythmia with GLP‐1 RAs ( N = 1; moderate) and increased heart rate with tirzepatide ( N = 3; low to moderate). Although the inverse association between GLP‐1 RAs and MACE and MI was significant and supported by high certainty evidence in both main and sensitivity analyses, these associations were no longer statistically significant among patients without CV disease (CVD) at baseline. Conclusion Findings suggest that GLP‐1 RAs are associated with reduced risk of MACE, and MI among people with OW/OB, but they were driven by studies with established CVD at baseline.
ABSTRACT Introduction The effectiveness of obesity prevention or obesity reduction policies is co‐determined by policy content, the implementation process, and contextual factors. This systematic review provides insight into implementation strategies used in whole‐of‐community obesity prevention policies aimed at changes in two types of outcomes: (1) a reduction in obesity/overweight prevalence, body mass index–related outcomes, and other weight‐related outcomes, or (2) a change in nutrition behaviors, physical activity, and sedentary behaviors or screen time. We specifically examined implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework, focusing on policies implemented in low socioeconomic status communities. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, eight databases were searched. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The efficacy of implementation strategies was considered supported if at least 66% of the studies that applied respective strategies reported significant improvements for a given outcome type across at least three studies. Results A total of 29 original studies were included. Fifteen implementation strategies from the ERIC framework were consistently associated with favorable outcomes. These strategies included altering incentive structures, assessing community readiness, and using data warehousing techniques. Six additional non–ERIC strategies (e.g., cultural adaptation and grassroots mobilization) received support across different outcome domains. Most studies (72%) had a low risk of bias. Conclusion Findings may help prioritize implementation strategies that may drive the success of whole‐of‐community obesity policies targeting disadvantaged populations. The results suggest a need to expand existing implementation taxonomies to include community‐driven strategies.
BACKGROUND:This review synthesized evidence on the association between fat-free mass (FFM) metrics and weight-related metabolic complications in adults with overweight or obesity. METHODS:A systematic search of Medline, Embase, Web of Science, and Google Scholar (inception to October 2024) identified 32 observational studies involving 138,935 participants. Random-effects meta-analyses were conducted for type 2 diabetes (T2DM, 5 studies, n = 41,235), metabolic syndrome (MetS, 3 studies, n = 2832), cardiovascular disease (CVD, 3 studies, n = 8980), and non-alcoholic fatty liver disease (NAFLD, 3 studies, n = 4570). Heterogeneity was assessed using I2. Sensitivity analyses stratification by FFM metric type were performed where feasible. RESULTS:Low FFM metrics were significantly associated with increased risk of T2DM (pooled RR = 1.46, 95% CI 1.11-1.91), MetS (OR = 4.48, 95% CI 2.18-9.22), CVD (RR = 2.03, 95% CI 1.27-3.26), and NAFLD (RR = 2.24, 95% CI 1.52-3.32). High heterogeneity was observed for T2DM (I2 = 90.9%) and MetS (I2 = 79.8%); however, sex-stratified sensitivity analyses eliminated heterogeneity for T2DM (I2 = 0%). Narrative synthesis of remaining studies generally supported these findings, though associations varied according to FFM metric type. CONCLUSIONS:Low FFM-related metrics were associated with increased risk of major weight-related metabolic complications, although the strength and consistency of associations differed by FFM metric type.
OBJECTIVE:To evaluate evidence on the impact of sleep health on weight loss in adults with excess weight undergoing behavioral or surgical weight loss interventions. METHODS:We conducted a systematic review of randomized controlled trials and quasi-experimental studies including adults aged ≥ 18 years with BMI ≥ 25 kg/m2. MEDLINE, Embase, and CENTRAL were searched from inception to September 2025. Screening, data extraction, and risk of bias assessment were performed in duplicate. Sleep was examined either as an exposure or as an intervention component. A narrative synthesis was conducted using the RU-SATED framework and stratified by sleep exposure versus sleep intervention studies. RESULTS:Thirty studies (13 randomized controlled trials and 17 quasi-experimental studies; 10,944 participants from 13 countries) were included. Evidence was mixed across sleep dimensions. In behavioral weight loss interventions, sleep manipulation studies suggested that sleep restriction reduced fat loss, whereas observational studies reported inconsistent associations between sleep duration and weight loss. Limited evidence suggested that greater sleep satisfaction and higher sleep efficiency may support weight loss, with approximately half of the studies reporting positive associations. Evidence for sleep regularity, timing, and alertness was sparse and inconsistent because of the small number of studies and methodological heterogeneity. CONCLUSION:Sleep satisfaction and sleep efficiency may support weight loss in behavioral interventions, whereas sleep duration shows inconsistent associations and sleep restriction may impair fat loss. Evidence for sleep regularity, timing, and alertness remains limited. High-quality experimental studies are needed to clarify the causal role of sleep health in weight loss outcomes.
INTRODUCTION:The paper aims to assess the effects of GLP-1 RAs, structured exercise, and their combination on body composition and cardiometabolic outcomes in adults with overweight or obesity. METHODS:PubMed, Web of Science, Scopus, and EBSCO were searched through April 2026 for English-language RCTs using terms related to obesity, GLP-1 RAs, exercise, and glucolipid metabolism outcomes. We included RCTs of adults (18-65 years, BMI ≥ 25 kg/m2) without major comorbidities, except for type 2 diabetes, testing GLP-1 RAs, structured exercise, or both. Of 2508 screened articles, nine studies comprising 1009 participants met eligibility criteria. Participants included 589F/420M, with a weighted mean age of 43.8 ± 12.2 years and weighted mean BMI of 32.6 ± 3.0 kg/m2. Risk of bias was assessed using RoB 2. A frequentist random-effects model calculated SMDs. Primary outcomes were changes in body weight, waist-to-hip ratio, and fat mass. Secondary outcomes included fasting glucose, HOMA-IR, triglycerides, LDL-C, and HDL-C. Meta-regression assessed weight loss as a predictor of metabolic outcomes. RESULTS:The combination of GLP-1 receptor agonists and exercise was associated with the greatest effects on weight (SMD -1.04; 95% CI -1.24 to -0.83), fat mass (SMD -1.01; 95% CI -1.27 to -0.75), and waist-to-hip ratio (SMD -0.55; 95% CI -0.91 to -0.18) compared with placebo. For fasting glucose, the SMD was -0.49 (95% CI -1.52 to 0.55); for HOMA-IR, -0.59 (95% CI -0.89 to -0.29). For lipid outcomes, no statistically significant differences were observed for triglycerides or LDL-C, whereas HDL-C increased compared with placebo (SMD 0.32; 95% CI 0.04 to 0.61). Confidence in the evidence was high for body weight and fat mass, moderate for waist-to-height ratio and most lipid outcomes, and very low for fasting glucose. CONCLUSIONS:Combined GLP-1 RA and structured exercise interventions improved weight, insulin sensitivity, and selected lipid parameters more than monotherapies or placebo.
INTRODUCTION:Overweight and obesity rates are rising globally, including among young adults, posing significant health risks. However, prevention programs in low- and middle-income countries (LMICs) are limited, and little is known about their applicability in these settings. This systematic review aimed to assess the effectiveness and feasibility of overweight and obesity prevention and management interventions among young adults in LMICs. METHODS:Databases, including Medline, Scopus, and Web of Science, were systematically searched to identify trials published between 2014 and February 2026. Studies were included if they targeted young adults in LMICs and reported outcomes such as body mass index (BMI) and/or waist circumference. Publications reporting feasibility outcomes were manually searched. A random-effects meta-analysis estimated the mean difference in outcomes by gender and intervention duration. A narrative synthesis complemented the random-effects meta-analysis. The Cochrane risk-of-bias tool and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) framework evaluated the evidence quality. RESULTS:Sixteen intervention studies met inclusion criteria, but none reported on feasibility. Nine studies were included in the meta-analysis on effectiveness. Pooled estimates show that mean BMI (kg/m2) (-1.13; 95% CI: -2.10, -0.17) and waist circumference (cm) (-1.66; 95% CI: -2.35, -0.96) were significantly lower in the intervention group compared to the controls. Greater effects were observed in longer durations of interventions (≥ 6 months). The quality of evidence was moderate. CONCLUSION:Obesity control interventions may benefit young adults in LMICs, but evidence is limited and moderate in quality. Future studies should evaluate feasibility using established implementation frameworks.
BACKGROUND:Obesity links to adverse cardiovascular outcomes, but subclinical cardiac remodeling patterns remain incompletely characterized. Cardiac magnetic resonance (CMR) provides reproducible assessments of myocardial structure, function, tissue characterization, and adiposity. We conducted a systematic review and meta-analysis to define the obesity-related CMR phenotype. METHODS:PubMed, MEDLINE, EMBASE, Cochrane, Web of Science, and Scopus were searched (2000-2025) for studies comparing CMR-derived cardiac parameters in adults with obesity (WHO criteria) versus controls without obesity. Standardized mean differences (SMDs) were pooled using random-effects meta-analysis. Sensitivity analyses and meta-regression explored heterogeneity. RESULTS:Twenty studies (1395 individuals with obesity, 1260 controls) were included. Obesity was associated with increased epicardial fat volume (SMD 0.74, 95% CI 0.46-1.01; p < 0.001), higher left ventricular mass/end-diastolic volume ratio (SMD 0.51, 95% CI 0.27-0.75; p < 0.001), increased left ventricular mass index (SMD 0.33, 95% CI 0.13-0.53; p = 0.001), and higher stroke volume (SMD 0.40, 95% CI 0.20-0.61; p < 0.001). Despite preserved left ventricular ejection fraction, global longitudinal strain (GLS) was impaired (SMD -0.44, 95% CI -0.67 to -0.20; p < 0.001), indicating subclinical systolic dysfunction. Sensitivity analyses excluding cohorts with cardiometabolic disease demonstrated consistent findings. Meta-regression identified body mass index as a modifier of GLS (p = 0.02), whereas age influenced left ventricular mass remodeling. CONCLUSIONS:Obesity is characterized by a distinct CMR phenotype of concentric ventricular remodeling, excess epicardial adiposity, increased hemodynamic adaptation, and early subclinical myocardial dysfunction despite preserved ejection fraction. These findings highlight potentially reversible early cardiac adaptations contributing to the excess cardiovascular risk associated with obesity. TRIAL REGISTRATION:Registration number: PROSPERO CRD420251083324.
Obesity is a chronic disease associated with substantial cardiometabolic, mechanical, and psychosocial burden, contributing significantly to global morbidity and mortality. Despite its impact, therapeutic strategies remain disproportionately conservative, often delaying effective intervention. In contrast, treatment algorithms for other chronic diseases, such as type 2 diabetes and rheumatoid arthritis, have adopted remission-oriented approaches aimed at suppressing disease activity rather than merely attenuating progression. In this context, we propose a remission-oriented paradigm for obesity. Remission is defined as a sustained, multidimensional state characterized by the achievement of clinically meaningful adiposity targets, alleviation of obesity-related complications, restoration of functional capacity, and improvement in psychological well-being. Importantly, remission is conceptualized as a continuum, analogous to glycemic states, and may be maintained with ongoing pharmacotherapy. We further propose an induction-remission-maintenance model that prioritizes early, effective intervention. This framework explicitly acknowledges the chronic nature of the disease of obesity, even in the presence of potent therapies, underscoring the need for ongoing monitoring and long-term disease surveillance. Despite challenges related to access, cost, and long-term adherence, this approach offers a structured, disease-centered model with the potential to improve clinical outcomes and reduce healthcare burden.
BACKGROUND/INTRODUCTION:Emerging literature links life dissatisfaction with maladaptive coping mechanisms, including compulsive eating, particularly in environments with limited health-promoting resources. This study explores how life satisfaction interacts with psychological and sociostructural factors to influence obesity risk, with a focus on the role of weight perception across the lifespan. METHODS:A thorough search was conducted, and data were uploaded in Covidence, a validated website-based screening and data extraction tool. After an extensive review process, 83 studies remained for extraction. A qualitative approach was then used to synthesize the articles, primarily effects of age. Our analysis also considered effects of gender, geographical/racio-ethnic, and cultural differences. RESULTS:Across the lifespan, life satisfaction was more strongly predicted by weight perception rather than BMI or objective weight status. This effect was particularly pronounced in females, who showed greater vulnerability to negative weight perception compared to their male counterparts. The findings emphasize the psychological burden of perceived body image and its role in driving dissatisfaction, irrespective of clinical weight categories. The findings highlight the influence of gender, geography, and cultural factors in the interplay between life satisfaction and obesity. CONCLUSIONS:This research supports a biopsychosocial framework of obesity, highlighting effects of weight perception on life satisfaction and health behaviors. Interventions aimed at psychosocial well-being and reframing weight perception, especially among young females, may serve as protective factors against maladaptive eating behaviors and long-term obesity. Future obesity interventions should consider life meaning, personality traits, and perceived body image to better target at-risk populations.
INTRODUCTION:Photovoice is a community-based participatory research methodology that empowers participants to document and reflect on their lived experiences through photography. This scoping review examines the use of Photovoice in obesity research to explore the contexts in which it has been used, its application, and key themes in the literature to date. METHODS:Eligible studies were peer-reviewed primary research published since 1997 that used Photovoice (with the process described) to collect empirical data from people with lived experience of obesity as the primary focus and were available in English, French, or Portuguese. Following the Joanna Briggs Institute guidelines, a systematic search was conducted in six databases, yielding 387 records, with 32 studies meeting the inclusion criteria. Key data, including study location, participant demographics, Photovoice methodology, and findings, were extracted and synthesized. RESULTS:Most studies were conducted in North America within community settings, predominantly with minority populations. Four key themes emerged: environmental influences, facilitators and barriers to healthy living, mental health and well-being, and perceptions of obesity. Although findings align with other research methodologies, Photovoice uniquely highlights participant voices and fosters critical community engagement. CONCLUSION:Photovoice is a valuable tool for obesity research, amplifying participant perspectives and contextual insights in ways more traditional methods may overlook. Future research should expand geographic and demographic diversity and adapt Photovoice for virtual formats to broaden its accessibility and explore its impact on participants, policy, and practice change.
OBJECTIVE:This work aimed to investigate the efficacy and safety of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in adults with acquired hypothalamic obesity (HO). DESIGN:Systematic review and meta-analysis. METHODS:Publications reporting relevant outcomes in patients with HO before and after RYGB or SG were identified through a systematic literature search. Two meta-analyses were performed: one based on individual patient data (IPD) and one on case-control studies. RESULTS:Thirteen publications including 36 unique patients with HO were included in the IPD meta-analysis. Percent total weight loss was 16.5% (95% CI, 11.6%-21.4%; p = 5.7 × 10-8) after a median follow-up of 31.5 months (IQR 24.0, 60.0). Weight loss after RYGB was slightly but not significantly larger compared with SG (17.4% vs. 15.2%). Type and rate of adverse events were reported to be as expected, and no major concerns were raised regarding hormone replacement therapy (HRT). Four publications including 49 patients with HO and 223 patients with common obesity were included in the case-control meta-analysis that showed a 12.5%-point lower weight loss in cases compared with controls with no major differences in the safety profile of the surgical procedures. CONCLUSIONS:Bariatric surgery in patients with acquired HO induces a clinically meaningful weight loss sustained for at least 2.5 years and appears to be safe. No significant differences were observed between RYGB and SG, but weight loss is substantially lower in patients with HO compared with patients with common obesity. However, the limited evidence calls for close surveillance if bariatric surgery is more widely adopted in this group of patients.
