Objective This study aimed to compare weight loss (WL) outcomes for patients taking antidepressants and/or antipsychotics with those not taking psychiatric medication. Methods A total of 17,519 adults enrolled in a lifestyle WL intervention at the Wharton Medical Clinics in Ontario, Canada, were analyzed. Sex-stratified multivariable linear regression analysis was used to examine the association of taking antidepressants, antipsychotics, both, or neither with WL when adjusting for age, initial weight, and treatment time. Results Twenty-three percent of patients were taking at least one psychiatric medication. Patients lost a significant amount of weight (P < 0.0001) regardless of psychiatric medication use. Women taking psychiatric medications lost a similar amount of weight as women who were not (P > 0.05). Conversely, men taking antidepressants lost only slightly less weight than men taking both classes or neither class of psychiatric medication (3.2 +/- 0.3 kg vs. 5.6 +/- 0.9 kg and 4.3 +/- 0.1 kg; P < 0.05). However, taking psychiatric medications that cause weight gain was associated with similar significant decreases in weight as taking medications that are weight neutral or associated with WL for both sexes (P > 0.05). Conclusions Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.

Summary A substantial proportion of patients undergoing bariatric surgery are female and of reproductive age. Guidelines suggest that pregnancy should be avoided for 12–18 months following bariatric surgery, and that women be appropriately counselled regarding contraception. We present a case in which a patient underwent a Roux‐en Y gastric bypass while unknowingly in the early stages of pregnancy. After a six‐week period liquid meal replacement for perioperative weight loss, a laparoscopic Roux‐en Y gastric bypass, and a short course of oral antibiotics for a post‐operative wound infection, the patient developed epigastric pain, odynophagia, oesophageal dysphagia, bloating and nausea with oral intake. Only after an abdominal X‐ray, two upper endoscopies and an upper gastrointestinal series was an intrauterine pregnancy seen incidentally on abdominal ultrasound. Ultimately, the patient underwent elective termination of her pregnancy. Patients who are, or are planning to soon become, pregnant should not undergo bariatric surgery. All female patients of reproductive age should be counselled on the importance of effective birth control prior to planning bariatric surgery. Beta‐human chorionic gonadotropin testing should be routinely considered before embarking on meal replacement or surgery.

Liraglutide is a glucagon-like peptide type 1 (GLP-1) analogue that is approved for long-term obesity management in North America. While bariatric surgery remains the gold standard for weight loss, an increasing number of patients are on liraglutide in the setting of ongoing workup for bariatric surgery. The presence of gastrointestinal symptoms prior to bariatric surgery may prompt testing for dysmotility, which affects surgical decision making. Here we report six cases where treatment with liraglutide was associated with reversible reduction in gastric and esophageal motility in screening for bariatric surgery. While liraglutide is known to delay gastric emptying, there are minimal reports of how this medication affects gastrointestinal investigations used in this context. The implications of these abnormal screening investigations on candidacy for bariatric surgery are discussed.

Bariatric surgery is the most effective long-term treatment of severe obesity. Unfortunately, many patients experience inadequate weight loss, weight plateau, or weight recidivism. We sought to determine the efficacy of high-dose liraglutide (3.0 mg once daily) in patients with prior bariatric surgery.

Digital clubbing, a resultant finding from the proliferation of connective tissue in the terminal portion of fingers or toes, has long been recognized as a sign for a number of underlying infectious, inflammatory, malignant, and vascular conditions.1 A profile angle >176° and a hyponychial angle >192° support the diagnosis of clubbing.1 Quantification of these angles can be done using plaster casts, shadowgraphs, planimeters, or digital photography—techniques that are cumbersome.2 Practically speaking, physicians commonly rely on subjective assessments at the bedside.

The authors sought to define the 95th percentile of plasma renin activity (PRA) in a sample of patients with confirmed primary aldosteronism (PA) prior to adjustment of medications as a practical "first-look" test to identify those with very low ultimate likelihood of having PA. The aldosterone to renin ratio (ARR) was measured without adjustment of antihypertensive medications, with further workup as appropriate. Two groups were defined: patients with surgically "confirmed PA" (n=58) and patients with "high-probability PA" (n=59), defined as having any of the following: computed tomography-confirmed adrenal adenoma plus lateralizing adrenal vein sampling (AVS) without surgery, high ARR and hypokalemia but nonlateralizing AVS, or ARR more than four times the upper limit of normal. The PRA 95th percentile was 1.0 ng/mL/h. All outliers had hypokalemia and two had adrenal adenomas. There was no difference between the confirmed and high probability groups. In the absence of highly suspicious clinical features, patients with unadjusted PRA >1.0 ng/mL/h do not warrant further investigation for PA.