Preclinical studies show that dietary or central administration of monounsaturated (MUFAs) and polyunsaturated fatty acids (PUFAs) can reduce food intake, enhance energy expenditure and attenuate hypothalamic inflammation (HI), whereas saturated fatty acids (SFAs) promote weight gain, HI, and neuronal injury. However, whether hypothalamic exposure to different fatty acids similarly influences HI and body weight in humans remains unclear. In this longitudinal study, we compared cerebrospinal fluid (CSF) free fatty acid (FFA) profiles between nineteen normal-weight controls and forty-four individuals with obesity, both at baseline and one year after bariatric surgery (BS). We also examined associations between CSF-FFA composition, MRI-based markers of HI—increased hypothalamic mean diffusivity (MD) and volume—and postoperative weight loss. At baseline, individuals with obesity had similar CSF concentrations of total FFA, SFA, and MUFA compared to controls, but significantly lower PUFA levels, mainly due to reduced docosahexaenoic acid (DHA). BS did not substantially alter CSF-FFA profiles. Lower baseline CSF-DHA levels were associated with higher hypothalamic MD and independently predicted less weight loss at one year. Postoperative increases in CSF-DHA correlated with reductions in hypothalamic MD. These findings suggest that brain DHA may influence hypothalamic microstructure and contribute to body weight regulation in human obesity.

CONTEXT:Impaired brain leptin transport is proposed as a mechanism in obesity-related leptin resistance. OBJECTIVES:We sought to evaluate plasma and cerebrospinal fluid (CSF) leptin dynamics before and 1 year after bariatric surgery (BS) and to explore their relationship with short-term weight loss and mid-term weight trajectories. METHODS:In this prospective longitudinal cohort study conducted between 2017 and 2025 at a tertiary hospital, we included 33 women with obesity eligible for BS (OB-group) and 13 age-matched control women (HC-group). Study procedures were conducted at baseline and 1 year after BS, including dual-energy x-ray absorptiometry body composition analysis and plasma/CSF sampling. Leptin levels were measured, and the CSF-to-plasma leptin ratio was calculated to assess brain leptin transport efficiency. OB-group participants were followed annually for 4 years, with body weight recorded at each visit. Weight change from year 1 to 4 was calculated, along with weight regains (WR) from nadir weight to year 4. RESULTS:At baseline, the OB-group exhibited elevated plasma and CSF leptin concentrations and reduced CSF-to-plasma leptin ratio. Following BS, leptin transport efficiency markedly improved. Although both plasma and CSF leptin decreased, the CSF leptin reduction was less pronounced. Neither baseline CSF leptin nor the CSF-to-plasma leptin ratio predicted weight loss at 1 year. Postsurgical CSF leptin levels and CSF-to-plasma leptin ratio were not associated with post-BS mid-term weight trajectories. CONCLUSION:Our findings indicate that obesity-related alterations in leptin transport are primarily attributable to the obese state rather than an intrinsic defect of the transport system and are potentially reversible through weight loss.

Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, but long-term success is often limited by recurrent weight gain (RWG). This study evaluates the association between metabolic adaptation (MA) and long-term RWG. Body composition (via bioimpedance) and resting energy expenditure (REE) via indirect calorimetry were assessed at baseline (n = 95), 2 (n = 29), and 12 months (n = 46) after gastric bypass (GBP, n = 68) or sleeve gastrectomy (SG, n = 27). Body weight was measured throughout the subsequent 4 years of follow-up. RWG was defined as the difference between maximum weight in years 3–5 and nadir in years 1–2. On average, MA (kcal/day) was − 130 (95

Introduction Obesity in women of reproductive age is a significant risk factor for infertility. Current treatment strategies primarily focus on weight reduction through lifestyle modifications, pharmacological interventions, or surgical procedures. However, there is still a lack of consensus on the most effective approach. Moreover, such interventions have limited effectiveness in maintaining WL and optimizing assisted reproduction results following assisted reproductive techniques, which may lead to stigmatization and negative experiences for patients.Although qualitative evidence regarding preconception and gestational stages has increased, literature specifically addressing women who simultaneously present obesity and infertility, as well as the impact of these conditions on their physical and emotional well-being, remains limited. Aim To explore the care trajectory of women with obesity and infertility. Methods We designed a mixed-methods study involving 10 health care professionals, a focus group and a co-creation workshop with 6 and 8 patients respectively, and an online survey was administered and completed by 33 out of a total of 150 women with obesity and reproductive pathology who were invited to participate (response rate 22%). Results While some aspects of preconception care were positively evaluated, the overall patient journey is complex. We identified four areas for improvement: providing personalized information, offering stigma-free emotional support, ensuring efficient time management, and promoting shared decision-making. Conclusions A comprehensive, multidisciplinary approach emerges as a key element to optimize care and enhance the experience of these women.

Weight-related bias, stigma, and discrimination significantly affect quality of life and health in persons with obesity. Their influence on post-operative outcomes following metabolic surgery and bariatric remains underexplored. This systematic review aimed to evaluate any impact of pre- and post-operative weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes, specifically physical health and mental health, including quality of life. This review was conducted in accordance with the PRISMA 2020 guidelines, with the protocol registered on PROSPERO. Comprehensive searches were performed across MEDLINE, PsycINFO, Embase, Web of Science, PEDro, CINAHL, ISRCTN, and CENTRA. Eligible studies included randomized controlled trials, clinical trials, longitudinal studies, cross-sectional studies, and qualitative research involving patients who underwent metabolic and bariatric surgery. Risk of bias was assessed using validated tools tailored to study design. Eleven studies met the inclusion criteria, examining the influence of weight bias, stigma, and discrimination on post-surgical outcomes. Physical health outcomes included weight loss and BMI. Mental health outcomes included depressive symptoms, disordered eating behaviours, and quality of life domains such as social interactions, occupational settings, sexual health, educational experiences, and post-surgical health management. Findings suggest that weight bias negatively influences mental health and quality of life, associating with depressive symptoms, problematic eating, and lower adherence to nutritional instructions and exercise, potentially impeding optimal physical outcomes. Despite some studies suggesting its negative impact on postoperative outcomes, current evidence on the impact of weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes is limited. Critical gaps remain in understanding how these psychosocial factors affect long-term disease management, self-care, and overall quality of life. Some studies suggest that weight bias is associated with poorer weight change, worse mental health, and lower adherence to health behaviours in patients who underwent metabolic and bariatric surgery. Psychosocial variables are still severely under-reported in patients who underwent metabolic and bariatric surgery. Future approaches call for integrated care and tailored tools co-created with patients for the assessment of weight bias-related outcomes.

The health benefits of metabolic and bariatric surgery (MBS) are associated with improvements in comorbidities and reduction in their incidence and mortality rates. Food restriction and anatomical changes result in a higher risk of nutritional complications and must be considered. This study aimed to evaluate the difference in adherence and daily protein intake between a protein liquid supplementation (PLS) versus a conventional protein powder (PPS) in patients undergoing (MBS). A 2-month parallel, randomized, controlled trial including 50 patients (PLS n = 15; PPS n = 35) undergoing Roux-en-Y gastric bypass (GBP) was conducted. Body composition (bioimpedance analysis), resting energy expenditure (indirect calorimetry), and nutritional status (serum levels of macronutrients and micronutrients) were evaluated before pre- and post-operatively. Dietary protein intake and supplementation adherence were monitored every 15 days. Weight loss and changes in fat-free mass were comparable between the two groups after GBP (PLS: − 12.9 ± 4.8 vs. PPS: − 14.5 ± 6.3) (p > 0.05), (PLS: − 12.5 ± 3.7 vs. PPS: − 11.2 ± 3.3) (p > 0.05), respectively. The PLS group showed a higher basal metabolic rate at 2 months (PLS: 1843.4 ± 278.3 vs. PPS: 1642.2 ± 249.8) (p < 0.05). Adherence to the PLS group (102.7 ± 77.2

Introduction: Current obesogenic environments, along with intrinsic factors, contribute to the obesity pandemic, which impacts the quality of life and healthcare for individuals with obesity. In addition, discrimination and stigma related to obesity remain widespread in our society. In this scenario, the Spanish Society for the Study of Obesity (SEEDO), in collaboration with 38 recognized scientific societies and 12 patients' organization, has elaborated the Spanish guideline for obesity management in adults, referred to as the GIRO guideline. GIRO aims to drive a shift in obesity management and serve as a guide for healthcare professionals (HCPs) to address this chronic and multifactorial disease. METHODS:A comprehensive systematic review was conducted and completed with experts' contribution, with a particular focus on Spanish society. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Experts selected the recommendations and determined their strength through consensus. RESULTS:A total of 121 recommendations were proposed, including 32 adopted from the Canadian Adult Obesity Clinical Practice Guidelines and 89 specific recommendations created for the Spanish context, and were distributed across five areas of application: (1) recognition of obesity as a chronic disease, (2) obesity assessment, (3) multidisciplinary approach to obesity treatment, (4) recommendations for obesity management in special populations, and (5) implementation of the GIRO guideline and future challenges. CONCLUSION:The GIRO recommendations are intended to serve as a useful and interactive tool for HCPs, policymakers, and other stakeholders to ensure access to and quality of healthcare for individuals living with obesity. .

Obesity represents a significant public health challenge, particularly in the context of coexisting chronic diseases and multi-morbidity. In Spain, and specifically in Catalonia, primary care plays a central role in prevention and management, yet barriers such as weight-related stigma can compromise care delivery. To evaluate the current state of obesity prevention and management within the health system, with a focus on implications for primary care in Catalonia, including prevalence, stigma, and integration of chronic disease care. A narrative literature review was conducted, including studies, government reports, and policy documents relevant to obesity prevalence, psychosocial factors, and healthcare system strategies. Persistent weight bias among healthcare professionals can delay diagnosis, reduce treatment adherence, and negatively affect patient experience. Integrated, patient-centered care models that consider physical, psychological, and social health have gained traction. Holistic assessment—including behavioral context, mental health, and social determinants alongside cardiorenal metabolic diseases—is central to these approaches. Effective obesity management requires integrated chronic disease management frameworks. Collaborative care models, community-based resources, and equitable health policies are essential. Incorporating patient experience helps identify unmet needs and improve care quality. A system-wide, holistic approach is critical to reducing the burden of obesity and related chronic diseases in Catalonia.

BackgroundWith over 1 billion individuals affected globally, obesity and obesity related diseases is now a leading cause of death. Metabolic and bariatric surgery (MBS) has emerged as a cornerstone intervention for severe obesity and its associated comorbidities. Despite its efficacy, postoperative care and follow-up after MBS remains highly variable worldwide.ObjectiveThe PARTNER study aimed to evaluate global clinical practices in the postoperative management following MBS by surveying multidisciplinary healthcare professionals.MethodsThis study was an international online survey conducted between October 2024 and January 2025. A multidisciplinary team developed the questionnaire based on existing literature and international guidelines. The survey assessed five domains: follow-up care, postoperative treatment, dietary management, patient support, and measurement of surgical outcomes. Responses were analysed descriptively.ResultsA total of 262 responses were received from 62 countries. Most respondents were bariatric surgeons (72.1%) working in public healthcare systems (73.3%). While 78.7% reported conducting three-month postoperative reviews, only 23.7% offered indefinite follow-up. Hybrid models of care (virtual and in-person) were common (56.9%). VTE prophylaxis and postoperative PPI use were recommended by 64.1% and 84.3% respectively. Nearly all respondents (98.1%) provided dietary advice, with protein and micronutrient supplementation widely endorsed. Only 56.1% routinely referred patients for psychological follow-up. Definitions of surgical success and failure varied widely, with inconsistent objective outcome measures.ConclusionThe PARTNER study reveals significant international variation in postoperative management practices following MBS. These findings underscore the need for more standardized, evidence-based guidelines to improve long-term outcomes and equity of care worldwide.

INTRODUCTION:Approximately 25-30% of patients undergoing bariatric surgery (BS) experience weight regain or suboptimal weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a therapeutic option in these cases. AIM:To evaluate the effectiveness of GLP-1 RAs in managing weight regain and suboptimal weight response after BS in a real-world setting. MATERIALS AND METHODS:Retrospective study of BS patients treated with GLP-1 RAs due to weight regain or suboptimal weight response. RESULTS:A total of 953 patients underwent BS between 2015 and 2020; 122 initiated treatment with GLP-1 RAs. The cohort was composed 78% women, with a mean age of 50.4±10.6 years and a baseline BMI of 44.7±6.3kg/m2. At the start of treatment, 41.9±20.5 months post-BS, the mean weight loss was 18.6±10%; 52% had lost <20% of their initial weight and 82% had regained >20% of the weight lost. 35% received liraglutide (LIRA) (1.8±0.5mg/day) and 65% semaglutide (SEMA) (1.0±0.8mg/week), with a mean treatment duration of 19.3±17.3 months. Maximum weight loss was 4.7±4.8% with LIRA vs. 8.3±5.9% with SEMA (p=0.01). Total weight loss (BS+GLP-1 RA) was 21.6±9.2% with LIRA vs. 25.6±10.5% with SEMA. The proportion of patients with a suboptimal weight response after BS+pharmacotherapy (<20%) significantly decreased (from 52% to 31%). CONCLUSIONS:SEMA led to greater weight reduction than LIRA, positioning it as a more effective option for managing post-BS weight regain.

Introducción Aproximadamente el 25-30% de los pacientes sometidos a cirugía bariátrica (CB) experimentan recuperación de peso o una pérdida subóptima. Los análogos del receptor de GLP-1 (arGLP1) han surgido como una opción terapéutica en estos casos. Objetivo Evaluar la eficacia de los arGLP1 en la recuperación de peso y pérdida de peso subóptima tras la CB en vida real. Materiales y métodos Estudio retrospectivo en pacientes con CB tratados con arGLP1 debido a recuperación de peso o pérdida insuficiente. Resultados Un total de 953 pacientes fueron intervenidos de CB entre los años 2015 y 2020, 122 iniciaron tratamiento con arGLP1. La cohorte incluyó un 78% de mujeres, con una edad media de 50,4±10,6 años e IMC inicial de 44,7±6,3kg/m2. Al inicio del tratamiento, 41,9±20,5 meses post-CB, la pérdida de peso fue 18,6±10%, el 52% mostró pérdida <20% del peso inicial y el 82% recuperó >20% del peso perdido.El 35% recibió liraglutida (LIRA) (1,8±0,5mg/día) y el 65% semaglutida (SEMA) (1,0±0,8mg/semana), con una duración media de 19,3±17,3 meses. La máxima pérdida de peso fue 4,7±4,8% con LIRA vs. 8,3±5,9% con SEMA (p=0,01). La pérdida total (CB+arGLP1) fue 21,6±9,2% con LIRA vs. 25,6±10,5% con SEMA. La proporción de pérdida insuficiente (<20%) disminuyó significativamente (52% a 31%). Conclusiones SEMA mostró una mayor reducción de peso que LIRA, posicionándose como una opción más efectiva en la recuperación de peso post-CB.

BACKGROUND:Roux-en-Y gastric bypass (RYGB) is a standard bariatric surgical technique, associated with suboptimal response and recurrent weight gain in 25%-50% of cases. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of duodenal switch with promising results. However, a comparison of the two techniques in a randomized clinical trial (RCT) has not yet been reported. This RCT aims to compare SADI-S and RYGB. METHODS:BYPSADIS is a randomized, open-label, multicentre clinical trial comparing SADI-S with RYGB. Patients aged 18-60 years with body mass index (BMI) = 40-50 kg/m2 will be recruited in six hospitals. Primary endpoints are as follows: (1) efficacy, measured as percentage of patients with total weight loss (TWL) > 30% at 5 years; and (2) safety, defined as percentage of patients experiencing at least one severe complication either at 90 days postoperatively (Clavien-Dindo >2) or up to 5 years, including severe malnutrition, diarrhea, dumping, hypoglycemia, or need for surgical reintervention. Sample size was calculated for both primary outcomes, needing 432 patients to prove superiority of SADI-S in efficacy and 423 to prove non-inferiority in safety, with statistical power of 0.8, alpha risk of 0.025, assuming 10% loss throughout follow-up. To ensure power for both primary endpoints, 450 subjects will be included, 225 SADI-S and 225 RYGB. Secondary outcomes include metabolic comorbidities, quality of life, digestive symptoms (dumping, bowel habits, and GERD), need of extra supplementations, and alimentary habits. Outcomes will be compared using one-sided 95% confidence interval of proportion difference between groups. DISCUSSION:To our knowledge, there is only one ongoing RCT comparing SADI-S with RYGB (SADISLEEVE trial, ClinicalTrials.gov identifier NCT03610256), which includes primary and revisional surgeries, without BMI restrictions and with varying limb lengths. The BYPSADIS trial will complement its findings and help to bridge the knowledge gap on whether SADI-S is more effective than RYGB, while offering a similar safety profile. TRIAL REGISTRATION:The study protocol has been approved by the Ethics Committee of the six participating hospitals and has been registered in ClinicalTrials.gov, NCT06789965.

Obesity is a heterogeneous health issue associated with stigma, depression, low self-esteem, body dissatisfaction, mood disorders, and anxiety impacting physical health, and quality healthcare. The aim of this pilot study was to explore the feasibility of using drawing, together with focus group discussions and an illness perception questionnaire, as a methodology to establish dialogue with patients living with obesity. A two-hour workshop was conducted with people living with obesity. Patients completed the Brief Illness Perception Questionnaire (BIPQ) and demographic information, followed by a drawing activity. Quantitative and qualitative data were analyzed using IBM SPSS, Version 27.0. and the MAXQDA software, respectively. Twelve participants (82

Protein intake is recognized as a key nutritional factor crucial for optimizing Metabolic Bariatric Surgery (MBS) outcomes by preventing protein malnutrition, preserving fat-free mass, and inducing satiety. This paper discusses the current evidence regarding protein intake and its impact on clinical outcomes following MBS. There are considerable gaps in the understanding of protein requirements following MBS, as existing guidelines are based on limited and inconsistent reports. This highlights the urgent need for updated clinical practice recommendations grounded in high-quality evidence. Further investigation using robust methodologies is essential to address existing research gaps related to the individualization of protein requirements following MBS. Future research should consider factors such as the time elapsed since surgery, the form and quantity of protein consumed, and necessary adjustments for physical activity. Ultimately, in alignment with recent literature, a more specific and personalized dietary protein approach should be examined.

ABSTRACT Background Patients perceive high levels of weight prejudice, stigma, and discrimination within health systems, affecting their ability to manage their obesity and related chronic conditions. Scientific and patient obesity associations worldwide have prioritized the reduction of weight stigma to improve patient experiences in health systems and overall health outcomes. Since a significant proportion of the population is now living with multiple chronic diseases related to obesity, healthcare systems must shift toward multi‐disease management frameworks incorporating person‐centered and non‐stigmatizing clinical conversations. Motivational Interviewing (MI) has the potential to transform clinical interactions by using non‐stigmatizing language, communication, and practices. Studies using MI in obesity management have solely focused on weight loss outcomes, while other patient experience related outcomes would also be relevant to evaluate. Methods A narrative review was undertaken to critically analyze the potential impact of MI on obesity and chronic disease management practices and experiences. Findings An analysis and contextualization of the MI theoretical framework for obesity management, based on the philosophy of motivational spirit, was reviewed, assessing micro skills or strategies. Conclusion MI may assist healthcare professionals conduct non‐stigmatizing clinical conversations in accordance with basic principles of collaborative therapeutic alliances. A proposal for research considerations that can help illuminate the potential for of MI in obesity management is also outlined.

Introducción La obesidad en mujeres en edad reproductiva es un factor de riesgo significativo para la esterilidad. Las estrategias actuales de tratamiento se orientan principalmente hacia la reducción ponderal mediante modificaciones del estilo de vida, intervenciones farmacológicas o quirúrgicas. Sin embargo, persiste una falta de consenso sobre la intervención más eficaz. Además, estas estrategias no suelen lograr una pérdida de peso sostenida ni garantizan resultados exitosos tras técnicas de reproducción asistida, lo que puede derivar en experiencias negativas para las pacientes.Si bien la evidencia cualitativa sobre las etapas preconcepcional y gestacional ha aumentado, la literatura específica en mujeres que presentan simultáneamente obesidad y esterilidad, así como el impacto de estas condiciones en su bienestar físico y emocional, continúa siendo limitada. Objetivo Estudiar la trayectoria asistencial de las mujeres con obesidad y esterilidad. Métodos Se diseñó un estudio con enfoque mixto que incluyó la participación de 10 profesionales sanitarios; grupo focal y taller de co-creación con 6 y 8 pacientes respectivamente, además de una encuesta online respondida por 33 de un total de 150 mujeres con obesidad y patología reproductiva. Resultados Aunque algunos aspectos de la atención preconcepcional fueron valorados positivamente, el recorrido asistencial de las pacientes es complejo. Identificamos cuatro áreas de mejora: ofrecer información personalizada, apoyo emocional libre de estigma, gestión eficiente del tiempo y promoción de la toma de decisiones compartida. Conclusiones Un abordaje integral y multidisciplinar se presenta como elemento clave para optimizar la atención y mejorar la experiencia de estas mujeres.