Cardio-psycho-metabolic outcomes of bariatric surgery: design and baseline of the WAS trial

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Abstract

Obesity is a rapidly emerging health problem and an established risk factor for cardiovascular diseases. Bariatric surgery profoundly reduces body weight and mitigates sequelae of obesity. The open, randomized controlled Würzburg Adipositas Studie (WAS) trial compares the effects of Roux-en-Y gastric bypass (RYGB) vs psychotherapy-supported lifestyle modification in morbidly obese patients. The co-primary endpoint addresses 1-year changes in cardiovascular function (peak VO ₂ during cardiopulmonary exercise testing) and the quality of life (QoL) (Short-Form-36 physical functioning scale). Prior to randomization, all included patients underwent a multimodal anti-obesity treatment for 6–12 months. Thereafter, the patients were randomized and followed through month 12 to collect the primary endpoints. Afterwards, patients in the lifestyle group could opt for surgery, and final visit was scheduled for all patients 24 months after randomization. Sample size calculation suggested to enroll 90 patients in order to arrive at minimally 22 patients per group evaluable for the primary endpoint. Secondary objectives were to quantify changes in body weight, left ventricular hypertrophy, systolic and diastolic function (by echocardiography and cardiac MRI), functional brain MRI, psychometric scales, and endothelial and metabolic function. WAS enrolled 93 patients (72 women, median age 38 years, BMI 47.5 kg/m ²) exhibiting a relevantly compromised exercise capacity (median peakVO ₂ 18.3 mL/min/kg) and the QoL (median physical functioning scale 50). WAS is the first randomized controlled trial focusing on the effects of RYGB on cardiovascular function beyond hypertension. In addition, it will provide a wealth of high-quality data on the cerebral, psychiatric, hepatic, and metabolic function in obese patients after RYGB.

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Is Open Access

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

Ashkan Afshin, Mohammad Forouzanfar, Marissa Reitsma … (2018)

Background While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain. Methods We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015. Results In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates. Conclusions The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

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Author and article information

Journal

Journal ID (nlm-ta): Endocr Connect

Journal ID (iso-abbrev): Endocr Connect

Journal ID (hwp): EC

Title: Endocrine Connections

Publisher: Bioscientifica Ltd (Bristol )

ISSN (Electronic): 2049-3614

Publication date (Electronic): 11 January 2022

Publication date Collection: 01 February 2022

Volume: 11

Issue: 2

Electronic Location Identifier: e210338

Affiliations

[1 ]Division of Endocrinology and Diabetology, Department of Internal Medicine I , University Hospital, University of Würzburg, Würzburg, Germany

[2 ]Comprehensive Heart Failure Center , University & University Hospital Würzburg, Würzburg, Germany

[3 ]Department of Psychiatry , Psychosomatics and Psychotherapy, University Hospital, University of Würzburg, Würzburg, Germany

[4 ]Division of Cardiology , Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany

[5 ]Department of General , Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany

[6 ]Department of Radiology , University Hospital, University of Würzburg, Würzburg, Germany

[7 ]Division of Pneumology , Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany

[8 ]Division of Hepatology , Department of Internal Medicine II, University Hospital, University of Würzburg, Würzburg, Germany

[9 ]Department of General Practice , University Hospital, University of Würzburg, Würzburg, Germany

[10 ]Center for Clinical Trials , University Hospital, University of Würzburg, Würzburg, Germany

Author notes

Correspondence should be addressed to M Fassnacht: fassnacht_m@ 123456ukw.de

Author information

Ann-Cathrin Koschker http://orcid.org/0000-0002-7085-8657

Article

Publisher ID: EC-21-0338

DOI: 10.1530/EC-21-0338

PMC ID: 8859939

PubMed ID: 35015697

SO-VID: 32589fbe-1a8a-40ef-a2a2-ab162807d148

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

History

Date received : 17 December 2021

Date accepted : 11 January 2022

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Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial
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