Till Hasenberg

Background: Comprehensive preoperative patient education is critical for optimizing postoperative outcomes and long-term weight management after bariatric surgery. Traditional in-person educational sessions, however, generate considerable greenhouse gas emissions, primarily due to participant travel. Telemedicine offers an environmentally sustainable alternative with the potential to reduce the carbon footprint within obesity care. This study aimed to quantify savings in greenhouse gas emissions and assess patient acceptance of virtual preoperative obesity educational sessions compared to conventional in-person courses. Methods: Between January and December 2024, N = 183 patients attending a virtual preoperative educational seminar for individuals with obesity—integrated into standard bariatric surgical preparation—were surveyed regarding their hypothetical travel behavior, had the seminar been held in person. Distances from participants’ residences to the seminar location and preferred transportation modes were used to calculate avoided CO₂ emissions utilizing the Transport Emission Model (TREMOD) developed by the German Federal Environment Agency. Results: The average one-way travel distance was 33.08 km, with 83.6% of participants indicating they would have traveled by private vehicle, predominantly powered by internal combustion engines. Transitioning to the virtual format resulted in a total avoidance of approximately 1.792 metric tons of CO₂ equivalent emissions over the study period. Patient acceptance of the virtual format was high, with 93.4% of the cohort rating it as equivalent or superior to in-person sessions. Notably, 25% of the participants stated they would not have attended the mandatory session if held exclusively in person, indicating that the virtual format successfully bridged a significant attendance gap. Conclusions: Given the increasing prevalence of obesity and the critical role of preoperative education in bariatric care, telemedicine represents an effective strategy to meaningfully reduce travel-related emissions. Virtual educational interventions eliminate CO₂-intensive journeys while maintaining broad accessibility and high patient satisfaction. Integrating telemedicine into obesity surgery care pathways can thus significantly contribute to sustainable, climate-conscious healthcare delivery.

Obesity is a risk factor in cardiovascular disease (CVD), and scalable treatment approaches are needed in routine care. The aim of this retrospective observational study was to investigate self-reported weight change during the use of a prescription digital therapy for multimodal lifestyle therapy for obesity. Adults with obesity and self-reported CVD risk factors (n = 4314) or self-reported established CVD (n = 1418) prescribed zanadio for up to 12 months were included. The primary outcome was percentage change in self-reported body weight over time. Clinically meaningful weight loss (≥5%) was observed in patients on continued prescriptions, with greater weight loss observed in patients with prolonged program exposure. The results were directionally consistent across analyses that used a randomly missing approach and a sensitivity analysis with the last observation forward, although estimates varied in magnitude. Interpretation of this data in a real-world setting is limited by self-reported weight and comorbidity data, attrition which is typical for weight loss programs in the reality of care, and uncertainty about the mechanism of missing data. These results suggest that zanadio may support clinically meaningful self-reported weight loss in patients continuing treatment, but further studies linking clinical data and with longer follow-up are needed.

Introduction Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease worldwide and is highly associated with obesity. The prevalences of both conditions have markedly increased in the Western civilization. Bariatric surgery is the most effective treatment for morbid obesity and its comorbidities such as NAFLD. Objectives Measure postoperative liver fat fraction (LFF) in bariatric patients by using in-opposed-phase MRI, a widely available clinical tool validated for the quantification of liver fat Methods Retrospective analyses of participants, who underwent laparoscopic Roux-Y-gastric-bypass (17) or laparoscopic sleeve gastrectomy (2) were performed using magnetic resonance imaging (MRI), bioelectrical impedance analysis (BIA), and anthropometric measurements 1 day before surgery, as well as 6, 12, and 24 weeks after surgery, LFF was calculated from fat-only and water-only MR images. Results Six months after surgery, a significant decrease of LFF and liver volume has been observed along with weight loss, decreased waist circumference, and parameters obtained by body fat measured by BIA. LFF significantly correlated with liver volume in the postoperative course. Conclusions MRI including in-opposed-phase imaging of the liver can detect the quantitative decrease of fatty infiltration within the liver after bariatric surgery and thus could be a valuable tool to monitor NAFLD/NASH postoperatively.

Bariatric surgery is proven to be the most effective therapy for obesity. However, the targeted weight reduction is not always achieved. Reliable predictors for postoperative success are rare. Also, most available predictors, such as gender and socioeconomic status, cannot be influenced. The aim of the study was to assess the reliability of the phase angle (PhA) as a predictor of weight reduction and body composition after bariatric surgery. One hundred seventy-three patients (127 with Roux-en-Y gastric bypass and 46 with sleeve gastrectomy), treated between January 2004 and December 2012, were included into this prospective trial. Bioelectrical impedance analysis (BIA) was performed before and five times within the first year after the operation. Correlation between excess weight loss (EWL) was calculated using Pearson’s correlation coefficient and a receiver operating characteristic (ROC) curve. The average weight loss was significant with a total weight loss of 30.1 %, while the PhA did not show any significant decrease during the first 12 months after surgery. The correlation between the preoperative PhA and the postoperative EWL was significant after 6 weeks and after 6, 9, and 12 months. The ROC curve has an area of 0.7. The best point of the curve is a PhA of 3.9° with a sensitivity of 81 % and a specificity of 54 %. PhA may be a useful predictor of EWL after bariatric surgery, and a PhA of 3.9° was calculated as the most suitable cut-off for a successful operation.

Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment. One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n = 127, mean body mass index (BMI) 45.7 ± 5.7 kg/m²) or sleeve gastrectomy (SG; n = 46, mean BMI 55.9 ± 7.8 kg/m²) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis. After 1 year of observation, %EWL was 62.9 ± 18.0 % in RYGB and 52.3 ± 15.0 % in SG (p = 0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7 ± 8.4 % in RYGB and 30.5 ± 7.6 % in SG patients, p > 0.4). Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery.

Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of metabolic syndrome and frequently accompanied with obesity, insulin resistance, hyperlipidemia and hypertension. NAFLD comprises a variety of clinical conditions ranging from simple steatosis (NAFL) to non-alcoholic steatohepatitis (NASH), with significant hepatic injury and possible progression to cirrhosis and hepatocellular carcinoma. The traditional "second hit" and the recent "multiple parallel hit" theories are the most popular explanations for the pathogenesis of NASH. NAFLD is usually diagnosed by ultrasonographic examination of the liver. For specific diagnosis of the extent and severity of NAFLD, in particular to determine NASH, the gold standard is still liver biopsy. Though, there are some promising non-invasive markers emerging for NAFLD diagnosis and assessment. Currently there is no specific therapy for NAFLD or NASH itself. Thus management of NAFLD mainly relies on initiating weight loss and on treatment of accompanying factors e.g. insulin resistance, hypertension or hyperlipidemia. In the present overview we aimed to summarize options for diagnosis and treatment of NAFLD and NASH based on the current literature.