25^th Global Obesity Meeting April 17-18, 2023 Rome, Italy

Dua Rana is a forth year medical student with immnse interest in bariatric surgery, gastroentrology, endocrinology and nephrology. Recently she publised three research papers and working on many more.

Bariatric Surgery is the standard treatment for morbid obesity and associated complications with improved quality of life and lower mortality. Bariatric Surgery is a safe, essential treatment for morbid obesity. Demand and access to bariatric surgery vary considerably depending on age, gender, and race. The COVID-19 Pandemic has impacted surgical access, potentially exacerbating disparities in bariatric surgery access. Therefore, it is imperative to study the complex interplay between different factors such as age and gender, and their impact on the decision-making process for bariatric surgery. This review highlights the factors influencing bariatric surgery access and the influence of the COVID-19 pandemic on health disparities in access to bariatric surgery, prompting further research and reform in healthcare provision to ensure health equity

In recent years, intestinal microflora has received increasing attention as a metabolic gateway between the outer environment and the host, particularly with regard to modulation of inflammation, energy metabolism and body weight homeostasis. Human intestinal microflora represents a complex ecosystem consisting of trillions of microorganisms and thousands of bacterial species that are deeply involved in different functions of host metabolism. A causal link between intestinal microflora and host metabolism was first provided when Turnbaugh et al. demonstrated that transplanting the intestinal microflora from obese mice could replicate the obese phenotype in germ-free mice. Differences in intestinal microflora composition between humans seem to represent a key factor affecting energy homeostasis. In both mice and humans, two bacterial phyla are dominant in the gut, the Gram-negative Bacteroidetes and the Gram-positive Firmicutes. Although few data exist at the genus and species level, studies in mice and in humans have demonstrated that obesity is associated with a reduction in the relative abundance of Bacteroidetes, and that the obese microflora has lower bacterial diversity than lean microflora. In overweight/obese humans, low faecal bacterial gene richness is associated with more marked overall adiposity and dyslipidaemia, impaired glucose homeostasis and higher low-grade inflammation. Intestinal microflora composition is strongly affected by dietary patterns. A high-fat and high-sugar Western diet increases the relative abundance of Firmicutes at the expense of the Bacteroidetes in animal models, whereas low-calorie diet induced weight loss may increase the relative abundance of Bacteroidetes in obese individuals. Data obtained in animal models of the human intestinal ecosystem indicate that switching from a low-fat, plant polysaccharide-rich diet to a high-fat/high-sugar “Western” diet may shift the structure of the microflora within a single day, changing the representation of metabolic pathways and altering microbiome gene expression. Consistently, a controlled-feeding study in humans showed that microflora composition changed detectably within 24 h of initiating a high-fat/low-fibre or low-fat/high-fibre diet, although the magnitude of the changes was modest. Kong et al. explored differences in host inflammatory variables and intestinal microflora in function of three distinct dietary clusters in overweight/obese subjects. They found that subjects having a healthier dietary pattern (higher consumption of fruits, yogurt and soups and lower consumption of sweets, confectionary and table sugar and sugary drinks) showed less pronounced metabolic impairment and had the highest gene richness and diversity in their intestinal microflora, despite there was no difference in total energy intake or body weight across dietary clusters. The bacteria in our gut not only play an important role in digestion but research indicates that our microbiome could also play a major role in whether or not we become obese. Animal Studies Gut microbes play a major role in energy extraction from food through a variety of mechanisms. Many plant polysaccharides and complex carbohydrates cannot be digested by the host; however, the gut microbes can metabolize these to short chain fatty acids (SCFA), such as butyrate, propionate and acetate. Butyrate is used as the primary energy source for colonic epithelial cells, while propionate and acetate are necessary for lipogenesis and gluconeogenesis in the liver. Differences in SCFA levels have been observed in obese and lean mice. For example, in a genetic model of obesity, ob/ob mice have increased butyrate and acetate concentrations in their ceca and less energy, determined by bomb calorimetry, in their feces compared to their lean counterparts

Aims: During laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Methods: A literature search was conducted in PubMed, EMBASE, Scopus, and Cochrane Library databases using the keywords Mesentery, Internal hernia, and Laparoscopy up to August 2, 2022. After searching, the process of selecting the literature that we got and extracting data was performed independently by two reviewers. Besides, we used the Cochrane risk of bias tool to assess the literature we included. Results: Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of subgroup analysis, the closure of the mesenteric defects showed a low incidence of IH in patients with >41 years (OR 2.62 [95% CI 1.89,3.63]; p <0.00001) and for Mean age≤41 years (OR 1.52 [95% CI 1.06,2.18]; p =0.02). Moreover, the closure of the mesenteric defects excels non-closure in terms of Jejunal mesenteric site where IH occurred (OR 3.01 [95% CI 1.91,4.75]; p <0.00001), hospital days (MD 0.49 [95% CI 0.35,0.64]; p <0.00001), reoperation (OR 2.18 [95% CI −2.04,2.33]; p <0.00001), while the non-closure of the mesenteric defects was superior to closure in regard to operative time using absorbable sutures purely (MD -15.00 [95% CI -17.31, -12.69]; p <0.00001). No difference was found between the two groups regarding Petersen’s and Jejunal mesenteric’s IH, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients.

Introduction: Obesity is a major health problem with serious sequences. There is little evidence on the development and growth of obesity among Lebanese women. This paper will describe 25 years’ changes in BMI and weight among Lebanese postmenopausal women. Subjects and methods: Data was collected from 12492 ambulatory Lebanese postmenopausal women attended outpatient clinic in one hospital between July 1997 and December 2021 and were subjected to osteodensitometry study. Gender, birthdate, height, weight and BMI were recorded in all patients. Patients on kidney dialysis and on chemotherapy, radiotherapy treatment were excluded. Result: The mean age of the 12492 women was 60.63 (SD 11.744) and the mean BMI was 30.09 (SD 5.780) and the average weight was 72.24 (SD 14.165). It was particularly notable that both BMI and weight were levelling off over 25 year of the survey. Conclusion: This epidemiology and survey provide a national data addressing prevalence of obesity over 25 years in Lebanese women. This prevalence of overweight was present over the years of this survey and our review indicates a clear tendency towards stabilization of the overweight epidemic among postmenopausal Lebanese women This raises a question if BMI is still a useful indicator of overall obesity or it’s a poor tool for defining the health of an individual. Or that it indicates a clear tendency towards stabilization of the obesity epidemic among postmenopausal women which could be the result of man median work focused on promoting better food habits or it’s a consequence of the lower socioeconomic status of subjects studied. Further studies are needed to examine socioeconomic factor influencing BMI and if TBF and % BF would be accurate measure of obesity which directly calculates a person’s relative body composition without regard to height and weight.