Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study.

Recent studies suggest that vegetarian diets may be recommended to promote weight loss in individuals living with obesity. However, limited studies have examined psychological factors (e.g., eating styles, impulsivity) among individuals who have adopted this type of diet, even though these factors are known to play a role in being overweight. The primary objective of the present study was to compare these characteristics in participants living with obesity or those with normal-weight across diet types. Participants were recruited from two hospital nutrition departments and the general population. They completed a diagnostic interview assessing the presence of an eating disorder, followed by self-administered questionnaires measuring dysfunctional eating styles (DEBQ), impulsivity (UPPS), and emotional competence (PEC). Vegetarian participants living with obesity engaged in more dysfunctional eating styles than did normal-weight omnivores and experienced more emotional difficulties than did both normal-weight omnivores and vegetarians. In contrast, there were no significant differences between omnivore participants living with obesity and those in the other groups. Moreover, participants living with obesity had comparable emotion regulation abilities to normal-weight participants. These results suggest that emotion regulation deficits can more likely be explained by the presence of psychopathological traits than by being overweight or one's choice of diet.

Seventy years of bariatric surgery: A systematic mapping review of randomized controlled trials.

While research publications on bariatric surgery (BS) have grown significantly over the past decade, there is no mapping of the existing body of evidence on this field of research. We performed a systematic review followed by a mapping of randomized controlled trials (RCTs) in BS for people with obesity. From January 2020 to December 2020, we performed a systematic review of RCTs evaluating BS, versus another surgical procedure, or versus a medical control group, through a search of Embase and PubMed. There was no restriction on outcomes for study selection. A total of 114 RCTs were included, most (73.7%) of which were based on a comparison with Roux-en-Y gastric bypass (RYGB) and conducted between 2010 and 2020. Only 15% of the trials were multicenter and few (3.5%) were international. The median number of patients enrolled was 61 (interquartile range [IQR]: 47.3-100). Follow-up time was 1 to 2 years in 36% and 22.8% of the trials, respectively. Weight loss was the most studied criterion (87% of RCTs), followed by obesity-related diseases, and medical and surgical complications (73%, 54%, and 47% of RCTs, respectively). Nutritional deficiency frequency, body composition, and mental health were little studied (20%, 18% and 5% of RCTs, respectively). Our literature review revealed that much research in BS is wasted because of replication of RCTs on subjects for which there is already body of evidence, with small populations and follow-up times mostly below 2 years. Yet several research questions remain unaddressed, and there are few long-term trials. Future studies should take into account the experience of the past 70 years of research in this field.

Spin occurs in bariatric surgery randomized controlled trials with a statistically nonsignificant primary outcome: A systematic review.

OBJECTIVES: To systematically identify the strategy and frequency of spin in reports of bariatric surgery randomized controlled trials (RCTs) with statistically nonsignificant primary endpoint. STUDY DESIGN AND SETTING: The use of specific reporting strategies to highlight the beneficial effect of an experimental treatment can affect the reader interpretation of trial results, particularly when the primary endpoint is not statistically significant. A literature search was performed to identify RCTs publications assessing the impact of bariatric surgery on obesity-related comorbidities published over the past 10 years (from January 2020 till December 2020) in MEDLINE and EMBASE. RCTs publications with statistically non-significant primary outcomes were included. RESULTS: Of 46 576 reports screened for title and abstract inclusion, 29 RCT reports met the inclusion criteria for spin analysis. In total, 16 abstracts (55%) and 18 main texts (62%) were classified as having a spin. In abstract results and conclusion sections, the spin was identified in 69% of reports. In main text results, discussion, and conclusion sections, the spin was recognized in 37%, 72%, and 76% of reports respectively. The spin consisted mainly of focusing on within-group improvements and the interpretation of statistically nonsignificant results as showing treatment equivalence. CONCLUSION: Spin occurred in a high proportion of bariatric surgery RCTs with a statistically nonsignificant primary endpoint.

Delayed retroperitoneal liposarcoma diagnosis and management in a patient with massive obesity.

People suffering from extreme obesity may be exposed to delayed diagnosis and treatment of cancer. A 37-year-old woman (weight = 245 kg, body mass index (BMI) = 79 kg/m2), presented a sepsis associated with nonspecific abdominal pain for 4 months. After several unsuccessful attempts due to her weight and a large waist circumference, abdominal CT scan was finally successfully performed and showed a large retroperitoneal mass. An ultrasound-guided core needle biopsy was performed and was in favor of a liposarcoma. Surgery was performed to remove the entire tumor of an estimated weight of 98 kg, a giant retroperitoneal dedifferentiated liposarcoma. This case highlights the difficulties to screen, diagnose, and manage cancers encountered in patients suffering from massive obesity.

Prospective multicentre randomised trial comparing the efficacy and safety of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus Roux-en-Y gastric bypass (RYGB): SADISLEEVE study protocol.

INTRODUCTION: Despite the non-negligible weight loss failure rate at midterm, Roux-en-Y gastric bypass (RYGB) remains the reference procedure in the treatment of morbid obesity with metabolic comorbidities. A recently emerged procedure, the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), could be more effective on weight loss with similar morbidity and lower weight loss failure rate than RYGB. We propose the first randomised, open, multicentre superiority trial comparing the SADI-S to RYGB (SADISLEEVE). METHODS AND ANALYSIS: The main objective is to demonstrate the superiority at 2 years after surgery of the SADI-S compared with RYGB in term of excess weight loss percentage. The secondary objectives are the evaluation of nutritional status, metabolic outcomes, overall complication rates and quality of life, within 2 years after surgery. Key inclusion criteria are obese patients with body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with at least one comorbid condition and candidate to a first bariatric procedure or after failure of sleeve gastrectomy. Patients randomised by minimisation in two arms, based on centre, surgery as a revisional procedure, presence of type 2 diabetes and BMI >50 kg/m2 will be included over 2 years.A sample size of 166 patients in each group will have a power of 90% to detect a probability of 0.603 that excess weight loss in the RYGB arm is less than excess weight loss in the SADI-S arm with a 5% two-sided significance level. With a drop-out rate of 10%, it will be necessary to include 183 patients per group. ETHICS AND DISSEMINATION: The study was approved by Institutional Review Board of Centre Hospitalier Universitaire Morvan (CPP1089-HPS1). Study was also approved by the French national agency for drug safety (2018061500148). Results will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT03610256.

Diagnostic and Therapeutic Management of Post-Gastric Bypass Chronic Diarrhea: a Systematic Review.

There is a lack of recommendation regarding exploration and treatment of chronic diarrhea following gastric bypass, while it is a common side effect of this surgery. The electronic databases MEDLINE and EMBASE were searched until July 2018. Of the 553 articles identified, 35 articles were included. Intestinal bacterial overgrowth and pancreatic exocrine insufficiency are the main etiologies of diarrhea following gastric bypass. The diagnostic approach must begin by eliminating infectious causes of diarrhea. Exocrine pancreatic insufficiency can be diagnosed with fecal fat quantification or fecal elastase 1 level evaluation. A positive lactulose breath test confirms suspicion of small intestine bacterial overgrowth. In conclusion, we propose sequential exploration and treatment of the possible etiologies of diarrhea depending on clinical symptoms.

[Nutritional Management of Nonalcoholic fatty liver disease (NAFLD)]. / Interventions nutritionnelles dans la prise en charge de la stéatose et la stéatohépatite non alcoolique.

Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity and insulin resistance. There is currently no pharmacological treatment validated in steatosis. The combination of weight loss and adequate physical activity can improve liver steatosis. In randomized trials and cohort studies, a weight loss of at least 7% and a diet approaching the Mediterranean diet have been associated with an improvement in hepatic fat content, an improvement in hepatic biomarkers, and regression of histological signs of steatosis. Bariatric surgery by losing weight can lead to an improvement in hepatic fat content.

Changes in total sperm count after gastric bypass and sleeve gastrectomy: the BARIASPERM prospective study.

BACKGROUND: The massive weight loss induced by bariatric surgery is associated with major benefits, but the effect on semen variables is still uncertain. OBJECTIVES: To explore semen modifications with gastric bypass and sleeve gastrectomy. SETTING: Five French University Hospitals. METHODS: Male candidates for bariatric surgery with no history of infertility were recruited in this controlled prospective study. Sperm characteristics were collected before surgery and then 6 months and up to 12 months after surgery. RESULTS: Forty-six adult men who underwent gastric bypass (n = 20) or sleeve gastrectomy (n = 26) were included. Total sperm count tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups, at -69.5 million (-96.8 to -42.2 million; P = 0.0021). Total sperm count at 12 months relative to baseline was -41.4 million (P = .0391) after gastric bypass and -91.1 million (P = .0080) after sleeve gastrectomy. This was counterbalanced by an associated resolution of hypogonadism and decrease of DNA fragmentation in most patients with time after surgery. CONCLUSION: Improvement in some semen variables after bariatric surgery observed in 3 previous studies is in contrast to the lower mean total sperm count found in this study at 1 year. The possible reversibility of this effect in the long term and the impact of surgery on fertility both remain unknown.

Management of Hypothalamic Obesity during Transition from Childhood to Adulthood.

Hypothalamic obesity (HO) is a rare and serious disease of various origins: tumor, traumatism, radiotherapy, vascular, genetic, or even psychotropic drug use. HO usually begins in childhood with eating disorders and progresses with an aggregate of severe comorbidities. Transition from pediatric to adult health care is a critical period to assure weight stability and a good management of comorbidities. In case of loss to follow-up, there is an increased risk of major weight gain and long-term complications with severe obesity. To minimize this risk, pediatric and adult specialists must work together to prepare, supervise, and monitor transition. Transition ideally involves the patient, parents, and care providers with a good communication between pediatric and adult teams from expert centers. Maintaining a diet and physical activity management plan, acquisition of autonomy for hormone replacement therapy and management of psychosocial consequences of obesity are fundamental issues in patients with HO. Patient associations and specialized diet center weight loss programs can help as well as group approaches.

A 78-Year-Old Man With Historical Goiter.

The purpose of this paper is to provide description of the natural evolution of an initially operable goitre into unmesurable form in a context of deeply unknown psychiatric disorders initially unknown.

Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: A retrospective study.

This study aimed to examine the associations of lifetime traumatic experience with presurgery and postsurgery eating pathology and postoperative weight loss in a sample of adult bariatric surgery patients using electronic medical record (EMR) data. Presurgery lifetime exposure to traumatic event, presurgery and postsurgery dysfunctional eating patterns, and post-operative total and excess weight losses were extracted from electronic medical records of 200 adult bariatric surgery patients in 2013 and 2014. Logistic regression analyses were conducted. During their lifetime, 60.5% of the patients (81.5% women, age = 44.4 ± 11.5 years; BMIpre = 44.9 ± 5.5 kg/m2 ) reported that they were exposed to a traumatic event. Before surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (OR = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviours (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06), and to overeating or disturbed eating (OR = 1.53) 12 months after surgery. Bariatric surgery candidates with a history of trauma exposure could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid insufficient postoperative weight loss as well as reappearance of dysfunctional eating patterns after surgery.

The measured glomerular filtration rate (mGFR) before and 6 months after bariatric surgery: A pilot study.

INTRODUCTION: Over the last few decades, the prevalence of obesity has increased dramatically. This increase has been mirrored by a rise in the risk of a number of health conditions, including hypertension, diabetes and chronic kidney disease. Although the weight loss following bariatric surgery has been shown to relieve the severity of diabetes and reduce hypertension, the effect on renal function has been less extensively evaluated. OBJECTIVE: The aims of the present study were to: (i) compare the estimated glomerular filtration rate (eGFR, using the MDRD and CKD-EPI equations) and the calculated glomerular filtration rate (using the 24-hour urine volume) with the measured glomerular filtration rate (mGFR) assessed with the plasma iohexol clearance method in severely obese patients, and (ii) evaluate the effect of weight loss on the mGFR 6 months after bariatric surgery. METHODS: Before and six months after bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), eligible patients for bariatric surgery were admitted as day cases to the nephrology unit, where they underwent a plasma iohexol clearance test. The GFR was also estimated using the MDRD and CKDEPI equations and the 24-hour urine method. Changes in eGFR and mGFR were compared using a Wilcoxon test for paired data. RESULTS: Data from 16 patients with severe obesity (mean ± standard deviation of Body Mass Index [BMI]: 43.9 ± 7.3 kg/m2) were analyzed. At baseline, 12 (75%) presented with hypertension and 10 (63%) presented with diabetes. The median [range] iohexol clearance rate was 109 [57-194] mL/min. The plasma iohexol clearance test evidenced hyperfiltration (mGFR>120 mL/min) in 7 patients. In contrast, the eGFR values generated by the MDRD equation, the CKDEPI equation and the GFR MFR calculated with the 24-hour urine method only identified hyperfiltration in 1, 0 and 5 patients, respectively. Six months after surgery, the mean BMI had fallen significantly (P<0.0012), and the severity of diabetes (according to the HbA1c level) had decreased significantly from 6.6 [6.0-9.8] % to 5.7 [5.2-8.6] % (P=0.025). The iohexol clearance rate increased slightly after bariatric surgery. Changes in BMI after surgery do not seem to be correlated with the changes in iohexol clearance. In patients displaying hyperfiltration at baseline, the mGFR fell significantly (n=7; P=0.01) and returned to near normal values. No significant changes in the eGFR were observed. CONCLUSION: Our results suggest that MDRD and CKD-EPI equations do not provide accurate estimates of the true GFR in severely obese patients (particularly in those with hyperfiltration). Iohexol clearance or other methods for determining mGFR should constitute the gold standard for the accurate evaluation of renal function in this context. Renal function (as evaluated by the mGFR) improved 6 months after bariatric surgery in severely obese individuals particularly in patients displaying hyperfiltration at baseline. However, these observations must be confirmed in a larger study with a longer follow-up period.

[Difficulties of follow-up of patients after bariatric surgery]. / Difficultés du suivi des patients après une chirurgie bariatrique

Difficulties of follow-up of patients after bariatric surgery. Since several years, there are existing guidelines for the follow- up of patients undergoing bariatric surgery. Despite this, many patients who have undergone bariatric surgery do not have the recommended follow-up. Patients are often lost to follow-up and are therefore more likely to have a weight regain after surgery. On the other hand, they may be exposed to a lower tight control of their comorbidities, an increase in the number of postoperative complications, and a high level of nutritional deficiencies. In addition, many situations may require special expertise that takes into account the history of bariatric surgery. Patients should benefit a personalized follow- up to maximize the beneficial effects of bariatric surgeries.

Difficultés du suivi des patients après une chirurgie bariatrique. Depuis plusieurs années, le suivi de patients opérés d'une chirurgie de l'obésité a fait l'objet de recommandations. Malgré cela, de nombreux patients opérés d'une chirurgie bariatrique n'ont pas le suivi recommandé et sont perdus de vue. Leur risque de reprise de poids au décours de la chirurgie est plus élevé. Par ailleurs, ils peuvent être exposés à un moins bon contrôle de leurs comorbidités, une augmentation du nombre de complications postopératoires, un degré plus élevé de carences nutritionnelles. Par ailleurs, de nombreuses situations peuvent nécessiter une expertise particulière prenant en compte l'antécédent de chirurgie bariatrique, c'est notamment le cas pour les choix thérapeutiques de certaines maladies chroniques, la prise en compte de contre-indications à certains médicaments, les suivis de contraception et de grossesse. Les patients doivent pouvoir bénéficier d'un suivi à vie personnalisé et multidisciplinaire pour potentialiser les effets bénéfiques de la chirurgie bariatrique. L'augmentation importante du nombre de patients bénéficiant par an d'une chirurgie bariatrique en France est préoccupante dans la mesure où elle va nécessiter une adaptation de l'organisation et de l'offre de soins qui devra prendre en compte la problématique des patients perdus de vue. Cette adaptation sera possible grâce à la formation des acteurs de santé amenés à prendre en charge ces patients, par le soutien des associations de patients et par l'existence de relais bien établis avec les centres de référence médico- chirurgicaux de prise en charge de l'obésité.

Postprandial GLP-1 Secretion After Bariatric Surgery in Three Cases of Severe Obesity Related to Craniopharyngiomas.

Craniopharyngiomas are rare cerebral tumors associated with severe obesity after hypothalamic surgery. A meta-analysis showed significant weight loss at 1 year after bariatric surgery in these patients even though more modest than in common causes of obesity. We hypothesized that this discrepancy could be partly explained by differences in GLP-1 secretion after surgery since patients with craniopharyngioma present a significantly higher degree of insulin resistance and hyperinsulinism than common obese control. We report three cases of bariatric surgery in patients presenting with hypothalamique obesity related to craniopharyngiomas. At 18 months, the mean weight loss was 20 kg with expected insulin resistance decrease. Before surgery, standardized test meal shows abolition of postprandial GLP-1 secretion in all patients with a progressive restoration in the patients with gastric bypass (GBP) surgery.

Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control.

BACKGROUND: Type 1 diabetes patients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obese patients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events. METHODS: Thirteen obese patients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obese patients without diabetes and with type 2 diabetes patients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia. RESULTS: At 12 months, median surgery-induced weight loss was 27.9 % (21.1-33.3), 26.1 % (24.8-29.7), and 27.5 % (21.8-32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetes patients versus 8.0 to 5.9 % in type 2 diabetes patients (P = 0.04 between the groups). In type 1 diabetes patients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each). CONCLUSIONS: Type 1 diabetes patients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.

Midterm outcomes of gastric bypass for elderly (aged ≥ 60 yr) patients: a comparative study.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is feasible for patients aged 60 years and older and is associated with a favorable early weight loss. However, data with longer follow-up in this age group are scarce. The present study compared weight loss and changes in co-morbidities 3 years after LRYGB between older patients (OP; ≥ 60 yr) and younger patients (YP; <60 yr). Data were collected prospectively in a single surgery university center (Paris, France). METHODS: Between January 2004 and May 2011, 48 OP and 610 YP underwent LRYGB. Three-year outcomes were available for 42 (87.5%) OP and 480 (78.7%) YP; 42 OP undergoing LRYGB were matched with 84 YP for sex, preoperative body mass index (BMI), and presence of type 2 diabetes. RESULTS: The sample was 81% female; preoperative BMI was 45.6 ± 6.4 kg/m² in OP versus 47.3 ± 5.2 kg/m² in YP patients (P = .12), and age was 62.6 ± 2.3 years in OP versus 42.9 ± 8.7 years in YP (P < .0001). The prevalence of coexisting conditions was comparable in both groups except for dyslipidemia (66.7% in OP versus 42.9% in YP; P = .01). At 3 years, percentage of weight loss and BMI change (kg/m²) was significantly lower in the OP group compared with YP (27.5 ± 8.6 versus 31.8 ± 12.1, P = .04; and -12.7 ± 4.9 versus -15.2 ± 6.2, P = .03). The rate of remission of hypertension was lower in OP than in YP (18.8% versus 53.8%; P = .002), as was that of both obstructive sleep apnea (60.6% versus 87.9%; P = .004) and dyslipidemia (42.9% versus 75.0%; P = .01). CONCLUSIONS: At 3 years, despite less favorable impact on weight than for younger patients, LRYGB provided significant weight loss and remission of co-morbidities for patients aged > 60 years. Long-term trials are needed to better evaluate the benefit of bariatric surgery in aging obese patients.

Similar postoperative safety between primary and revisional gastric bypass for failed gastric banding.

IMPORTANCE: Adjustable gastric bands are widely used because of low postoperative morbidity, but their long-term results are poor, often leading to revisional surgery. OBJECTIVE: To assess the safety of revisional procedures by comparing the 30-day outcomes of primary gastric bypass vs revisions following failed adjustable gastric banding. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review using logistic regression models to compute odds ratios (95% CIs) across preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) quartiles to evaluate the risk for major adverse outcomes at 30 days (death, venous thromboembolism, reinterventions, and failure to be discharged). The prospective database of a single university surgical center in Paris, France, was queried for clinical and other relevant data among all patients undergoing primary or revisional laparoscopic gastric bypass between January 1, 2004, and June 30, 2013. MAIN OUTCOMES AND MEASURES: The primary outcome was a comparison between 30-day outcomes of primary gastric bypass and procedures following failed adjustable gastric banding. RESULTS: In total, 831 patients had a primary procedure (group 1), and 177 patients had a secondary procedure after failed adjustable gastric banding (group 2). Overall, 78.7% of patients were female, the mean (SD) patient age was 42.6 (11.6) years, the mean (SD) body mass index was 47.6 (7.6), and mortality at 30 days was 0.5%. The rates of major adverse outcomes were similar in group 1 (7.8%) and group 2 (8.5%) (P = .77). In multivariate analyses, odds ratios for major adverse outcomes across preoperative body mass index quartiles (<42, 42-46, >46 to 52, and >52) were 1.00, 0.39 (95% CI, 0.20-0.77; P = .006), 0.55 (95% CI, 0.30-1.02; P = .06), and 0.50 (95% CI, 0.27-0.94; P = .03), respectively. CONCLUSIONS AND RELEVANCE: The 30-day major adverse outcome rates were similar for primary gastric bypass and for procedures following failed adjustable gastric banding. Long-term comparative studies are required to better understand the quadratic relationship between body mass index and early postoperative outcomes.

Clinical review: Bariatric surgery following treatment for craniopharyngioma: a systematic review and individual-level data meta-analysis.

OBJECTIVES: Craniopharyngiomas are rare low-grade tumors located in the hypothalamic and/or pituitary region. Hypothalamic involvement and treatment resulting in hypothalamic damage are known to lead to development of "hypothalamic obesity" (HyOb) in 50% of cases. The management of HyOb, associated with eating disorders and rapid comorbidities, is an important issue. Bariatric surgery is the most effective therapy for weight loss in patients with severe exogenous obesity. The aim of this systematic review and meta-analysis was to determine the 12-month outcome of bariatric surgery for HyOb due to craniopharyngioma treatment. METHODS AND RESULTS: Relevant studies were identified by searches of the MEDLINE and EMBASE databases until January 2013. A total of 21 cases were included: 6 with adjustable gastric banding, 8 with sleeve gastrectomy, 6 with Roux-en-Y gastric bypass, and 1 with biliopancreatic diversion. After data pooling, mean weight difference was -20.9 kg after 6 months (95% confidence interval [CI], -35.4, -6.3) and -15.1 kg after 12 months (95% CI, -31.7, +1.4). The maximal mean weight loss was achieved by the gastric bypass group: -31.0 kg (95% CI, -77.5, +15.5) and -33.7 kg (95% CI, -80.7, +13.3) after 6 and 12 months, respectively. CONCLUSIONS: In this largest ever published study on the effect of bariatric surgery on obesity after craniopharyngioma treatment, we observed an important weight loss after 1 year of follow-up. Larger studies are warranted to establish appropriate selection criteria and the best surgical technique to perform bariatric surgery.