Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide, and obesity is a significant risk factor for HCC development and progression.Bariatric surgery has been shown to reduce cancer risk, including a lower prevalence of HCC. However, the mechanisms underlying this effect remain largely unexplored. This study aims to investigate the impact of bariatric surgery on HCC progression in a dimethylbenz[a]anthracene (DMBA)-induced obesity mouse model.

Obesity, defined as a body mass index (BMI) > 30 kg/m2, affects 42% of adults in the United States and has an estimated annual medical cost of $173 billion.1 Bariatric surgery is the most effective treatment for obesity, yet it remains underutilized. 2-5 The recent approval of Glucagon-Like Peptide-1 receptor agonists (GLP-1RA) for weight loss represents a potentially important adjunctive treatment that is receiving widespread interest. 6-8 Given the novel nature of GLP-1RA, there is now considerable confusion and variation in how and when to use either medical or surgical treatment for obesity. As a result, the introduction of GLP-1RA may lead to considerable changes in utilization patterns for both medical and surgical obesity treatments in the coming years. To optimize utilization of obesity treatments, there is a critical need to evaluate the impact of GLP-1RA introduction on clinician and patient perceptions affecting decision-making for medical versus surgical obesity treatment.

Glucagon-like peptide 1 (GLP-1) is a hormone that helps regulate blood glucose levels through improved insulin sensitivity and release of insulin from the pancreas, control hunger, induce satiety and plays a role in the metabolic health of a person. GLP-1 receptor agonists (GLP1-RAs) have been shown to be effective in achieving weight loss in patients with type 2 diabetes while improving blood glucose control. Bariatric surgical procedures have been shown to be effective in treating obesity as well as superior to best medical therapy for treatment of diabetes. Bariatric surgery has been shown to be effective in helping people with obesity lose weight and improve their health not just through restriction of calories but also through a positive impact in modifications of gut hormones, changes in circulating bile acids, modifications in the gut microflora as well as other undefined mechanisms. The combined benefits of GLP1-RAs with bariatric surgery have only been studied to a limited effect. In this randomized trial, the effects of continuation or discontinuation of GLP1-RA therapy in patients undergoing bariatric surgery will be determined.

While associations between weight gain and canonical pro-carcinogenic factors such as increased inflammation and metabolic derangements have been drawn[1–5], increasing attention is now drawn to the protective effects of weight loss interventions against development of malignancies[6–11]. As one of the most powerful tools to attain durable weight loss, bariatric surgery has become of greater interest as an intervention against cancers involving endocrine and metabolomic homeostasis, such as breast cancer where bariatric surgery confers up to a 37% risk reduction of breast cancer[12–18]. However, current literature exploring the relationship between breast cancer and weight loss has been retrospective human and small-scale mouse syngeneic graft studies without a focused delve into tumor microenvironment changes and surrounding breast stroma; limiting their generalizability and ability to conclude causality[12, 15, 16].

We are excited to report that the second ASMBS Obesity in America Survey, sponsored by the ASMBS Foundation, soon-to-be TREO Foundation, has been published in SOARD and over the last few weeks, has been the focus of news stories in US News & World Report, HealthDay, UPI, News Medical, Bariatric News and many others.

The survey explored public perceptions of obesity and its treatment amid the COVID-19 pandemic. Researchers hypothesized that the American experience with COVID-19 would change the public’s views and behaviors on obesity, which emerged as a major risk factor for severe outcomes from COVID. 

Among the Key Findings 

• Nearly a third of Americans said COVID-19 made them more worried than ever about having obesity, prompting 6.4 million to consider treatment with bariatric surgery and anti-obesity medications for the first time in their lives. 
• Obesity was considered the biggest health threat facing the country, as big as cancer and even more of a threat than heart disease, diabetes, and COVID-19.

• Misperceptions persist about the best methods for long-term weight loss with nearly 75% thinking dieting and exercise alone was the most effective, even more so than involving a doctor (65%) or having bariatric and metabolic surgery (56%).

The survey shows public awareness and concerns over the dangers of obesity have never been higher. However, once the pandemic is long over, the disease of obesity will continue to exist in epidemic proportions if we don’t act, which is why your continued support is so vital. We must turn this new consideration of bariatric treatment into action – and the time is now! 

Our partnership with ASMBS remains strong, and together with our donors, we will fuel the change we seek. Visit www.TREOFoundation.org to learn how you can help transform the landscape of obesity treatment. 

Healthy Regards,

Carl Pesta, DO

President, ASMBS Foundation

Metabolic and bariatric surgery (MBS) is the most effective obesity treatment, though the mechanisms underlying its marked weight loss compared to dietary/behavioral approaches remain unclear. Despite its efficacy, however, weight regain can occur. Although weight regain can result from anatomic failure (e.g. gastro-gastric fistula), regain is typically multifactorial (e.g. environment, behavioral stressors, new diagnoses). Surgical treatment for weight regain is increasing1, but understanding weight regain physiology and how surgical treatment alters that physiology remains poorly understood. Better understanding of weight regain physiology and MBS treatments remains critically important.

To reveal whether patients who undergo bariatric surgery are at increased risk for developing a post-surgical cannabis use disorder and will also shed light on whether cannabis use affects post-surgical weight loss and medical comorbidities. To guide programmatic recommendations and monitoring to help optimize outcomes for patients pursuing bariatric surgery and to support future grant applications including identifying distal and proximal predictors of cannabis use, as well as, development of technology-based interventions to reduce substance use and problematic eating behaviors to optimize weight loss outcomes.

To reveal whether patients who undergo bariatric surgery are at increased risk for developing a post-surgical cannabis use disorder and will also shed light on whether cannabis use affects post-surgical weight loss and medical comorbidities. To guide programmatic recommendations and monitoring to help optimize outcomes for patients pursuing bariatric surgery and to support future grant applications including identifying distal and proximal predictors of cannabis use, as well as, development of technology-based interventions to reduce substance use and problematic eating behaviors to optimize weight loss outcomes.

To not only elucidate the immediate benefits of bariatric surgery in asthma but also achieve important insights that can better aid understanding of the mechanism by which these procedures improve the disease in obese patients.

To not only elucidate the immediate benefits of bariatric surgery in asthma but also achieve important insights that can better aid understanding of the mechanism by which these procedures improve the disease in obese patients.

To understand the metabolic and microbiome differences between obese patients with metabolic syndrome and healthy obese patients.

The liver plays a central role in obesity-induced insulin resistance and normalization of blood glucose in the immediate period following RYGB. We sought to understand the genetic pathways which underlie resolution of insulin resistance and blood glucose levels.

The objective of the study is to evaluate a newly developed Internet-delivered (via e-learning modules) acceptance-based behavioral intervention (ABTi) for individuals who are experiencing weight regain post-surgery. We are assessing ABTi’s efficacy on stopping and/or reversing weight by comparing it to a wait-list control (WLC) condition. We are also evaluating its effect on targeted weight control behaviors and acceptance-based skills. Finally, we are examining the relationship between weight outcomes and changes in process variables through exploratory analyses.

The objective of the study is to evaluate a newly developed Internet-delivered (via e-learning modules) acceptance-based behavioral intervention (ABTi) for individuals who are experiencing weight regain post-surgery. We are assessing ABTi’s efficacy on stopping and/or reversing weight by comparing it to a wait-list control (WLC) condition. We are also evaluating its effect on targeted weight control behaviors and acceptance-based skills. Finally, we are examining the relationship between weight outcomes and changes in process variables through exploratory analyses.

To understand the metabolic and microbiome differences between obese patients with metabolic syndrome and healthy obese patients.

To evaluate the importance of the gut hormone response to age-associated diabetes remission following the two most prevalent bariatric surgery procedures performed today, laparoscopic RYGB (LRYGB) and laparoscopic sleeve gastrectomy (SG).