Objective

To develop the Chinese Expert Consensus on Medical Knowledge Dissemination in Metabolic and Bariatric Surgery （2024 Edition） （The Consensus）， aiming to promote the professionalization and standardization of medical knowledge dissemination in metabolic and bariatric surgery in China.

Methods

The Delphi method was employed to gather expert opinions.Based on a comprehensive analysis of domestic and international models and content of medical knowledge dissemination in metabolic and bariatric surgery， as well as relevant guidelines for obesity and metabolic diseases in China， 11 experts with extensive experience in this field discussed and summarized 46 consensus statements.An initial draft was created， followed by a first-round expert survey.After incorporating feedback from the survey， a revised version was used to create a second-round questionnaire， which was completed by 214 experts.The final consensus was developed after further revisions.

Results

The Consensus includes 46 consensus statements addressing three main areas below： the current status of medical knowledge dissemination in metabolic and bariatric surgery， approaches to medical knowledge dissemination， and key points and considerations for delivering high-quality dissemination in this field.

Conclusions

The Consensus is both scientifically rigorous and practical， providing standards and guidelines for implementing medical knowledge dissemination in metabolic and bariatric surgery in China.

Ghrelin， a short peptide hormone secreted primarily from the stomach into the blood，induces a rapid increase in energy intake and may induce weight gain and obesity in the long term.Ghrelin levels in serum were increased by fasting but suppressed after meals.Therefore， inhibiting ghrelin signaling may have some potential in treating weight loss.Previous studies have explored different approaches to inhibit the ghrelin system for treating obesity， but until now， no therapy based on antagonizing the ghrelin system has been applied in clinical practice.This article discusses the role of ghrelin in appetite control in humans， reviews different approaches to inhibit the ghrelin system， and evaluates their potential as antiobesity therapies.

Laparoscopic sleeve gastrectomy （LSG） has become the most commonly performed bariatric surgery worldwide.Its primary weight loss mechanism is to restrict food intake in patients with obesity by reducing gastric volume.The measurement of the postoperative residual gastric volume is crucial in assessing the quality of the surgery and predicting weight loss outcomes.This article summarizes the methods for measuring residual stomach volume to assist clinicians in better predicting weight loss outcomes，optimizing surgical techniques， and guiding perioperative management.

Metabolic and bariatric surgery is the only effective option for individuals with severe obesity to achieve long-term and stable weight loss.However， patients may have varying degrees of skin laxity after surgery， negatively impacting their psychology and quality of life.Body contouring surgery has been demonstrated to be effective in improving skin laxity， but its prevalence is low worldwide.This paper discusses the preoperative assessment， preparation， and postoperative complications of body contouring surgery， summarizes the current surgical approaches and research progress for skin laxity in different body parts， and based on this， provides a prospect for body contouring surgery following metabolic and bariatric surgery.

Obesity and depression are two common health problems， and there are common pathogenesis and correlation between them.That is， obesity can increase the risk of depression， which in turn can increase the risk of developing obesity.Among them， hormone levels， neurotransmitter changes，inflammatory response， inheritance， and other factors are important mediators of the relationship between the two.In addition， environmental factors such as eating habits and exercise behavior， and psychosocial factors such as self-esteem and social support also have an impact on the relationship between obesity and depression.In this paper， the etiology and related mechanisms between obesity and depression are comprehensively summarized and summarized， and scientific and effective weight loss is advocated， aiming to provide more reliable evidence for early prevention and clinical treatment of these patients.

Metabolic and bariatric surgery is currently the most effective treatment for morbid obesity and type 2 diabetes.How to retract liver tissue safely and effectively is the key to promote the surgical process.In this paper， the selection and application of various liver retraction methods in weightloss metabolic surgery in recent years are described.Their surgical field exposure， liver function influence，bleeding degree， pain degree， and difficulty of operation are analyzed， and the advantages and disadvantages of different methods are compared.The aim is to provide a valuable reference for researchers and clinicians in metabolic and bariatric surgery.

Sarcopenia is an age-related pathological change in muscle mass and strength loss.Sarcopenia and obesity share a common pathological mechanism， and there are mutually reinforcing mechanisms.The concept of sarcopenic obesity （SO） has been widely recognized， which is mainly manifested by a decrease in muscle mass accompanied by an absolute or relative increase in fat mass.The increasing incidence of SO is a significant public health risk in aging societies.Because of some differences in diagnostic criteria， the prevalence of SO in the East and the West is inconsistent.Low muscle strength is the most important diagnostic criteria for SO， and dietary intervention and physical exercise are the main measures to treat SO.This article reviews the definition， epidemiology， diagnostic methods， treatment， and other aspects of SO， so as to provide the basis and direction for further research in the future.

Non-alcoholic fatty liver disease （NAFLD） is a pathologic condition manifested by the excessive accumulation of visceral fat in the liver so much so that it gradually progresses to end-stage liver cirrhosis and hepatocellular carcinoma.Some of the NAFLD patients could be comorbid with sarcopenic obesity （SO）， especially those of the elderly.As the world's aging population grows， SO has come into the spotlight as a special type of obesity.From the perspective of pathophysiology， SO and NAFLD share many common influencing factors， such as inflammation， aging， insulin resistance， myokines， etc.However， the interactions between these factors remain elusive.Bariatric metabolic surgery has been an effective means to improve glucose and lipid metabolism for young adults and older patients with obesity as well.Clarifying the pathogenesis of sarcopenic obesity and the mechanism of the metabolic disorder process is an important prerequisite for evaluating the feasibility of bariatric and metabolic surgery.In this review， we tried to elucidate the pathogenesis and interrelationship of sarcopenic obesity and NAFLD and provide an overview of the related treatment advancements.

Objective

To investigate the effect of sarcopenia on sleeve gastrectomy in patients with obesity.

Methods

A retrospective analysis was performed on the data of 68 patients who received laparoscopic sleeve gastrectomy at the Department of Bariatric and Metabolic Surgery of the First Affiliated Hospital of Xiamen University from 2021 to 2022 and were regularly followed up for 1 year， including 28 males and 40 females.The patients were divided into the sarcopenia group （16 patients） and the nonsarcopenia group （52 patients） according to whether they had sarcopenia.The effect of postoperative weight loss （TWL%） was compared using T-test.

Results

The overall weight loss effect （%TWL） and ameliorative effect of complications in the sarcopenia group was lower than that in the non-sarcopenia group （male：21.73±5.54 vs. 33.50±9.05， P=0.006； female： 25.23±5.71 vs. 36.41±9.69， P＜0.001）.The obesity-related comorbidities of the two groups were improved after surgery， but the improvement rate was not statistically significant （P＞0.05）.

Conclusions

Based on the results of this study， the postoperative effect of bariatric surgery in patients with sarcopenia is worse than that in patients with non-sarcopenia.Preoperative assessment of sarcopenia in patients with obesity has a certain reference value for predicting the effect of weight loss after sleeve gastrectomy.

Objective

To identify the factors that best predict the risk of atherosclerosis in male patients with type 2 diabetes mellitus（T2DM） from the parameters evaluated by the oral glucose tolerance test （OGTT）.

Methods

A total of 171 hospitalized male patients with T2DM in Tianjin Medical University Chu Hsien-I Memorial Hospital from October 2019 to October 2023 were divided into atherogenic phenotype group （group A， AIP≥0.06） and non-atherogenic phenotype group （group N， AIP＜0.06）.The patients were accepted OGTT.The homeostasis model insulin resistance index （HOMA-IR）， insulin secretion index（HOMA-β）， insulin action index （IAI）， quantitative insulin sensitivity check index （QUICKI）， C peptide insulin resistance index （HOMA IR-CP） and C-peptide islet function index suitable for diabetes patients（HOMA islet-CP DM） were calculated according to OGTT results.

Results

Fasting C-peptide， C-peptide values at 60 min and 120min after oral administration of 75g glucose， ln（HOMA-IR）， ln （HOMA-β）， ln（HOMA IR-CP） and ln （HOMA islet-CP DM） in Group A were higher than those in group N （P＜0.05），while IAI and QUICKI were lower than those in group N （P＜0.05）.AIP was positively correlated with C-peptide values at different times， ln（HOMA-IR）， ln （HOMA-β）， Ln（HOMA-IR-CP） and ln（HOMA islet CP-DM） （P＜0.001）， while negatively correlated with IAI and QUICKI （P＜0.001）.Multiple linear regression analysis showed that fasting C-peptide and QUICKI were independent influencing factors of AIP.

Conclusions

Fasting C-peptide and QUICKI are independent predictors of AIP in male patients with type 2 diabetes， which deserves clinicians' attention.

Objective

To investigate the cognition of obesity and bariatric surgery in patients with metabolic unhealth and to analyze the factors affecting the acceptance of bariatric surgery.

Methods

A questionnaire survey was conducted among a total of 348 individuals with obesity who underwent physical examinations at the Affiliated Hospital of North Sichuan Medical College from February 2021 to December 2023， as well as those who visited the hospital's weight loss clinic during the same period for metabolic unhealthy obesity.Among them， 130 were willing to undergo bariatric surgery， while 169 were unwilling.Multivariate logistic regression was used for quantitative data analysis.

Results

The acceptance of bariatric surgery in metabolically unhealthy patients with obesity is mainly affected by factors such as age，education level， and professional background.Perceptions of obesity and disease associations， physician advice， and the need for weight loss also significantly influenced the willingness to undergo surgery.

Conclusions

Strengthening health education， improving health communication channels， enhancing doctorpatient communication， and providing social policy support can effectively promote bariatric surgery and improve patients' acceptance of bariatric surgery.

This article reports the clinical cases of three patients who underwent single-incision laparoscopic sleeve gastrectomy （SILSG） in the General Surgery Department of Beijing Luhe Hospital，Capital Medical University， in April 2024.All three patients underwent surgery with the in-situ division of the proximal stomach via a middle approach.The average age of the three patients was （40.3±2.1） years；preoperative weight was （85.2±5.3） kg； height was （1.62±0.03） m； and BMI was （32.6±2.4） kg/m².All surgeries were performed successfully without conversion to multi-port surgery.The average operation time was （145.0±18.0） minutes； intraoperative blood loss ranged from 10 to 20 mL.Postoperative recovery was uneventful， with no complications such as intra-abdominal bleeding， gastric leakage， or wound infection.Follow-up at 1， 3， and 6 months postoperatively showed satisfactory weight loss and no significant symptoms of acid reflux or heartburn.These preliminary results suggest that the surgical approach of the in-situ division of the proximal stomach via a middle approach is safe and feasible for SILSG， but further long-term followup of more cases is needed to confirm its safety and long-term efficacy.