Obesities

In our surgical center, we have observed a high occurrence of hiccups and rhinorrhea following bariatric surgery. This retrospective study aimed to assess the frequency of post-prandial hiccups and rhinorrhea following bariatric surgery and explore potential behavioral and clinical associations. The study was performed at Cannizzaro Hospital (Catania, Italy), an institution accredited by SICOB (Italian Society for Bariatric and Metabolic Surgery) as a national referral center. The cohort included bariatric patients who completed a preoperative psychological evaluation and adhered to a one-year post-surgical follow-up between October 2022 and November 2023. Data on eating behaviors, mental status and dietary habits were collected for each patient before surgery, while clinical records, including the recurrence of hiccups and rhinorrhea, were acquired at the following time points: baseline and 1, 3, 6 and 12 months post-surgery. Post-prandial hiccups and/or rhinorrhea were reported by 49.5% of patients at 1 month and persisted in 46.8% after 12 months. No significant associations were found between the symptoms and weight loss, BES score, or psychological traits, except for slight associations with smoking and carbonated beverage intake. In our cohort, the etiology of hiccups and rhinorrhea appears unrelated to behavioral or psychological factors and may instead reflect vagal hyper-responsiveness after gastric fundus resection.

Endoscopic sleeve gastroplasty (ESG) does not produce homogeneous results, with some patients showing little weight loss after the procedure. The aim of the present study was to evaluate the ability of pre-procedural psychometric questionnaires to predict insufficient weight loss after ESG in patients with obesity. Patient candidates for ESG were requested to complete the following psychometric questionnaires: Short Form-36 (SF-36), Symptom Checklist-90 Revised (SCL-90-R), Binge Eating Scale (BES), Yale Food Addiction Questionnaire (Y-FAS), Eating Attitude Test-26 (EAT-26), and Barratt Impulsiveness Scale-11 (BIS-11). The results of the psychometric scores were then compared with the ESG outcome, which was considered a therapeutic failure if the %EWL was less than 30% at 12 months after the follow-up. Thirty-five patients (8 males and 27 females, mean age 49 years, range 21–75 years) were included in this study. At the one-year follow-up, the mean %EWL was 40 ± 43%. Male sex and higher preoperative BMI were identified as risk factors for poor weight loss. A logistic regression analysis adjusted for sex and preoperative BMI showed that low scores on the SF-36 (Subscale Mental Health), high scores on the SCL_90-R, and an elevated BES score were predictors of therapeutic failure. The results of the present study seem to confirm the usefulness of the SF-36, SCL-90R, and BES questionnaires in the selection of patients eligible for ESG.

The American Academy of Pediatrics recently revised its guidelines on pediatric obesity treatment to recommend that primary care providers offer anti-obesity medications to patients based on age and body mass index. Anti-obesity medications like glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are efficacious in lowering body mass index (BMI) and improving metabolic health, including in children. However, although the landscape for medication production and insurance coverage is rapidly evolving, these medications can be difficult to access due to cost, lack of insurance coverage, and supply chain issues. Compounded versions of GLP-1 RAs offer the benefits of providing lower cost and higher availability alternatives to FDA-approved versions. But they include risks associated with less regulated medications. This paper identifies the risks and benefits of compounded GLP-1 RA use in the pediatric population, particularly considering structural inequities in obesity burden and treatment, and offers recommendations for pediatricians to ethically and equitable address compounded GLP-1 RA use with their patients and their families.