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Background: The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. The study compared early postoperative complications (≤30‐day) following one‐anastomosis gastric bypass (OAGB) morbidity in patients with morbid obesity class IV obesity, body mass index (BMI) ≥50–59.9 kg/m2, and class V obesity, BMI ≥60 patients. Methods: We retrospectively reviewed perioperative OAGB outcomes in three BMI groups. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Patient‐reported complications were ranked by Clavien–Dindo Classification (CDC). Results: Between January 2017–December 2021, consecutive patients with obesity class III (n = 2950), IV (n = 256), and V (n = 23) underwent OAGB. BMI groups were comparable in sex, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5 ± 25.6 min), IV (70.5 ± 28.7 min), and V (80.0 ± 34.7 min), respectively (p = 0.018); no difference in LOS. In respective BMI classes, ≤30‐day complication rates were 3.2%, 3.5%, and 4.3% (p = 0.926). The respective number of patients with CDC grades of one to two were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p = 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p = 0.669. There was 0.06% mortality (n = 2 in 3229), both in BMI class III. Conclusions: OAGB is a safe BS procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30‐day morbidity in the three BMI groups. [ABSTRACT FROM AUTHOR]

Summary: The measurement of habitual energy intake remains a challenge in nutrition research. High levels of misreporting, particularly among adults with obesity, have been observed when comparing self‐reported energy intake to energy expenditure assessed via the doubly labeled water technique. Little is known about misreporting in adults with class III obesity (body mass index ≥40 kg/m2). This systematic review assessed the representation of adults with class III obesity in dietary validation studies and the validity of self‐reported dietary energy intake for this group. Studies were included in this review if they: compared self‐reported energy intake assessment method(s) to doubly labeled water, had participants ≥18 years old, and included participants with class III obesity. Fifteen studies met these criteria. Of those, eight included information about the number of participants with class III obesity. Out of 1784 participants across eight studies, 63 (3.5%) participants had class III obesity, compared to 9.2% of US adults with class III obesity. Six studies provided data on validity of energy intake assessment for class III obesity, with five of these showing underreporting. Participants with class III obesity are underrepresented in dietary validation studies. Future research should explore the role of weight status on dietary reporting accuracy. [ABSTRACT FROM AUTHOR]

Background: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast in persons with Class III obesity (body mass index ≥ 40 kg/m2). Methods: Dobutamine stress echocardiography (DSE) was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre‐existent coronary artery disease (CAD). DSE without intravenous contrast was initially performed on 62 patients with class III obesity, then was subsequently was performed with intravenous contrast on 66 patients with class III obesity. Left ventricular (LV) regional wall motion was assessed at baseline and peak stress using the 16‐segment model. Results: In the intravenous contrast group, 1046 of 1056 LV segments studied (99.1%) were well‐visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well‐visualized and interpretable at peak stress. In the non‐contrast group, 905 of 992 segments studied (91.2%) were well‐visualized and interpretable at baseline and 886 of 992 segments studied (89.3%) were well‐visualized and interpretable at peak stress. A significantly greater number of LV segments were well‐visualized and interpretable in the intravenous contrast group than in the group compared to the non‐contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in one patient. All patients underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of intravenous contrast during DSE significantly improves visualization and interpretability of LV segments in patients with class III obesity. [ABSTRACT FROM AUTHOR]

Introduction: The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. Material and methods: This is a population‐based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509 395 women who underwent hysterectomy for benign gynecological disease: 430 865 (84.6%) non‐obese women, 50 435 (9.9%) women with class I‐II obesity and 28 095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort‐level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient‐level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple‐group generalized boosted model. Results: The rate of class III obesity increased by 40.4%, higher than the rate of class I‐II obesity (22.2%) (both, P <.001). In parallel, cohort‐level rates of perioperative complication and prolonged hospitalization for ≥7 days increased by 19.4% and 54%, respectively (P <.001). In a weighted model, class I‐II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08‐1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28‐1.51) had a significantly increased risk of perioperative complications compared with non‐obesity. Larger body habitus was associated with higher total charge (median, $35 180, $36 094 and $39 382; all values cited in US dollars) and prolonged admission rate for ≥7 days (2.9%, 3.1% and 3.9%) (both, P <.001). Conclusions: The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society‐based approaches are necessary to reduce the obesity rate and hysterectomy morbidity. [ABSTRACT FROM AUTHOR]