Ali Aminian
@Ali_Aminian_MD
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Professor of Surgery, Director of Bariatric & Metabolic Institute, Cleveland Clinic
United States
Joined July 2017
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A large meta-analysis published in
@TheLancet
today:
✅ Bariatric surgery ⬆️ life expectancy by 9️⃣ years in patients with
#diabetes
& by 5️⃣ years in patients without diabetes.
✅ Bariatric surgery is a LIFE-SAVING treatment
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169
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#BariatricSurgery
is associated with striking 40% ⬇️ in adverse cardiovascular outcomes. Specifically,
41% ⬇️in death
62% ⬇️in heart failure
31% ⬇️in heart disease
33% ⬇️in stroke
60% ⬇️in kidney failure
By operating on 13 patients, 1 life can be saved
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💥 Breaking:
President Biden signs an executive order that ALL mesenteric defects must be closed at the time of gastric bypass surgery.
@ASMBS
@SAGES_Updates
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New
#Impact
Factor of SURGERY J:
1.
@JAMASurgery
13.6
2.
@AnnalsofSurgery
10.1
7.
@BJSurgery
5.7
13.
@JAmCollSurg
4.6
26.
@DCRjournal
4.0
30.
@SOARD_JOURNAL
3.8
36.
@JournalObesity
3.4
41.
@SurgJournal
3.4
44.
@SurgEndosc
3.1
65.
@JournalofGISurg
2.6
84.
@AmJSurgery
2.1
2
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213
💥
@ClevelandClinic
SPLENDOR study in
@JAMA_current
suggests bariatric surgery as the 1st effective Rx for NASH:
⬇️ 88% risk of progression to cirrhosis
⬇️ 70% risk of serious cardiac complications
#AHA21
#LiverMTG21
#TLMdX
#LiverTwitter
#CardioTwitter
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Happy Persian New Year (
#Nowruz
) from our family to all who celebrate the first day of spring!!
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💥
@ClevelandClinic
study shows impressive benefits of losing weight (with weight loss surgery) on
#COVID19
severity:
⬇️ 49% risk of hospitalization
⬇️ 63% need for oxygen
⬇️ 60% risk of severe
#Covid
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There are ONLY 3 effective treatments for obesity which produce substantial & sustained weight loss in most patients:
1️⃣
#BariatricSurgery
2️⃣ Tirzepatide by
@LillyPad
3️⃣ Semaglutide by
@novonordisk
I wish they were accessible to all patients.
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🔆 In
#Medicare
patients with
#obesity
, bariatric surgery:
⬇️ 37% death
⬇️ 54% heart failure
⬇️ 37% heart attack
⬇️ 29% stroke
Published in JACC:
#CardioTwitter
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54
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💥
@ClevelandClinic
SPLENDID study in
@JAMA_current
shows impressive benefits of losing weight (with weight loss surgery) on
#cancer
risk:
⬇️ 32% risk of developing cancer
⬇️ 48% dying from cancer
#ASCO2022
#ASCO22
#ADA2022
#ADA22
#ASMBS2022
#ASMBS22
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This is NOT a character flaw.
This is a medical condition which requires treatment.
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Published today in
@TheLancet
Management of
#obesity
follows the same principles as management of other CHRONIC conditions.
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✨ How Safe is the Current Practice of Bariatric Surgery?
Risk of dying from surgery: 0.0008, or 4 in 5000 operations, or 1 in 1250.
Of 230,576 operations performed in the 🇺🇸 accredited centers during 2022, 186 patients died.
But in long-term, surgery ⬇️ risk of dying by 50%.
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I’m deeply honored & humbled to receive the ‘Distinguished Clinical Research Achievement Award’ from
@CRForumUS
for our
@JAMA_current
@JAMANetwork
study showing a large cancer risk reduction after bariatric surgery
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Published in
@AnnalsofSurgery
today:
COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period
#COVID19
#COVID
ー19
#coronavirus
#CoronaVirusChallenge
#covid19surgery
@AmCollSurgeons
@CovidSurg
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3 facts that we shouldn’t forget:
1) RYGB is stonger than SG for
#diabetes
2) Difference in long-term remission rate of
#T2D
is 15% favoring RYGB (NOT 70%!).
3) Complications rate of SG is 50% lower than RYGB.
We need individualized (personalized) practice
@ASMBS
#OW2019
New online:
#Gastric
#bypass
versus
#sleeve
#gastrectomy
in patients with type 2
#diabetes
(Oseberg): a single-centre, triple-blind, randomised controlled trial
#T2DM
#bariatric
#metabolic
#surgery
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“As a cardiologist, I cannot remember any study, not studies involving statins, or studies involving blood pressure medication, having this large of a treatment effect,” says Dr. Steven Nissen.
#ESCCongress
#ESCcongress2019
#WCC2019
@ASMBS
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In patients with heart failure &
#obesity
:
Bariatric surgery: ⬇️ 45% risk of death
GLP-1 RA drugs: ⬇️ 18% risk of death
✨ The sad part of story: ONLY 1% of eligible patients undergo
#bariatricsurgery
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💥 Presentation of SPLENDOR study on >1100
@ClevelandClinic
patients with biopsy-proven NASH at
#ESCCongress
@escardio
✅ 1st study to report a treatment modality that can ⬇️ risk of major adverse cardiovascular & liver outcomes in NASH.
#medtwitter
#CardioTwitter
@DLBHATTMD
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#Bariatric
procedure selection is a shared decision between patient & surgeon. We consider these conditions in our practice at
@CCFSurgery
@CleClinicMD
:
@AnnalsofSurgery
@Trends_Endo_Met
@asmbs
@IfsoSecretariat
@SAGES_Updates
@AmCollSurgeons
@AISChannel
@TheAACE
@BariatricTimes
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Remarkable 40% reduction in cardiovascular morbidity and mortality after metabolic and bariatric surgery compared with usual care.
#ESCCongress
#ESCcongress2019
#WCC2019
@escardio
@ASMBS
@CCFSurgery
@ClevelandClinic
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Tomorrow in operating room I have
#geriatric
#bariatricsurgery
schedule:
- 79 year old woman (Sleeve Gastrectomy)
- 70 year old man (Gastric Bypass)
Advanced age alone is not a contra-indication for bariatric and
#metabolic
surgery.
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Discontinuation of medications after obesity surgery:
🔅 75% of
#diabetes
💊
🔅 60% of cholesterol 💊
🔅 50% of
#hypertension
💊
By
@rhowMD
@davearterburn
@DanaTelem
@jdimick1
@JAMASurgery
@ASMBS
@AmDiabetesAssn
@American_Heart
@EASOobesity
#CardioTwitter
Among patients taking medications for obesity-related conditions before bariatric surgery, gastric bypass and sleeve gastrectomy both had high rates of medication discontinuation after surgery, however gastric bypass was slightly more effective.
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@ASMBS
Position Statement on
#Bariatric
Surgery in Class I
#Obesity
(BMI 30-35)
[Supported by
@AmDiabetesAssn
& Endorsed by
@SAGES_Updates
]
@SOARD_JOURNAL
@BariatricNews
@BariatricTimes
@obesityhelp
@AISChannel
@IFSOMENAC
@julietta_chang
@StacyBrethauer
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Cleveland Clinic Develops Calculator To Estimate 10-Year Risk Of
#Diabetes
Complications
Details today at “Top 10 Papers” session at
#ASMBS2019
#OW2019
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70 year old man with severe
#obesity
,
#fattyliver
, severe NASH, and liver fibrosis underwent sleeve gastrectomy 3 years ago.
Repeat liver biopsy few days ago showed RESOLUTION of NASH and liver fibrosis.
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Bariatric surgery is recommended for individuals with BMI >35, regardless of presence, absence, or severity of comorbidities.
@ASMBS
@IfsoSecretariat
@SAGES_Updates
@American_Heart
@AmCollSurgeons
@escardio
@ACCinTouch
@AASLDtweets
@EASOobesity
@AmericanCancer
#ACC23
#WCCardio
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Just saw a patient 1-year after
#BariatricSurgery
(virtual visit):
- Lost 100 lbs
- Off ALL
#diabetes
medications (was on 4 drugs before surgery: Jardiance, Glipizide, Metformin & Januvia)
- Off
#hypertension
&
#cholesterol
drugs
- Sleep apnea resolved (AHI 132 ➡️ 10)👇 👇
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The most important slide from my today’s lecture at
#IFSO2018
: “Evidence Based
#Bariatric
Procedure Selection”
5-yr data of 4 RCTs:
- No significant difference in
#diabetes
remission between
#RYGB
&
#sleevegastrectomy
.
- Even if there is a difference, that difference is <14%
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🔥 Tirzepatide led to 22.5% weight loss in adults with
#obesity
💥 63% lost >20% of their weight
@LillyPad
@1900b
@ASMBS
@UK_ASO
@Cabps_Obesity
@Obesitysoc
@ObesityUK_org
@EASOobesity
@MichaelAlbertMD
@drbutsch
@CMichaelGibson
@EricTopol
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Heading to
#Paris
to present cardiovascular outcomes after
#bariatricsurgery
as a late-breaking research at
#ESCCongress
@escardio
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Professor Lee Kaplan at
#IFSOnapoli2023
:
“Treating
#obesity
[with bariatric surgery & with new generation of anti-obesity medications] is an effective & valuable means of promoting heart health.”
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✅ 5-Year Impact of Metabolic Surgery on Quality of Life in Patients with
#Obesity
&
#Diabetes
Surgical Patients Reported:
⬆️Energy
⬇️Fatigue
⬇️Pain
⬆️Physical Functioning
⬆️General Health Perception
Findings are presented today at
#AmerSurg21
#ASA2021
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MOSAIC was published today in
@JACCJournals
Bariatric surgery in patients with obstructive
#sleep
apnea (
#OSA
) and
#obesity
:
✨42% ⬇️ MACE
✨37% ⬇️ Death
✨70% ⬇️ Heart Failure
✨24% weight loss at 10-years
#cardiactwitter
3
36
84
Received a note from an 80-year old patient who had
#bariatricsurgery
last year at
@ClevelandClinic
:
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“Sleeve Gastrectomy: Metabolic Surgical Procedure of Choice?”
Published in
@Trends_Endo_Met
(impact factor: 11 from
@CellPressNews
)
@asmbs
@IfsoSecretariat
@IFSOMENAC
@BariatricTimes
@BariatricNews
@gensurgnews
@obesityhelp
@CleClinicNews
@CCFSurgery
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<<<BREAKING NEWS>>>
The 2nd version of bariatric surgery decision-making app that has several more useful calculators for clinical practice will be released at
@ASMBS
@ObesityWeek
#OW2019
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Continues Improvement in Safety of
#BariatricSurgery
:
Sleeve Gastrectomy Leak Rate:
6% in 2005
1.5% in 2013
0.9% in in 2014
0.3% in 2015
@asmbs
@IfsoSecretariat
@NeilFlochMD
@StacyBrethauer
@PSchauerMD
@AmCollSurgeons
@jdimick1
@ObesitySociety
@BariatricNews
@TheEndoSociety
0
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How Much Weight Loss is Required for Cardiovascular Benefits?
Published in
@AnnalsofSurgery
➡️
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32
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One of the most important studies at
#OW2018
that can’t be missed:
YOMEGA RCT of RYGB vs mini-gastric bypass:
Comparable
#weightloss
at 1-year. Significantly higher serious complications with mini-gastric bypass.
Mini-gastric bypass is actually not a mini-surgery!!
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A 25-year old 👩🏻🦰 with severe
#diabetes
& severe fatty liver (stage 3 bridging fibrosis):
🔴 Before
#BariatricSurgery
:
255 lbs
On 💯 units of insulin per day
A1C 11%
Fibroscan score 15.7
🟢 1-year After Gastric Bypass:
185 lbs
Off diabetes drugs
A1C 5.6%
Fibroscan score 9.4
👇
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Abnormal liver function tests from fatty liver disease (
#NAFLD
and
#NASH
) are normalized in >80% of patients after
#BariatricSurgery
(
#sleevegastrectomy
and
#RYGB
)
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STAMPEDE Subanalysis Shows Cardiovascular Benefits After Bariatric Surgery via
@CleClinicMD
with
@PSchauerMD
@StacyBrethauer
@DLBHATTMD
@asmbs
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🔆 What’s the biggest health threat in the 🇺🇸?
By 2030 (only 8 years from now):
💢1 in 2 adults will have obesity.
💢1 in 4 will have severe obesity.
Source:
@NEJM
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🔆 1 year after stopping semaglutide, patients regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables.
🔆
@novonordisk
STEP 1 trial extension by
@ProfBatterhamMD
@DrRobertKushner
🔆Ongoing treatment is required
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🔴 Gastric bypass is better 😡
🔴 Sleeve is better 😡
🟢Reality: In selected patients, both are great, safe, & effective tools.
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13
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Study on ~2 million primary care patients with
#obesity
in the UK:
- Only 3% were referred for weight management.
- Only 1% (with severe obesity) underwent bariatric surgery.
Primary care physicians, family doctors, and general practitioners should prioritize obesity treatment
Delighted to have had a role in this study led by the wonderful
@kdcoulman
.
@capcbristol
@UEAResearch
@UeaMed
@UK_ASO
@BDA_Obesity
@OHA_updates
@ObesityEmpower
@ObesityAPPG
@ObesityInst
@ObesityUK_org
@GPING_RCGP
@bariatricBOMSS
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A mathematical modeling by
@KevinH_PhD
:
“Gastric bypass surgery resulted in a persistent intervention magnitude more than 4-fold greater than calorie restriction and about double that of
#tirzepatide
and
#semaglutide
.”
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25
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🔆 Weight loss data from RCTs:
✴️ Wegovy (Semaglutide 2.4 mg) in patients without diabetes: 15%
✴️ Wegovy in patients with diabetes: 10%
✴️ Sleeve gastrectomy: 26%
✴️ Roux-en-Y gastric bypass: 30%
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⬇️ risk of breast cancer (by half) &
⬇️ risk of advanced breast cancer (by half) after bariatric surgery
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Saw my postop patient today at
@CleClinicMD
who had sleeve gastrectomy for
#obesity
and
#infertility
last year.
She has lost 160 lbs and is 11-week pregnant.
She was so happy and that really made my day! 👪
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13
69
Excited to present our new clinical calculator to estimate the late relapse of
#diabetes
after
#bariatricsurgery
at
@ObesityWeek
@asmbs
#OW2018
3
31
66
7 Golden Years with
@StacyBrethauer
and
@PSchauerMD
at
#BariatricSurgery
Service,
@CCFSurgery
at
@ClevelandClinic
.
Great achievements and unforgettable memories!
Wish you the best my dear friend at
@OSUSurgery
@OhioState
6
14
69
A patient lost near 80 lbs with
#Mounjaro
in 8 months.
With current weight of 265 lbs (BMI 45) and still having severe
#obesity
, patient will undergo
#BariatricSurgery
(gastric bypass) in the next few days to help her losing more weight.
12
7
66
Please listen to interview of
@ehlJAMA
(deputy editor of
@JAMA_current
) with Dr Steven Nissen, one of the most eminent cardiologists in the world about cardiovascular effects of
#bariatricsurgery
.
Dr Nissen is NOT a bariatric surgeon.
@ASMBS
@escardio
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36
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Informative Graph:
BMI is a poor index of metabolic risk & should not be eligibility criteria for
#BariatricSurgery
.
A patient with BMI 32 & metabolic disease would benefit more from surgical
#weightloss
than a patient with BMI 40 without metabolic dis.
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#Year2019
, a unique & difficult year for me, comes to an end.
Despite all work challenges, I’m glad that I could take excellent care of my patients at
@ClevelandClinic
.
My last
#BariatricSurgery
in 2019 will be
#RYGB
in a patient with BMI of 32 & uncontrolled
#diabetes
.
@ASMBS
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3
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Obesity could shift severe COVID-19 disease to younger ages
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38
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In
@JAMA_current
study that showed 40% lower risk of major adverse cardiovascular events after
#bariatricsurgery
, subgroup analysis indicated that beneficial effects of surgery are seen in all subgroups, including no difference if baseline BMI>40 vs BMI<40
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🔴 Opinion on starting
#Insulin
EARLY for type 2 diabetes in
@JAMA_current
video👇👇
🟢 Why not considering
#BariatricSurgery
EARLY which can modify the pathophysiology of
#diabetes
in patients with
#obesity
?🤔
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14
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To our
#CardioTwitter
colleagues attending
#ACC23
#WCCardio
, please consider referring your patients with BMI > 35 for bariatric surgery.
Bariatric surgeons can tremendously help you managing your patients’ CV risk.
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Can NASH Be Surgically Cured?
Bariatric Surgery ➡️ Simultaneous
#NASH
Resolution & Fibrosis Improvement In 50% Of Patients.
#livertwitter
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20
64
Bariatric surg may reduce
#Alzheimer
's risk through GLP-1 mediated neuroprotective effects
@asmbs
@NeilFlochMD
#obsm
0
30
63
✅ For surgeons who operate on pts with
#diabetes
:
1️⃣.Metformin should be withheld on day of surgery
2️⃣.SGLT2 inhibitors must be discontinued 3–4 days before surgery (⬆️ risk of DKA)
@AmDiabetesAssn
Guidelines 👇
@ASMBS
@SAGES_Updates
@T4UGIS
@ASCRS_1
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29
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Success (but Unfinished) Story of Metabolic Surgery
Please look at the summary of 29 studies!!
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17
62
Adults with
#obesity
who undergo
#bariatricsurgery
are less likely to die from a myocardial infarction or
#stroke
compared with adults who do not undergo bariatric surgery, whether or not they have obesity at the time of the event
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41
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🔥 Obesity epidemic is a major cause of ⬆️
#Cancer
& ⬆️ Cancer Death & must be addressed.
#CancerMoonshot
#CancerResearch
@JoeBiden
@POTUS
@FLOTUS
@DrBiden
@CDCDirector
@BidenCancer
@OncologyTimes
@ASTRO_org
@FDAOncology
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New Estimate of
#Bariatric
Surgery Numbers from
@asmbs
:
- 5% annual growth in 2017
- Sleeve gastrectomy dominates (60%)
- Stable rate of revisional surgery
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Summary of SLEEVEPASS trial by
@PaulinaSalminen
et al:
🟢 Both gastric bypass & gastric sleeve are DURABLE & COMPARABLE metabolic procedures, with 10-year weight loss of ~ 25%
🟢 Risk of Barrett esophagus was also similar (4%), much lower than prior retrospective reports
@ASMBS
10-year follow-up of the SLEEVEPASS RCT: both sleeve and gastric bypass resulted in good
#weightloss
. Reflux was more prevalent after sleeve. The incidence of
#Barrettesophagus
was much lower than in previous trials, and similar after both procedures.
0
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GATEWAY trial: gastric bypass is more effective than medical therapy for uncontrolled hypertension.
@rvcohen
@asmbs
@American_Heart
@CircAHA
@ObesitySociety
@CardioNews
@BariatricNews
3
48
63
✅ 2 validation studies in the current issue of
@JournalObesity
showed that the IMS Score is the most accurate tool to predict chance of
#diabetes
remission after bariatric surgery in:
1️⃣. Western Europeans 👇
2️⃣. East Asians 👇
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Recurrence rate in 5yrs after repair of large hiatal hernia:
🔴 suture repair ➡️ 39%
🔴 absorbable mesh ➡️ 56%
🔴 nonabsorbable mesh ➡️ 42%
Data not supporting use of mesh
@AnnalsofSurgery
@SAGES_Updates
@ajitaprabhumd
@DKrpataMD
@DanaTelem
@AuroraPryor
@DrLeenaK
@o_m_ghanem
Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh
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63
I’m heartbroken & devastated that one of my surgical mentees at Tehran University who then became my good friend & a caring competent liver transplant surgeon died of cancer.
R.I.P. Habib!
💔😢
LIFE IS SHORT & HARD!!!
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