Obesity is an independent risk factor for end-stage kidney disease （ESKD）， significantly increasing treatment difficulty and leading to worsened prognosis. Metabolic and bariatric surgery effectively addresses obesity in ESKD patients by reducing body weight， improving metabolic disorders， slowing renal function decline， and increasing kidney transplant success rates.However， these patients face higher surgical risks， necessitating individualized assessment and optimized perioperative management through a multidisciplinary team （MDT） approach， including nutritional support， complication prevention， and long-term follow-up.This article explores the mechanisms， clinical benefits， and perioperative management strategies of metabolic and bariatric surgery through a literature review and two case reports. While MDT and this surgical approach represents a promising therapeutic strategy for obese ESKD patients， its broader clinical implementation requires further high-quality evidence for validation.
The global prevalence of obesity has continued to rise globally over the past two decades. Obesity is closely associated with increased risk of metabolic， cardiovascular， and other diseases， reduced quality of life and shortened life expectancy. Bariatric surgery is recognized as a highly effective weight loss measure， with studies showing its effects lasting more than 10 years. Moreover， bariatric surgery not only leads to weight loss but also improves cardiovascular and metabolic risk factors， such as type 2 diabetes， hypertension， and dyslipidaemia. It also demonstrates sound therapeutic effects on other obesity-related diseases， such as polycystic ovary syndrome（PCOS）， sleep apnea， and osteoarthritis. Studies have shown that patients undergoing bariatric surgery have reduced all-cause mortality， cardiovascular events and cancer risk.The emergence of glucagon-like peptide-1 receptor agonist therapies （GLP-1 RA， semaglutide） and GLP-1/GIP dual receptor agonist （tirzepatide） has demonstrated significant weight loss effects with continuous use. Similar to bariatric surgery， these drugs can improve outcomes for type 2 diabetes， cardiovascular mortality， and other obesity-related complications. The article compares bariatric surgery with enteral proinsulin agonists in terms of weight loss efficacy， complication rates， risk profile， cost-effectiveness， and accessibility， explores the value and promise of these popular drugs and bariatric surgery in the treatment of obesity.
Objective To investigate whether extracts of Eucommia ulmoides leaves and Gardenia have the effects on promoting white adipose browning， and to explore their possible mechanisms. Methods The effects of Eucommia ulmoides leaves and Gardenia extracts on mature 3T3-L1 cells were detected using CCK8 assay， Western blotting， qRT-PCR， Oil red O staining， BODIPY staining， and mitochondrial fluorescent dye. Subsequently， autophagy inhibitors （rapamycin） were used to explore their possible mechanisms of action. Results Eucommia ulmoides leaves and Gardenia extracts could upregulate browning-related proteins and mRNAs （PRDM16， PGC-1α and UCP-1） （all P < 0.05）， inhibited autophagy-related proteins （Beclin-1 and p62） and mRNAs （LC3， Beclin-1 and p62） and the expression of autophagosomes （all P < 0.05）， inhibited lipid droplet accumulation， and increased mitochondrial abundance. The use of autophagy activator （rapamycin） restored the autophagy effect of Eucommia ulmoides leaf and Gardenia extracts on 3T3-L1 cells （all P < 0.05）， and it was found that the browning effect of Eucommia ulmoides leaf and Gardenia extracts on 3T3-L1 cells was also reversed by autophagy activator （all P < 0.05）. Conclusion Extracts of Eucommia ulmoides leaves and Gardenia have the effects upon promoting the browning of white adipocytes by inhibiting autophagy， demonstrating potential clinical applications in the clinical prevention and treatment of obesity and related metabolic diseases.
Objective To investigate and formulate the healthy high-protein and low-carbohydrate diet pattern suitable for the normal weight group. Methods Twenty-four SPF grade male C57BL/6 mice aged 6 to 8 weeks （weighing 15 to 20 g） were randomly divided into the control group （Ct group）， 5% high-protein low-carbohydrate diet group （5%LCD group）， and 30% high-protein low-carbohydrate diet group （30%LCD group）， with 8 mice in each group. The mice were fed with a basic diet， 5% LCD， and 30% LCD for 4 weeks， respectively. The food intake， water intake， and body weight were observed， and the blood lipid indexes and the content of cecal short-chain fatty acids were measured. Results Compared with the Ct group， food intake in the 5%LCD and 30%LCD groups was increased （both P < 0.01）. Compared with the Ct group， the serum total cholesterol （TC） and low-density lipoprotein cholesterol （LDL-C） contents in the 5%LCD group were increased （both P < 0.05）， and the serum LDL-C and high-density lipoprotein cholesterol （HDL-C） levels in the 30%LCD group were increased （both P < 0.05）. Compared with the Ct group， the secretions of propionic acid， isobutyric acid， and isovaleric acid in the cecal contents of mice in the 5%LCD and 30%LCD groups were decreased （all P < 0.05）. Conclusion Based on a comprehensive assessment of body weight， lipid metabolism， and short-chain fatty acid secretion， 30% LCD is more suitable as an effective dietary recommendation due to its higher HDL-C levels.
Objective To investigate the effect of respiratory resistance training combined with weight loss exercise on balance function in patients with abdominal obesity （AO）. Methods A total of 66 AO patients who visited the Hypoglycemic Weight Loss Clinic of the Endocrinology Department of the Third Affiliated Hospital of Sun Yat-sen University between November 2022 and May 2024 were enrolled （AO group）， along with 35 healthy volunteers （healthy control group）. The AO group was divided into a control group （n = 33） and an intervention group （n = 33）. All AO patients received standard weight loss exercise training for 4 weeks； in addition， the intervention group underwent respiratory resistance training. The maximal inspiratory pressure （MIP）， maximal expiratory pressure （MEP）， diaphragm thickening ratio （DTR）， and balance function of participants were collected before and after the intervention. Balance function assessments included the Balance Error Scoring System （BESS） for evaluating static balance and the Functional Reach Test （FRT） for evaluating dynamic balance. Results There were no statistically significant differences in age between the healthy group and the AO group （P > 0.05）. Before intervention， BMI， waist-to-hip ratio （WHR）， MIP， MEP， DTR， and FRT scores were significantly higher in the AO group than in the healthy group， while BESS scores were significantly lower （all P < 0.001）. No significant differences were observed between the control and intervention groups in BMI， WHR， MIP， MEP， DTR， BESS， or FRT before intervention （all P > 0.05）. After 4 weeks of intervention， MIP， MEP， DTR， and BESS scores improved significantly in both the control and intervention groups （all P < 0.05）， with greater improvements observed in the intervention group （P < 0.05）. FRT results showed no significant change in the control group after intervention （P > 0.05）， while the intervention group demonstrated better performance than the control group （P = 0.005）. Conclusion Respiratory resistance training combined with weight loss exercise can significantly improve balance function in patients with AO.
Objective To develop a scientifically sound and standardized Maladaptive Eating Behavior Questionnaire after Bariatric Metabolic Surgery （MEBQBS）， and to test its reliability and validity， providing a reference for early identification of maladaptive eating behaviors in post-bariatric patients. Methods Guided by the conceptual model of maladaptive eating behaviors after bariatric-metabolic surgery， the dimensions and item pool for the scale were initially constructed through literature review， focus group discussions， and a pilot survey. Item analysis was used to select the scale items. A convenience sample of 324 patients after bariatric surgery who attended follow-up visits at Jiangsu Province Hospital from January to October 2024 was surveyed to verify the reliability and validity of the scale. Results The MEBQBS consisted of 53 items， covering four measurement domains and eight sub-domains， namely emotional eating（negative emotional eating and positive emotional eating sub-domains）， grazing （unplanned， repeated small food intakes）， food cravings （positive outcome expectations， emotional cravings， and food addiction sub-domains） and loss of control eating （emotional experience and behavior sub-domains）. Exploratory factor analysis identified eight common factors， with a cumulative variance contribution rate of 69.54%. The overall Cronbach’s α coefficient for the scale was 0.97， with a split-half reliability of 0.79. Confirmatory factor analysis showed a goodness-of-fit chi-square test of 1.87， a goodness-of-fit index （GFI） of 0.80， a normed fit index （NFI） of 0.88， an incremental fit index （IFI） of 0.94， a non-normed fit index （NNFI） of 0.93， a comparative fit index （CFI） of 0.94， and a root mean square error of approximation （RMSEA） of 0.05. The total score and domain scores of the MEBQBS were positively correlated with total score of the Three-Factor Eating Questionnaire （TFEQ） -R21 （all P < 0.01）. Conclusion The MEBQBS demonstrates good reliability and validity and can provide a scientific tool for evaluating unhealthy eating behaviors in Chinese patients after bariatric surgery.
Objective To explore clinical predictive value of Chinese visceral adipose index （CVAI） for patients with metabolic syndrome （MetS） complicated with obstructive sleep apnea hypopnea syndrome （OSAHS） scheduled for bariatric metabolic surgery （BMS）. Methods By the convenience sampling method， 243 patients with MetS who were scheduled to undergo BMS in Department I of Gastroenterology Diagnosis and Treatment of the First Hospital of Hebei Medical University from November 2023 to December 2024 were selected. All patients were divided into OSAHS and non-OSAHS groups according to whether they were complicated with OSAHS. Clinical data were collected and CVAI was calculated in two groups. The influencing factors of MetS patients complicated with OSAHS scheduled to undergo BMS were identified by Logistic regression analysis. The receiver operating characteristic （ROC） curve was plotted. The predictive value of CVAI for MetS patients complicated with OSAHS was evaluated. Results Among 243 MetS patients scheduled to undergo BMS， there were statistically significant differences between the OSAHS and non-OSAHS groups in terms of gender， age， weight， body mass index （BMI）， neck circumference， abdominal circumference， hip circumference， fasting blood glucose and CVAI （all P < 0.05）. Multivariate Logistic regression analysis showed that age， hip circumference and CVAI were associated with OSAHS in MetS patients scheduled for BMS （all P < 0.05）. CVAI had certain predictive value， and the screening value was even better when combined with hip circumference. Conclusions CVAI can be used as a predictive indicator for whether MetS patients are complicated with MetS who are scheduled for BMS. The detection of serological indicators required for calculating CVAI is simple and has clinical practical value in reducing preoperative screening costs and improving the diagnostic rate.
Objective To explore the real experience of diet management in patients after bariatric and metabolic surgery， so as to provide theoretical basis for formulating postoperative dietary management plans for patients. Methods Based on the capability， opportunity， motivation-behavior （COM-B） model， 15 patients who had undergone bariatric and metabolic surgery and returned for follow-up at the Gastrointestinal Surgery Outpatient Clinic of Northern Jiangsu People’s Hospital from January to May 2024 were selected for semi-structured interviews. The data were analyzed using directed content analysis. Results Based on the interview content， a total of 3 themes and 10 sub-themes were extracted， including the constraints of physical and cognitive abilities on dietary management （early postoperative discomfort symptoms affecting dietary behavior， limited access to dietary management knowledge， overly broad dietary guidance）； the influence of environmental factors on dietary management （the positive role of social and family support， the constraints of social situations on dietary management， the economic burden restricting continuous intervention）； and the impact of internal psychological motivations on dietary management （improper emotional coping leading to loss of control over diet， the challenge of habitual behaviors to dietary management， psychological contradictions and conflicts in dietary management， self-reflection and growth in dietary management）. Conclusions Patients after bariatric metabolism surgery face multiple challenges in dietary management， including physical and psychological constraints from individuals， insufficient social and family support， and emotional distress. Medical staff should assist patients in identifying and addressing obstacles in dietary management， provide individualized dietary guidance， improve the diversified social support system， enhance the sustainability of dietary management， and help patients achieve more ideal weight loss results， thereby improving their quality of life.
Objective To compare the interventional effectiveness of low-energy balanced diet and nutritional meal replacement in overweight and obese individuals admitted to the Nutrition Clinic of hospitals. Methods Sixty overweight and obese patients admitted to Department of Clinical Nutrition of Jinhua Maternal and Child Health Hospital between September 2023 and September 2024 were selected as the study subjects. They were divided into low-energy balanced diet group （n = 30） and nutritional meal replacement group （n = 30）. The low-energy balanced diet and nutritional meal replacement were conducted for 4 weeks. The changes in body mass and body composition indicators before and after interventions were collected and compared between two groups. Results Before treatment， there were no significant differences in the age， baseline body weight， body mass index （BMI）， body fat percentage， and waist circumference between two groups （all P > 0.05）. After corresponding interventions， body weight， BMI， body fat percentage， visceral fat grade， waist circumference and basal metabolic age in two groups were significantly lower compared with the levels before interventions （all P < 0.05）. Moreover， body weight， BMI and body fat percentage in the nutritional meal replacement group were all lower than those in the low-energy balanced diet group， and the differences were statistically significant （all P < 0.05）. Conclusion Compared with low-energy balanced diet intervention， nutritional meal replacement is more conducive to improving body composition and achieving better weight loss effect in a short period of time， which is suitable for weight management in hospitals.
Obesity and food addiction have become major threats to public health， and their synergistic interactions exacerbate metabolic abnormalities and comorbidities. Glucagon-like peptide-1 receptor agonist （GLP-1RA） has emerged as a promising therapeutic option for these conditions， and their mechanism of action has become a major research focus. Evidence indicates that GLP-1RA suppress appetite and delay gastric emptying through central and peripheral pathways. Furthermore， they modulate mesolimbic dopamine system （MLDS）， reduce the release of dopamine in the nucleus accumben， attenuate the rewarding effects of high-calorie foods and ameliorate addictive eating behaviors， thereby treating obesity. However， adverse gastrointestinal effects and potential long-term risks of GLP-1RA necessitate cautious clinical management. In this article， recent clinical advances in the application of GLP-1RA applications for the treatment of obesity and food addiction were reviewed， providing reference for drug selection for obesity and food addiction.
Obesity is a chronic disease caused by the long-term interaction of multiple environmental factors on a specific genetic background. Among these factors， the overactivation of mineralocorticoid receptors （MR） plays a significant role in adipose tissue remodeling in obesity. In the obese state， the MR overactivation in adipose tissue can promote adipose tissue differentiation and adipogenesis， and induce adipose tissue inflammation， oxidative stress， adipokine secretion disorders， and insulin resistance. These mechanisms contribute to adipose tissue remodeling in obesity， which is a key determinant of obesity-related metabolic diseases. Moreover， the use of MR antagonists can partially reverse the adipose tissue remodeling in obesity caused by MR overactivation. Therefore， it is of significant importance to clarify the role and mechanisms of MR overactivation in adipose tissue remodeling in obesity.
