Koball, Afton M.

ABSTRACT Bardet‐Biedl syndrome (BBS) is a rare autosomal recessive disorder characterized by clinical and genetic heterogeneity. Data on the prevalence of clinical manifestations and comorbidities in BBS, particularly in pediatric patients, are limited. This study aimed to assess the prevalence and various manifestations of endocrine and other clinical comorbidities among pediatric and adult patients with BBS. This retrospective chart review included pediatric and adult patients with BBS evaluated at an academic tertiary care center in the United States between 2000 and 2024. The study included 31 patients (7 children and 24 adults) with seven identified pathogenic variants associated with BBS. The most common genetic etiology was biallelic variants in BBS1 (36%). Obesity was diagnosed in 86% of children and 100% of adults. No children had diabetes or prediabetes, whereas 46% of adults were affected. Dyslipidemia was identified in 29% of children and 46% of adults. No thyroid abnormalities were identified in children, whereas 25% of adults were affected. Retinal dystrophy was present in 71% of children and 96% of adults. Polydactyly was observed in 100% of children and 75% of adults. Chronic kidney disease was present in 29% of children and 63% of adults. This study highlights the clinical heterogeneity and substantial multisystem burden of BBS across pediatric and adult patients. The greater prevalence of diabetes/prediabetes, dyslipidemia, thyroid abnormalities, chronic kidney disease, and visual impairment among adults suggests that these complications may emerge or progress over time. Early recognition, proactive longitudinal surveillance, and comprehensive multidisciplinary care are essential to optimize management across the lifespan.

ABSTRACT Background Experiencing weight stigmatization is linked to maladaptive eating, poorer mental health, and increased risk of weight gain, potentially impacting metabolic bariatric surgery (MBS) outcomes. This meta‐analysis aimed to synthesize patient experiences of weight stigmatization before and after MBS and to examine the association of presurgical weight stigma on postsurgical weight loss. Methods This preregistered study followed PRISMA guidelines. Six databases were searched through March 2025; eligible studies included published articles and dissertations/theses available in English that quantitatively measured presurgical weight stigma among MBS samples and included relevant outcomes. Meta‐analyses utilized random effects models with change scores converted to Hedge's g and associations between presurgical experienced weight stigma and post‐MBS weight change converted to coefficient r . Results Forty‐one studies were included, with 36 reporting on experienced weight stigma change pre‐ to post‐MBS and 10 studies reporting on the relationship between pre‐MBS experienced weight stigma and post‐MBS weight loss. Conclusions Results revealed weight stigmatization decreased substantially after MBS (6–12 months, g = 1.28; 13–24 months, g = 1.16; 25–36 months, g = 1.26). Presurgical weight stigma was not associated with weight loss post‐surgery ( r = 0.05). Findings are limited by minimal studies reporting on longer term relationships between baseline stigma, post‐MBS weight loss, and additional health outcomes.

Introduction: Psychosocial assessments by behavioral health (BH) professionals before metabolic and bariatric surgery (MBS) are recommended by national guidelines. Accordingly, insurance companies often require patients to undergo psychosocial assessments before MBS. This paper reviews the historical evolution of the MBS psychosocial assessment, clarifies the role of BH professionals within the team before and after MBS, and describes strategies to effectively utilize psychosocial assessments to optimize patient outcomes. Methods: Authors conducted a manual search of the available literature and completed a narrative review. Results: The original intent of the psychosocial assessment for MBS was to correlate psychiatric profiles to weight loss outcomes or identify which patients were predicted to succeed or “fail” after MBS. Historically, these evaluations were gatekeeping mechanisms, which invalidates the myriad ways that psychosocial assessments can identify and support patients. Controversy exists about the necessity of these evaluations, leading some MBS team members and patients to see it as an unavoidable “checkbox” with little clinical utility outcomes. Conclusion: Viewing the psychosocial assessment as a checkbox minimizes the potential benefits to patients and MBS team members. Additionally, it diminishes the expertise of BH professionals who are uniquely trained to support this patient population toward an optimal surgical outcome.

ABSTRACTBackgroundMetabolic and bariatric surgery (MBS) is the most effective and durable approach to treating obesity, yet recurrent weight gain occurs in a subset of patients. Primary care often serves as a routine point of contact for patients following MBS and is a potential gateway for addressing and/or preventing recurrent weight gain.MethodsAlthough guidelines for the management of recurrent weight gain after MBS exist, this narrative review was undertaken to clarify the role of the primary care providers in enhancing long‐term outcomes and preventing weight gain after MBS.FindingsRegular follow‐up in primary care provides an opportunity to identify challenges related to weight management and overall health outcomes, which may include concerns related to nutrition, mental or physical well‐being, body image, motivation, and behavior change, for example. The availability of multidisciplinary providers within primary care settings, including behavioral health specialists, dietitians, and physical therapists, is an important strength of this setting in addressing potential post‐MBS concerns such as recurrent weight gain.ConclusionThis review outlines clinical considerations for managing recurrent weight gain post‐MBS in primary care and includes recommendations for both primary care providers and specialty clinicians working in primary care to deliver care effectively and mitigate weight stigma post‐MBS.

CONTEXT: Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear. OBJECTIVE: To determine the effect of brief, primary care interventions for pediatric weight management on BMI. DATA SOURCES: Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies. STUDY SELECTION: Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years. DATA EXTRACTION: Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools. RESULTS: A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (–0.04, [95% confidence interval, –0.08 to –0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, –0.21 to 0.22]; P = .98). LIMITATIONS: Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured. CONCLUSIONS: BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.