Background: Over 2 million people in England were estimated to be eligible for bariatric surgery in 2006. In 2014, clinical guidelines were updated, widening potential eligibility, meanwhile, obesity prevalence rose. However, numbers receiving surgery decreased, and concerns exist of inequalities in access between population groups. This study is aimed at estimating the number of adults eligible for surgery in England and to compare demographics with those that receive surgery. Methods: BMI and comorbidity status were used to determine eligibility for bariatric surgery within participants of the 2014 Health Survey for England dataset (6938 adults), based on the National Institute of Health and Care Excellence guidelines. Results were scaled up using national population estimates. The demographics of eligible participants were compared against 2014/2015 hospital episode statistics for sex and age group using a chi-squared analysis. Results: Of the total population of England, 7.78% (95% CI 7.1–8.6%), or 3,623,505 people, could have been eligible for bariatric surgery in 2014; nearly a million more than if previous guidelines applied. Eligibility peaked at ages 45–54, with most in the 35–64 age group (58.9%). 58.4% of those eligible were women. Patients receiving surgery were far more likely to be female than male (76.1%) and the distribution skewed towards younger ages when compared with those eligible. Conclusion: Bariatric surgery may benefit many people in England; significant investment is required so that service provision is adequate for demand. Differences between demographics of those eligible and receiving surgery may be explainable; however, the potential health inequality should be investigated.

Weight Loss Surgery (WLS), including sleeve-gastrectomy (SG), results in significant weight loss and improved metabolic health in severe obesity (BMI ≥ 35 kg/m²). Previous studies suggest post-operative health benefits are impacted by nutrient deficiencies, such as Vitamin D (25(OH)D) deficiency, while it is currently unknown whether nutrient levels may actually predict post-surgery outcomes. As such, this study investigated whether 25(OH)D levels could predict metabolic improvements in patients who underwent SG. Patients with severe obesity (n = 309; 75% female) undergoing SG participated in this ethics-approved, non-randomized retrospective cohort study. Anthropometry, clinical data, 25(OH)D levels and serum markers were collected at baseline, 6-, 12- and 18-months post-surgery. SG surgery resulted in significant improvements in metabolic health at 6- and 12-months post-surgery compared with baseline, as expected. Patients with higher baseline 25(OH)D had significantly lower HbA1c levels post-surgery (p < 0.01) and better post-surgical T2DM outcomes, including reduced weight regain (p < 0.05). Further analysis revealed that baseline 25(OH)D could predict HbA1c levels, weight regain and T2DM remission one-year post-surgery, accounting for 7.5% of HbA1c divergence (p < 0.01). These data highlight that higher circulating 25(OH)D levels are associated with significant metabolic health improvements post-surgery, notably, that such baseline levels are able to predict those who attain T2DM remission. This highlights the importance of 25(OH)D as a predictive biomarker of post-surgery benefits.

Due to human error, the authors neglected to multiply the rate by 100 in order to get the percentage; therefore, the published percentage for penetration rate was out by a factor of 100. The correct percentage is included in the paragraph below. This penetration rate of 0.17% is particularly low compared with other published penetration rates, for example, 1.24% in the USA (where the eligible population was defined as adults with BMI ≥ 40) [15] and 0.54% in Canada in 2017 (where the eligible population was defined as adults with BMI ≥ 35) [16].

Background/Objectives: Sleeve gastrectomy (SG) improves glycaemic control; however, it also markedly accelerates gastric emptying, which can lead to exaggerated postprandial glucose and insulin excursions and, in some cases, postprandial hyperinsulinaemic hypoglycaemia. In non-surgical populations, fat preloads can reduce postprandial glycaemia by slowing gastric emptying, but their effects after SG are unclear. Methods: Ten adults >1-year post-SG completed a randomised, open-label, crossover study involving two mixed-meal tolerance tests (MMTTs), preceded (−30 min) by either a moderate, fat-dominant preload (28 g Brazil nuts) or 100 mL water (control). Blood samples were collected over three hours to assess plasma glucose, insulin, c-peptide, and total glucagon-like peptide-1 (GLP-1). Hypoglycaemia and dumping symptoms were assessed using validated questionnaires. Nadir plasma glucose concentration was the primary outcome. Results: Nadir plasma glucose was identical between conditions (both 3.8 mmol/L; 95% CI: −0.4, 0.3, p = 0.849), and neither peak glucose nor overall postprandial glucose exposure (incremental area under the curve iAUC_{0–180 min}) differed between the preload and water conditions. Insulin and c-peptide concentrations immediately before the MMTT were higher after the fat-dominant preload (both p < 0.001). Overall insulin and c-peptide responses during the MMTT (iAUC_{0–180 min}) remained comparable between conditions (95% CI −225, 2665; p = 0.442 and −67,787, 70,263; 0.968), but peak values for both hormones were higher after the preload (95% CI 2.9, 79.1, p = 0.038 and 17.3, 2402.7, p = 0.040, respectively). Total GLP-1 was also elevated prior to the MMTT (95% CI 1.6, 22.8, p = 0.028), while its early and overall postprandial responses did not differ (both p > 0.05). Ratings of hypoglycaemia and dumping symptoms were similar for both study arms. Discussion: A moderate, fat-dominant preload consumed before a mixed meal did not alter nadir or overall postprandial glucose in adults without diabetes after SG. However, the preload was associated with higher peak insulin secretion, a finding that should be interpreted with caution, as the study was not powered for secondary outcomes. Given the unique gastrointestinal physiology after SG, further research is needed to determine how different nutrient compositions or timing approaches influence postprandial glucose homeostasis in this population.