Jøran Sture Hjelmesæth

• Young, Juliet; Seeberg, Kathrine; Aakre, Kristin Moberg; Borgeraas, Heidi; Nordstrand, Njord & Wisløff, Torbjørn [Show all 9 contributors for this article] (2023). The liver-heart axis in patients with severe obesity: The association between liver fibrosis and chronic myocardial injury may be explained by shared risk factors of cardiovascular disease. Clinical Biochemistry. ISSN 0009-9120. 123. doi: 10.1016/j.clinbiochem.2023.110688. Full text in Research Archive Show summary

  Background: Severe obesity is associated with increased risk of non-alcoholic fatty liver disease and cardiovascular disease. We hypothesized that liver fibrosis as quantified by the Enhanced Liver Fibrosis (ELF) test would be predictive of myocardial injury and fibrosis, expressed by high sensitivity cardiac troponin T and I (hs-cTnT and hs-cTnI) concentrations. Material and methods: We performed cross-sectional analyses of baseline data from 136 patients (mean age 45 years, 38 % male) with severe obesity participating in the non-randomized clinical trial Prevention of Coronary Heart Disease in Morbidly Obese Patients (ClinicalTrials.gov NCT00626964). Associations between ELF scores, hs-cTnT, and hs-cTnI concentrations were assessed using linear regression analysis. Results: ELF scores were associated with hs-cTnT in the unadjusted model (B 0.381, 95% Confidence Interval [CI] 0.247, 0.514), but the association was attenuated upon adjustment for potential confounders (B -0.031, 95% CI -0.155, 0.093). Similarly, for hs-cTnI, an observed association with ELF scores in the unadjusted model was attenuated upon adjustment for potential confounders ((B 0.432, 95% CI 0.179, 0.685) and (B 0.069, 95% CI -0.230, 0.367), respectively). Age, sex, hypertension, and estimated glomerular filtration rate were amongst the shared predictors of ELF score, hs-cTnT, and hs-cTnI that provided the univariable models with the highest R-squared and lowest Akaike Information Criterion values. Conclusions: Contrary to our hypothesis, ELF score did not predict myocardial injury and fibrosis, but rather demonstrated that an association between liver fibrosis and myocardial injury and fibrosis may be explained by shared risk factors of cardiovascular disease. Keywords: Enhanced Liver Fibrosis test; NT-proBNP; cardiac fibrosis; cardiac troponin; liver fibrosis; myocardial injury; severe obesity.

• Kvitne, Kine Eide; Hovd, Markus; Johnsen, Line Kristin; Wegler, Christine; Karlsson, Cecilia & Artursson, Per [Show all 14 contributors for this article] (2023). Digoxin Pharmacokinetics in Patients with Obesity Before and After a Gastric Bypass or a Strict Diet Compared with Normal Weight Individuals. Clinical Pharmacokinetics. ISSN 0312-5963. doi: 10.1007/s40262-023-01320-9. Full text in Research Archive
• Handin, Niklas; Yuan, Di; Ölander, Magnus; Wegler, Christine; Karlsson, Cecilia & Jansson-Löfmark, Rasmus [Show all 10 contributors for this article] (2023). Proteome deconvolution of liver biopsies reveals hepatic cell composition as an important marker of fibrosis. Computational and Structural Biotechnology Journal. ISSN 2001-0370. 21, p. 4361–4369. doi: 10.1016/j.csbj.2023.08.037. Full text in Research Archive Show summary

  Human liver tissue is composed of heterogeneous mixtures of different cell types and their cellular stoichiometry can provide information on hepatic physiology and disease progression. Deconvolution algorithms for the identification of cell types and their proportions have recently been developed for transcriptomic data. However, no method for the deconvolution of bulk proteomics data has been presented to date. Here, we show that proteomes, which usually contain less data than transcriptomes, can provide useful information for cell type deconvolution using different algorithms. We demonstrate that proteomes from defined mixtures of cell lines, isolated primary liver cells, and human liver biopsies can be deconvoluted with high accuracy. In contrast to transcriptome-based deconvolution, liver tissue proteomes also provided information about extracellular compartments. Using deconvolution of proteomics data from liver biopsies of 56 patients undergoing Roux-en-Y gastric bypass surgery we show that proportions of immune and stellate cells correlate with inflammatory markers and altered composition of extracellular matrix proteins characteristic of early-stage fibrosis. Our results thus demonstrate that proteome deconvolution can be used as a molecular microscope for investigations of the composition of cell types, extracellular compartments, and for exploring cell-type specific pathological events. We anticipate that these findings will allow the refinement of retrospective analyses of the growing number of proteome datasets from various liver disease states and pave the way for AI-supported clinical and preclinical diagnostics.

• Svanevik, Marius; Lorentzen, Jolanta Halabowska; Borgeraas, Heidi; Sandbu, Rune; Seip, Birgitte Karen Berggreen & Medhus, Asle Wilhelm [Show all 11 contributors for this article] (2023). Patient-reported outcomes, weight loss, and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre, randomised controlled trial. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 11(8), p. 555–566. doi: 10.1016/S2213-8587(23)00127-4. Show summary

  Little is known about the comparative effects of various bariatric procedures on patient-reported outcomes. We aimed to compare 3-year effects of gastric bypass and sleeve gastrectomy on patient-reported outcome measures in patients with obesity and type 2 diabetes. Methods The Oseberg trial was a single-centre, parallel-group, randomised trial at Vestfold Hospital Trust, a public tertiary obesity centre in Tønsberg, Norway. Eligible patients were aged 18 years or older with previously verified BMI 35·0 kg/m 2 or greater. Diabetes was diagnosed if glycated haemoglobin was at least 6·5% (48 mmol/mol) or by their use of anti-diabetic medications with glycated haemoglobin at least 6·1% (43 mmol/mol). Eligible patients were randomly assigned (1:1) to gastric bypass or sleeve gastrectomy. All patients received identical preoperative and postoperative treatment. Randomisation was done with a computerised random number generator and a block size of ten. Study personnel, patients, and the primary outcome assessor were blinded to allocations for 1 year. The prespecified secondary outcomes reported here were 3-year changes in several clinically important patient-reported outcomes, weight loss, and diabetes remission. Analyses were done in the intention to treat population. This trial is ongoing, closed to recruitment and is registered with ClinicalTrials.gov , NCT01778738 . Findings Between Oct 15, 2012 and Sept 1, 2017, 319 consecutive patients with type 2 diabetes scheduled for bariatric surgery were assessed for eligibility. 101 patients were not eligible (29 did not have type 2 diabetes according to inclusion criteria and 72 other exclusion criteria) and 93 declined to participate. 109 patients were enrolled and randomly assigned to sleeve gastrectomy (n=55) or gastric bypass (n=54). 72 (66%) of 109 patients were female and 37 (34%) were male. 104 (95%) of patients were White. 16 patients were lost to follow up and 93 (85%) patients completed the 3-year follow-up. Three additional patients were contacted by phone for registration of comorbidities Compared with sleeve gastrectomy, gastric bypass was associated with a greater improvement in weight-related quality of life (between group difference 9·4, 95% CI 3·3 to 15·5), less reflux symptoms (0·54, 0·17 to –0·90), greater total bodyweight loss (8% difference, 25% vs 17%), and a higher probability of diabetes remission (67% vs 33%, risk ratio 2·00; 95% CI 1·27 to 3·14). Five patients reported postprandial hypoglycaemia in the third year after gastric bypass versus none after sleeve-gastrectomy (p=0·059). Symptoms of abdominal pain, indigestion, diarrhoea, dumping syndrome, depression, binge eating, and appetitive drive did not differ between groups. Interpretation At 3 years, gastric bypass was superior to sleeve gastrectomy in patients with type 2 diabetes and obesity regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about similarities and differences between expected outcomes after the two surgical procedures.

• Tønnesen, Christer Julseth; Hjelmesæth, Jøran Sture; Aabakken, Lars; Lund, Randi Størdal; Johnson, Line Kristin & Hertel, Jens Kristoffer [Show all 9 contributors for this article] (2023). A pilot study of implementation of endoscopic sleeve gastroplasty (ESG) in Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(10), p. 1180–1184. doi: 10.1080/00365521.2023.2204389. Full text in Research Archive Show summary

  Bariatric surgery is the most effective treatment for obesity but is invasive and associated with serious complications. Endoscopic sleeve gastroplasty (ESG) is a less invasive weight loss procedure to reduce the stomach volume by full-thickness sutures. ESG has been adopted in many countries, but implementation at Scandinavian centres has not yet been documented. We performed a clinical pilot trial at a Norwegian centre with the primary objective to assess the feasibility of the ESG procedure. Patients and methods We included the first 10 patients treated with ESG at a Norwegian centre in a single-arm pilot study. The eligibility criteria were either a body mass index (BMI) of 40–49.9 kg/m2, BMI 35–39.9 kg/m2 and at least one obesity-related comorbidity, or BMI 30–34.9 kg/m2 and type 2 diabetes. Patient follow-up resembled the scheme used for bariatric surgery at the center, including dietary plans and outpatient visits. Results All procedures were technically successful except for one patient who had adhesions between the stomach and anterior abdominal wall, related to a prior hernia repair, resulting in less-than-intended stomach volume reduction. Mean total body weight loss (TBWL) after 26 and 52 weeks was 12.2% (95% CI 8.1–16.2) and 9.1% (95% CI 3.3 − 15.0). One patient experienced a minor suture-induced diaphragmatic injury, which was successfully managed conservatively. Conclusions This first Scandinavian clinical trial of ESG, documenting the implementation of the procedure at a Norwegian center, demonstrated acceptable feasibility and safety, with large variations in individual weight loss during the 52-week follow-up period.

• Hovd, Markus Herberg; Robertsen, Ida; Johnson, Line Kristin; Krogstad, Veronica; Wegler, Christine & Kvitne, Kine Eide [Show all 16 contributors for this article] (2023). Neither Gastric Bypass Surgery Nor Diet-Induced Weight-Loss Affect OATP1B1 Activity as Measured by Rosuvastatin Oral Clearance. Clinical Pharmacokinetics. ISSN 0312-5963. 62(5), p. 725–735. doi: 10.1007/s40262-023-01235-5. Full text in Research Archive
• Pfabigan, Daniela Melitta; Hertel, Jens Kristoffer; Svanevik, Marius; Lindberg, Morten; Sailer, Uta & Hjelmesæth, Jøran Sture (2022). Single-centre, non-randomised clinical trial to investigate the effects of bariatric surgery on social experiences and biomarkers of well-being one year after surgery in individuals with severe obesity: a protocol for the Bariatric Surgery and Social Experiences (BaSES) study. medRxiv. doi: 10.1101/2022.12.21.22283770. Show summary

  Introduction Obesity is linked to increased loneliness and less enjoyment of social interactions. While bariatric surgery is the most effective treatment targeting morbid obesity, there is limited understanding as to whether patients experience social interactions differently after surgery. The Bariatric Surgery and Social Experiences Study (BaSES) is designed to assess potential changes in how much patients enjoy and engage in daily social interactions 1 year after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Methods and analysis Single-centre, non-randomised clinical trial carried out at the Morbid Obesity Centre at Vestfold Hospital Trust, Norway. Eligible patients will undergo either RYGB, SG or single anastomosis sleeve ileal bypass (SASI). The primary outcome measure is change in the social experience score (assessed with a questionnaire) from a pre-surgery to a follow-up assessment 1 year after RYGB and SG. The respective changes after SASI will be assessed and considered exploratory. Ethics and dissemination The most recent protocol version of this study was reviewed and approved by the Regional Committee for Medical Research Ethics South East Norway (REK sør-øst A) on the 29th of August 2022 (ref: 238406). The results will be disseminated to academic and health professional audiences and the public via publications in international peer-reviewed journals and conferences. Trial registration number NCT05207917 (ClinicalTrials.gov)

• Berk, Kirsten A.; Borgeraas, Heidi; Narverud, Ingunn; Mulder, Monique T.; Øyri, Linn Kristin Lie & Verhoeven, Adrie J M [Show all 14 contributors for this article] (2022). Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids. Lipids in Health and Disease. ISSN 1476-511X. 21(145), p. 1–14. doi: 10.1186/s12944-022-01756-1. Full text in Research Archive Show summary

  Limited evidence suggests that surgical and non-surgical obesity treatment differentially influence plasma Lipoprotein (a) [Lp(a)] levels. Further, a novel association between plasma arachidonic acid and Lp(a) has recently been shown, suggesting that fatty acids are a possible target to influence Lp(a). Here, the effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) were compared, and it was examined whether the effects were mediated by changes in plasma fatty acid (FA) levels. Methods The study includes two independent trials of patients with overweight or obesity. Trial 1: Two-armed intervention study including 82 patients who underwent a 7-week low energy diet (LED), followed by Roux-en-Y gastric bypass and 52-week follow-up (surgery-group), and 77 patients who underwent a 59-week energy restricted diet- and exercise-program (lifestyle-group). Trial 2: A clinical study including 134 patients who underwent a 20-week very-LED/LED (lifestyle-cohort). Results In the surgery-group, Lp(a) levels [median (interquartile range)] tended to increase in the pre-surgical LED-phase [17(7–68)-21(7–81)nmol/L, P = 0.05], but decreased by 48% after surgery [21(7–81)—11(7–56)nmol/L, P < 0.001]. In the lifestyle-group and lifestyle-cohort, Lp(a) increased by 36%[14(7–77)—19(7–94)nmol/L, P < 0.001] and 14%[50(14–160)—57(19–208)nmol/L, P < 0.001], respectively. Changes in Lp(a) were independent of weight loss. Plasma levels of total saturated FAs remained unchanged after surgery, but decreased after lifestyle interventions. Arachidonic acid and total n-3 FAs decreased after surgery, but increased after lifestyle interventions. Plasma FAs did not mediate the effects on Lp(a). Conclusion Bariatric surgery reduced, whereas lifestyle interventions increased plasma Lp(a), independent of weight loss. The interventions differentially influenced changes in plasma FAs, but these changes did not mediate changes in Lp(a).

• Barstad, Lisa Ah Fung Ha; Johnson, Line Kristin; Borgeraas, Heidi; Hofsø, Dag; Svanevik, Marius & Småstuen, Milada Cvancarova [Show all 8 contributors for this article] (2022). Changes in dietary intake, food tolerance, hedonic hunger, binge eating problems, and gastrointestinal symptoms after sleeve gastrectomy compared with after gastric bypass; 1-year results from the Oseberg study—a randomized controlled trial. American Journal of Clinical Nutrition. ISSN 0002-9165. 117(3), p. 586–598. doi: 10.1016/j.ajcnut.2022.11.016. Full text in Research Archive
• Haugstøyl, Martha Eimstad; Cornillet, Martin; Strand, Kristina; Stiglund, Natalie; Sun, Dan & Dyer, Laurence [Show all 15 contributors for this article] (2022). Distinct T cell subsets in adipose tissue are associated with obesity. European Journal of Immunology. ISSN 0014-2980. doi: 10.1002/eji.202249990. Full text in Research Archive Show summary

  Adipose tissue inflammation is a driving factor for the development of obesity-associated metabolic disturbances, and a role of adipose tissue T cells in initiating the pro-inflammatory signaling is emerging. However, data on human adipose tissue T cells in obesity are limited, reflected by the lack of phenotypic markers to define tissue-resident T cell subsets. In this study, we performed a deep characterization of T cells in blood and adipose tissue depots using multicolor flow cytometry and RNA sequencing. We identified distinct subsets of T cells associated with obesity expressing the activation markers, CD26 and CCR5, and obesity-specific genes that are potentially engaged in activating pro-inflammatory pathway, including ceramide signaling, autophagy, and IL-6 signaling. These findings increase our knowledge on the heterogeneity of T cells in adipose tissue and on subsets that may play a role in obesity-related pathogenesis.

• Seeberg, Kathrine; Hofsø, Dag; Borgeraas, Heidi; Grimnes, John Olav; Fatima, Farhat & Seeberg, Lars Thomas [Show all 10 contributors for this article] (2022). Association between hepatic steatosis and fibrosis with measures of insulin sensitivity in patients with severe obesity and type 2 diabetes - a cross-sectional study. BMC Gastroenterology. ISSN 1471-230X. 22(1). doi: 10.1186/s12876-022-02550-0. Full text in Research Archive Show summary

  Obesity, non-alcoholic fatty liver disease (NAFLD) and insulin resistance are three pathological conditions highly correlated, but this relationship is not fully elucidated. Hence, we aimed to assess the association of hepatic steatosis and fibrosis with different measures of insulin sensitivity in patients with severe obesity and type 2 diabetes mellitus (T2DM). Methods A cross-sectional study (Oseberg trial) including patients with T2DM referred for bariatric surgery at Vestfold Hospital Trust, Norway. Magnetic resonance imaging (MRI) and the enhanced liver fibrosis (ELF) test was used for estimation of liver fat fraction (LFF) and degree of fibrosis, respectively. Oral and intravenous glucose tolerance tests were applied for estimation of insulin sensitivity (HOMA2S, Matsuda ISI and MinMod SI). Results A total of 100 patients (mean [SD] age 47.5 [9.7] years, 65% women, BMI 42.0 [5.3] kg/m2 and 98% with metabolic syndrome) were included in the analyses. The mean (SD) LFF in the total population was 19.1 (11.5), and the mean (SD) ELF score was 8.46 (0.84), a value representing moderate fibrosis. LFF was inversely associated with HOMA2S and Matsuda ISI, and both measures were significantly higher in the no or low-grade steatosis group compared with the medium-to-high grade steatosis group (mean difference [95% CI] 5.9 [2.2-9.6]%, Cohen’s d = 0.75), and (0.7 [0.3-1.1], Cohen’s d = 0.80, respectively). There was no association between LFF, as a categorical or continuous variable, and MinMod SI. The proportions of patients with none to mild fibrosis, moderate fibrosis and severe fibrosis were 14, 78 and 6%, respectively, and there were no significant associations between level of fibrosis and measures of insulin sensitivity. Conclusions Patients with morbid obesity and T2DM demonstrated high levels of liver fat fraction, and we showed that hepatic steatosis, but not the degree of liver fibrosis, was associated with different measures of insulin sensitivity in patients with severe obesity and T2DM. Further, our results might indicate that the LFF is primarily associated with hepatic, and not peripheral insulin sensitivity. To improve the diagnosis of NAFLD and the prediction of its progression, more studies are needed to reveal the pathological mechanistic pathways involved in NAFLD and insulin sensitivity.

• Kvitne, Kine Eide; Åsberg, Anders; Johnson, Line Kristin; Wegler, Christine; Hertel, Jens Kristoffer & Artursson, Per [Show all 14 contributors for this article] (2022). Impact of type 2 diabetes on in vivo activities and protein expressions of cytochrome P450 in patients with obesity. Clinical and Translational Science (CTS). ISSN 1752-8054. 15(11), p. 2685–2696. doi: 10.1111/cts.13394. Full text in Research Archive Show summary

  Previous studies have not accounted for the close link between type 2 diabetes mellitus (T2DM) and obesity when investigating the impact of T2DM on cytochrome P450 (CYP) activities. The aim was to investigate the effect of T2DM on in vivo activities and protein expressions of CYP2C19, CYP3A, CYP1A2, and CYP2C9 in patients with obesity. A total of 99 patients from the COCKTAIL study (NCT02386917) were included in this cross-sectional analysis; 29 with T2DM and obesity (T2DM-obesity), 53 with obesity without T2DM (obesity), and 17 controls without T2DM and obesity (controls). CYP activities were assessed after the administration of a cocktail of probe drugs including omeprazole (CYP2C19), midazolam (CYP3A), caffeine (CYP1A2), and losartan (CYP2C9). Jejunal and liver biopsies were also obtained to determine protein concentrations of the respective CYPs. CYP2C19 activity and jejunal CYP2C19 concentration were 63% (−0.39 [95% CI: −0.82, −0.09]) and 40% (−0.09 fmol/μg protein [95% CI: −0.18, −0.003]) lower in T2DM-obesity compared with the obesity group, respectively. By contrast, there were no differences in the in vivo activities and protein concentrations of CYP3A, CYP1A2, and CYP2C9. Multivariable regression analyses also indicated that T2DM was associated with interindividual variability in CYP2C19 activity, but not CYP3A, CYP1A2, and CYP2C9 activities. The findings indicate that T2DM has a significant downregulating impact on CYP2C19 activity, but not on CYP3A, CYP1A2, and CYP2C9 activities and protein concentrations in patients with obesity. Hence, the effect of T2DM seems to be isoform-specific.

• Hjelmesæth, Jøran Sture & Sjöberg, Agneta (2022). Human body weight, nutrients, and foods: a scoping review. Food & Nutrition Research (FNR). ISSN 1654-6628. 66. doi: 10.29219/fnr.v66.8814. Full text in Research Archive Show summary

  The aim of this article (scoping review) is to elucidate the current knowledge for the potential role of body weight for setting and updating Dietary Reference Values (DRVs) and Food-Based Dietary Guidelines (FBDGs). The following research questions were formulated: What is known about the association between intakes of specific nutrient and/or foods (exposure/intervention) and body weight (outcome) in the general population? What is known about the association between body weight (exposure) and intakes of specific nutrient and/or foods (outcomes)? Is there any evidence suggesting specific effects of foods or nutrients on body weight independent of caloric content? Methods: To identify potentially relevant articles, PubMed was searched from January 1, 2011 to June 9, 2021. The search strategy was drafted by the NNR2022 Committee. The final results were exported into EndNote. Systematic reviews (SRs), scoping reviews (ScRs), reviews, and meta-analyses (MAs) on the topic ‘Body weight’ published between January 1, 2011 and June 9, 2021, including human participants from the general population, in English or Scandinavian language (Norwegian, Swedish, or Danish), were considered eligible. Main findings: First, the overall body of evidence based on findings from SRs and MAs of observational and clinical studies indicates that changes in intakes of specific nutrients (sugar, fiber, and fat) and/or foods (sugar sweetened beverages, fiber rich food, and vegetables) are associated with modest or small short-term changes (0.3–1.3 kg) in body weight in the general population (with or without obesity/overweight), while long-term studies are generally lacking. Second, no study in our search assessed any association between body weight (exposure) and intakes of specific nutrients or foods (outcomes). Third, limited evidence suggests, but does not prove, that some foods or nutrients may have specific effects on body weight or body weight measures independent of caloric content (e.g. nuts and dairy). These findings may inform the setting and updating of DRVs and FBDGs in NNR2022.

• Kvitne, Kine Eide; Hole, Kristine; Krogstad, Veronica; Wollmann, Birgit Malene Tovik; Wegler, Christine & Johnson, Line Kristin [Show all 19 contributors for this article] (2022). Correlations between 4β-hydroxycholesterol and hepatic and intestinal CYP3A4: protein expression, microsomal ex vivo activity, and in vivo activity in patients with a wide body weight range. European Journal of Clinical Pharmacology. ISSN 0031-6970. 78(8), p. 1289–1299. doi: 10.1007/s00228-022-03336-9. Full text in Research Archive Show summary

  Purpose Variability in cytochrome P450 3A4 (CYP3A4) metabolism is mainly caused by non-genetic factors, hence providing a need for accurate phenotype biomarkers. Although 4β-hydroxycholesterol (4βOHC) is a promising endogenous CYP3A4 biomarker, additional investigations are required to evaluate its ability to predict CYP3A4 activity. This study investigated the correlations between 4βOHC concentrations and hepatic and intestinal CYP3A4 protein expression and ex vivo microsomal activity in paired liver and jejunum samples, as well as in vivo CYP3A4 phenotyping (midazolam) in patients with a wide body weight range. Methods The patients (n = 96; 78 with obesity and 18 normal or overweight individuals) were included from the COCKTAIL-study (NCT02386917). Plasma samples for analysis of 4βOHC and midazolam concentrations, and liver (n = 56) and jejunal (n = 38) biopsies were obtained. The biopsies for determination of CYP3A4 protein concentration and microsomal activity were obtained during gastric bypass or cholecystectomy. In vivo CYP3A4 phenotyping was performed using semi-simultaneous oral (1.5 mg) and intravenous (1.0 mg) midazolam. Results 4βOHC concentrations were positively correlated with hepatic microsomal CYP3A4 activity (ρ = 0.53, p < 0.001), and hepatic CYP3A4 concentrations (ρ = 0.30, p = 0.027), but not with intestinal CYP3A4 concentrations (ρ = 0.18, p = 0.28) or intestinal microsomal CYP3A4 activity (ρ = 0.15, p = 0.53). 4βOHC concentrations correlated weakly with midazolam absolute bioavailability (ρ =  − 0.23, p = 0.027) and apparent oral clearance (ρ = 0.28, p = 0.008), but not with systemic clearance (ρ =  − 0.03, p = 0.81). Conclusion These findings suggest that 4βOHC concentrations reflect hepatic, but not intestinal, CYP3A4 activity. Further studies should investigate the potential value of 4βOHC as an endogenous biomarker for individual dose requirements of intravenously administered CYP3A4 substrate drugs.

• Asbjørnsen, Rikke Aune; Hjelmesæth, Jøran Sture; Smedsrød, Mirjam Lien; Wentzel, Jobke; Ollivier, Marianne & Clark, Matthew M. [Show all 8 contributors for this article] (2022). Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE. JMIR Human Factors. ISSN 2292-9495. 9(2). doi: 10.2196/37372. Full text in Research Archive Show summary

  Background: Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective: This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods: This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results: A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions: Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance.

• Kvitne, Kine Eide; Krogstad, Veronica; Wegler, Christine; Johnson, Line Kristin; Kringen, Marianne K. & Hovd, Markus Herberg [Show all 19 contributors for this article] (2022). Short- and long-term effects of body weight, calorie restriction and gastric bypass on CYP1A2, CYP2C19 and CYP2C9 activity. British Journal of Clinical Pharmacology. ISSN 0306-5251. 88(9), p. 4121–4133. doi: 10.1111/bcp.15349. Full text in Research Archive Show summary

  Roux-en-Y gastric bypass (RYGB) may influence drug disposition due to surgery-induced gastrointestinal alterations and/or subsequent weight loss. The objective was to compare short- and long-term effects of RYGB and diet on the metabolic ratios of paraxanthine/caffeine (cytochrome P450 [CYP] 1A2 activity), 5-hydroxyomeprazole/omeprazole (CYP2C19 activity) and losartan/losartan carboxylic acid (CYP2C9 activity), and cross-sectionally compare these CYP-activities with normal-to-overweight controls. Methods This trial included patients with severe obesity preparing for RYGB (n = 40) or diet-induced (n = 41) weight loss, and controls (n = 18). Both weight loss groups underwent a 3-week low-energy diet (<1200 kcal/day, weeks 0-3) followed by a 6-week very-low-energy diet or RYGB (both <800 kcal/day, weeks 3-9). Follow-up time was 2 years, with four pharmacokinetic investigations. Results Mean ± SD weight loss from baseline was similar in the RYGB-group (13 ± 2.4%) and the diet group (10.5 ± 3.9%) at week 9, but differed at year 2 (RYGB −30 ± 6.9%, diet −3.1 ± 6.3%). From weeks 0 to 3, mean (95% confidence interval [CI]) CYP2C19 activity similarly increased in both groups (RYGB 43% [16, 55], diet 48% [22, 60]). Mean CYP2C19 activity increased by 30% (2.6, 43) after RYGB (weeks 3-9), but not in the diet-group (between-group difference −0.30 [−0.63, 0.03]). CYP2C19 activity remained elevated in the RYGB group at year 2. Baseline CYP2C19 activity was 2.7-fold higher in controls compared with patients with obesity, whereas no difference was observed in CYP1A2 and CYP2C9 activities. Conclusion Our findings suggest that CYP2C19 activity is lower in patients with obesity and increases following weight loss. This may be clinically relevant for drug dosing. No clinically significant effect on CYP1A2 and CYP2C9 activities was observed.

• Berge, Jarle; Hjelmesæth, Jøran Sture; Kolotkin, Ronette Loganzo; Støren, Øyvind; Bratland-Sanda, Solfrid & Hertel, Jens Kristoffer [Show all 10 contributors for this article] (2022). Effect of aerobic exercise intensity on health-related quality of life in severe obesity: a randomized controlled trial. Health and Quality of Life Outcomes. ISSN 1477-7525. 20. doi: 10.1186/s12955-022-01940-y. Full text in Research Archive Show summary

  Background Aerobic exercise is an important part of obesity treatment and may improve health-related quality of life (HRQOL). The objective of this study was to compare the effect of two different exercise programs on health-related quality of life in patients with severe obesity. Methods This was a single-center, open-label, randomized, parallel-group study comparing the effects of a 24-week moderate-intensity continuous training (MICT) program and a combined high-intensity interval training program with MICT (HIIT/MICT). The primary objective (specified secondary outcome) was to assess HRQOL by using the general health dimension of the Short Form Health Survey (SF-36). The secondary objectives were to assess other dimensional SF-36 scores, the impact of weight on the physical and psychosocial aspects of quality of life (IWQOL-Lite), and the burden of obesity-specific weight symptoms (WRSM). Results 73 patients were enrolled and reported patient reported outcome measures, with 71 patients (55% females) allocated to either MICT (n = 34) or HIIT/MICT (n = 37). In the intention-to-treat analysis, general health scores increased between baseline and 24-week follow-up in both the HIIT/MICT group and the MICT group, with a mean change of 13 (95% CI 6–21) points and 11 (95% CI 5–17) points, respectively, with no difference between the groups. The effect sizes of these changes were moderate. The vitality and social functioning scores of SF-36, and the physical function and self-esteem scores of IWQOL-Lite increased moderately in both groups, with no difference between groups. The tiredness, back pain, and physical stamina scores based on WRSM showed moderate to strong changes in both the groups. Conclusions Patients who had completed a combined HIIT/MICT program did not experience larger improvements in general health compared with those completing a clean 24-week MICT program. Exercise may confer general health benefits independent of intensity.

• Wegler, Christine; Wisniewski, Jacek R.; Robertsen, Ida; Christensen, Hege; Hertel, Jens Kristoffer & Hjelmesæth, Jøran Sture [Show all 10 contributors for this article] (2022). Drug disposition protein quantification in matched human jejunum and liver from donors with obesity. Clinical Pharmacology and Therapeutics. ISSN 0009-9236. 111(5), p. 1142–1154. doi: 10.1002/cpt.2558. Full text in Research Archive Show summary

  Mathematical models, such as physiologically based pharmacokinetic (PBPK) models, are used to predict e.g., drug disposition and toxicity. However, populations differ in the abundance of proteins involved in these processes. To improve the building and refinement of such models, they must take into account these inter-individual variabilities. In this study, we used global proteomics to characterize the protein composition of jejunum and liver from 37 donors with obesity enrolled in the COCKTAIL study. Liver protein levels from the 37 donors were further compared with those from donors without obesity. We quantified thousands of proteins and could present the expression of several drug-metabolizing enzymes, for the first time, in jejunum, many of which belong to the cytochrome P450 (e.g., CYP2U1) and the amine oxidase [flavin-containing] (e.g., MAOA) families. Although we show that many metabolizing enzymes had greater expression in liver, others had higher expression in jejunum (such as, MAOA and CES2), indicating the role of the small intestine in extrahepatic drug metabolism. We further show that proteins involved in drug disposition are not correlated in the two donor-matched tissues. These proteins also do not correlate with physiological factors such as BMI, age, and inflammation status in either tissue. Furthermore, the majority of these proteins are not differently expressed in donors with or without obesity. Nonetheless, inter-individual differences were considerable, with implications for personalized prediction models and systems pharmacology.

• Fatima, Farhat; Hjelmesæth, Jøran Sture; Hertel, Jens Kristoffer; Svanevik, Marius; Sandbu, Rune & Småstuen, Milada Cvancarova [Show all 7 contributors for this article] (2022). Validation of Ad-DiaRem and ABCD Diabetes Remission Prediction Scores at 1-Year After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in the Randomized Controlled Oseberg Trial. Obesity Surgery. ISSN 0960-8923. 32(3), p. 801–809. doi: 10.1007/s11695-021-05856-2. Show summary

  Background Prediction of type 2 diabetes (T2DM) remission is an important part of risk-benefit assessment before bariatric surgery. Study Design Advanced-DiaRem (Ad-DiaRem) and ABCD diabetes remission scores for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were calculated using baseline data. Differences in model discrimination using area under the curve of receiver operating curve (AUC-ROC) and model calibration were tested for complete remission (HbA1c ≤ 6.0% without antidiabetic medications) in the two groups. Optimal cutoff scores were calculated using the Youden index. Results We randomized 109 patients to either SG or RYGB. With one patient lost to follow-up in each group, the scores were calculated for 54 patients in the SG group and 53 patients in the RYGB group. Both models showed moderate predictive power without any significant difference between the groups: AUC-ROCs (95% CI) for the Ad-DiaRem score (SG versus RYGB) were 0.872 (0.780–0.964) versus 0.843 (0.733–0.954), p = 0.69, and for the ABCD score 0.849 (0.752–0.946) versus 0.750 (0.580–0.920), p = 0.32, respectively. Using optimal cutoff points derived from the whole study population, the actual proportion of diabetes remission was significantly higher than predicted for both the Ad-DiaRem and ABCD scores in the RYGB group. Diabetes duration and glycated haemoglobin predicted diabetes remission in the entire Oseberg population. Conclusion Both the Ad-DiaRem and ABCD scores showed moderate ability to discriminate between those who achieved remission of T2DM and those who did not after SG and RYGB. Larger studies are needed for the identification of procedure-specific optimal cutoffs.

• Seeberg, Kathrine; Borgeraas, Heidi; Hofsø, Dag; Småstuen, Milada Cvancarova; Kvan, Nils Petter & Grimnes, John Olav [Show all 12 contributors for this article] (2021). Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis A Randomized Controlled Trial. Annals of Internal Medicine. ISSN 0003-4819. 175(1), p. 74–83. doi: 10.7326/M21-1962. Show summary

  Background: Weight loss improves fatty liver disease. No randomized trial has compared the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on liver fat content and fibrosis. Objective: To compare the 1-year effects of SG and RYGB on hepatic steatosis and fibrosis. Design: Single-center, randomized, controlled trial (Oseberg [ObesitySurgery in Tønsberg]). (ClinicalTrials.gov: NCT01778738) Setting: Tertiary care obesity center in Norway. Participants: 100 patients (65% female; mean age, 47.5 years; mean body mass index, 42 kg/m2) with type 2 diabetes mellitus (T2DM). Intervention: From January 2013 to February 2018, patients were randomly assigned (1:1 ratio) to SG or RYGB. Measurements: The primary outcome was remission of T2DM (previously published). Predefined secondary outcomes in the present study were hepatic steatosis and fibrosis assessed by magnetic resonance imaging (liver fat fraction), enhanced liver fibrosis (ELF) test, noninvasive indices, and liver enzymes. Results: Liver fat fraction declined similarly after SG (−19.7% [95% CI, −22.5% to −16.9%]) and RYGB (−21.5% [CI, −24.3% to −18.6%]) from surgery to 1-year follow-up, and almost all patients (SG, 94%; RYGB, 100%) had no or low-grade steatosis at 1 year. The ELF score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis at 1 year, with no substantial between-group difference. Limitations: Single-center study, short follow-up time, and lack of power for secondary outcomes. Conclusion: With an almost complete clearance of liver fat 1 year after surgery, RYGB and SG were both highly effective in reducing hepatic steatosis. Bariatric surgery had less influence on degree of fibrosis in the short term, but assessment of long-term progression is warranted.

• Salte, Odd Bjørn; Svanevik, Marius; Risstad, Hilde; Hofsø, Dag; Høgestøl, Ingvild Kristine & Johnson, Line Kristin [Show all 11 contributors for this article] (2021). Standard versus distal Roux-en-Y gastric bypass in patients with BMI 50–60 kg/m2: 5-year outcomes of a double-blind, randomized clinical trial. BJS Open. ISSN 2474-9842. 5(6), p. 1–9. doi: 10.1093/bjsopen/zrab105. Full text in Research Archive Show summary

  Background The optimal surgical weight loss procedure for patients with a BMI of 50 kg/m2 or more is uncertain. This study compared distal Roux-en-Y gastric bypass (RYGB) with standard RYGB. Methods In this double-blind RCT, patients aged 18–60 years with a BMI of 50–60 kg/m2 were allocated randomly to receive standard (150 cm alimentary, 50 cm biliopancreatic limb) or distal (150 cm common channel, 50 cm biliopancreatic limb) RYGB. The primary outcome (change in BMI at 2 years) has been reported previously. Secondary outcomes 5 years after surgery, such as weight loss, health-related quality of life, and nutritional outcomes are reported. Results Between May 2011 and April 2013, 123 patients were randomized, 113 received an intervention, and 92 attended 5-year follow-up. Mean age was 40 (95 per cent c.i. 38 to 41) years and 73 patients (65 per cent) were women; 57 underwent standard RYGB and 56 distal RYGB. BMI was reduced by 15.1 (95 per cent c.i. 13.9 to 16.2) kg/m2 after standard and 15.7 (14.5 to 16.9) kg/m2 after distal RYGB; the between-group difference was −0.64 (−2.3 to 1.0) kg/m2 (P = 0.447). Total cholesterol, low-density lipoprotein cholesterol, and haemoglobin A1c levels declined more after distal than after standard RYGB. High-density lipoprotein cholesterol levels increased more after standard RYGB. Vitamin A and vitamin D levels were lower after distal RYGB. Changes in bone mineral density, resting metabolic rate, and total energy intake were comparable. Conclusion Distal RYGB did not enable greater weight loss than standard RYGB. Differences in other outcomes favouring distal RYGB may not justify routine use of this procedure in patients with a BMI of 50–60 kg/m2.

• Tønnesen, Christer Julseth; Hjelmesæth, Jøran; Hofsø, Dag; Tonstad, Serena; Hertel, Jens Kristoffer & Heggen, Eli [Show all 14 contributors for this article] (2021). A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 57(2), p. 232–238. doi: 10.1080/00365521.2021.1994641. Full text in Research Archive
• Fatima, Farhat; Hjelmesæth, Jøran Sture; Birkeland, Kåre Inge; Gulseth, Hanne Løvdal; Hertel, Jens Kristoffer & Svanevik, Marius [Show all 11 contributors for this article] (2021). Gastrointestinal hormones and β-cell function after gastric bypass and sleeve gastrectomy: a randomized controlled trial (Oseberg). Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 107(2), p. e756–e766. doi: 10.1210/clinem/dgab643. Full text in Research Archive Show summary

  Context Whether Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differentially affect postprandial gastrointestinal hormones and β-cell function in type 2 diabetes remains unclear. Objective To compare gastrointestinal hormones and β-cell function assessed by an oral glucose tolerance test (OGTT) 5 weeks and 1 year after surgery hypothesizing higher GLP-1 levels and greater β-cell response to glucose after RYGB than after SG. Design, Setting, Patients, and Interventions Randomized, triple blind, single-center trial at a tertiary care center in Norway. Primary outcomes; diabetes remission and IVGTT derived β-cell function. Participants with obesity and type 2 diabetes allocated (1:1) to RYGB or SG. Main outcome measures Gastrointestinal hormone profiles and insulin secretion [β-cell glucose sensitivity (β-GS)] derived from 180 minutes OGTTs. Results 106 patients (67% women), mean (SD) age 48 (10) years. Diabetes remission rates at 1-year were higher after RYGB than after SG, 77% versus 48%, p = 0.002. Incremental area under the curve (iAUC0-180) glucagon-like peptide-1 (GLP-1) and β-GS increased more after RYGB than after SG, 1-year between-group difference 1173 pmol/l*min (95% CI 569 to 1776), p = 0.0010, and 0.45 pmol/kg/min/mmol (95% CI 0.15 to 0.75), p = 0.0032, respectively. Post-surgery, fasting and postprandial ghrelin levels were higher and decremental AUC0-180 ghrelin, iAUC0-180 glucose-dependent insulinotropic polypeptide, and iAUC0-60 glucagon were greater after RYGB than after SG. Diabetes remission at 1 year was associated with higher β-GS and higher GLP-1 secretion. Conclusions RYGB was associated with greater improvement in β-cell function and higher postprandial GLP-1 levels than SG.

• Kvitne, Kine Eide; Robertsen, Ida; Skovlund, Eva; Christensen, Hege Staaland; Krogstad, Veronica & Wegler, Christine [Show all 18 contributors for this article] (2021). Short- and long-term effects of body weight loss following calorie restriction and gastric bypass on CYP3A-activity – a non-randomized three-armed controlled trial. Clinical and Translational Science (CTS). ISSN 1752-8054. doi: 10.1111/cts.13142. Full text in Research Archive
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hofsø, Dag; Svanevik, Marius; Seip, Birgitte Karen Berggreen & Hjelmesæth, Jøran (2021). Sleeve gastrectomy confers higher risk of gastroesophageal reflux disease than gastric bypass. A Randomized Controlled Trial From the Oseberg Reflux Working Group. Gastroenterology. ISSN 0016-5085. 161(6), p. 2044–2046. doi: 10.1053/j.gastro.2021.08.021. Full text in Research Archive
• Berge, Jarle; Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Gjevestad, Espen Svendsen; Småstuen, Milada Cvancarova & Johnson, Line Kristin [Show all 10 contributors for this article] (2021). Effect of Aerobic Exercise Intensity on Energy Expenditure and Weight Loss in Severe Obesity-A Randomized Controlled Trial . Obesity. ISSN 1930-7381. 29(2), p. 359–369. doi: 10.1002/oby.23078. Full text in Research Archive Show summary

  Objective This study aimed to compare the effects of two aerobic exercise programs of different intensities on energy expenditure. Methods This was a single‐center randomized controlled trial of patients with severe obesity allocated to a 24‐week moderate‐intensity continuous training (MICT) program or a combined MICT with high‐intensity interval training (HIIT/MICT) program. The primary outcome was energy expenditure during exercise (EEDE). Secondary outcomes included resting metabolic rate, cardiorespiratory fitness, and body composition. Results A total of 82 (56% females) patients were screened, and 71 (55% females) patients were allocated to HIIT/MICT (n = 37) or MICT (n = 34). Per‐protocol analysis showed that EEDE increased by 10% (95% CI: 3%‐17%) in the HIIT/MICT group (n = 16) and 7.5% (95% CI: 4%‐10%) in the MICT group (n = 24), with no differences between groups. In the 8‐ to 16‐ week per‐protocol analysis, the HIIT/MICT group had a significantly larger increase in EEDE compared with the MICT group. Resting metabolic rate remained unchanged in both groups. HIIT/MICT and MICT were associated with significant weight loss of 5 kg and 2 kg, respectively. Conclusions Patients completing a 24‐week combined HIIT/MICT program did not achieve a higher EEDE compared with those who completed a 24‐week MICT program. The HIIT/MICT group experienced, on average, a 3‐kg‐larger weight loss than the MICT group.

• Lund, Randi Størdal; Hertel, Jens Kristoffer; Sandbu, Rune & Hjelmesæth, Jøran (2020). Patient complaints following bariatric surgery 2012-18 . Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.20.0194. Full text in Research Archive
• Asbjørnsen, Rikke Aune; Wentzel, Jobke; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Clark, Matthew M. & Solberg Nes, Lise [Show all 7 contributors for this article] (2020). Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study. Journal of Medical Internet Research. ISSN 1438-8871. 22(11). doi: 10.2196/22598. Full text in Research Archive
• Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Holt, Ane Hjetland; Benestad, Beate; Seeberg, Lars Thomas & Lindberg, Morten [Show all 10 contributors for this article] (2020). Laparoscopic gastric bypass versus lifestyle intervention for adolescents with morbid obesity. Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.20.0526. Full text in Research Archive Show summary

  BAKGRUNN Kunnskapsgrunnlaget om effekten av og komplikasjoner ved vektreduserende kirurgi hos ungdom er mangelfullt. Hovedformålet med 4XL-studien er å avklare om laparoskopisk Roux-en-Y gastrisk bypassoperasjon (LGBP) kombinert med livsstilsintervensjon er en sikker og effektiv behandlingsmetode. MATERIALE OG METODE Materialet er hentet fra en pågående ikke-randomisert intervensjonsstudie av ungdom med sykelig overvekt, der man sammenlikner effektene av gastrisk bypass kombinert med livsstilsintervensjon og livsstilsintervensjon alene. RESULTATER Totalt 39 pasienter (64 % jenter) behandlet med gastrisk bypass og 96 pasienter (57 % jenter) behandlet med livsstilsintervensjon ble undersøkt før og ett år etter behandlingsstart. Ved inklusjon var gjennomsnittsalderen (SD) hhv. 16,7 år (1,0) vs. 15,6 år (1,3), og gjennomsnittlig BMI 45,6 kg/m2 (4,4) vs. 43,3 kg/m2 (4,1) i de to gruppene. Gjennomsnittlig prosentuelt vekttap var 30 % (95 % KI 27 til 33) etter kirurgi versus en vektøkning på 1 % (95 % KI −1 til 3) i kontrollgruppen. Forskjellen mellom gruppene var 31 % (95 % KI 27 til 34, p < 0,001). Kardiometabolske risikofaktorer bedret seg kun etter kirurgi. Etter gastrisk bypass ble det registrert to tidlige (< 6 uker) mindre alvorlige komplikasjoner. Ett år etter kirurgi hadde totalt 4 (10 %) pasienter anemi, 8 (21 %) jernmangel og 4 (10 %) lave vitamin B12-verdier. 20 av 33 testede (61 %) pasienter hadde lavt totimers-blodsukker (< 2,8 mmol/L) etter glukosebelastning. FORTOLKNING Resultatene støtter tidligere studier som har vist at gastrisk bypass er assosiert med betydelig vektreduksjon hos unge pasienter med sykelig overvekt. 4XL-studien er foreløpig for liten og oppfølgingstiden for kort til å kunne vurdere risikoen for langtidskomplikasjoner.

• Hofsø, Dag; Hillestad, Thor Olav Widerøe; Halvorsen, Erling; Fatima, Farhat; Johnson, Line Kristin & Lindberg, Morten [Show all 9 contributors for this article] (2020). Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg). Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. doi: 10.1210/clinem/dgaa808. Full text in Research Archive Show summary

  Context Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health. Objective To compare changes in bone mineral density and markers of bone turnover one year after SG and RYGB. Design, Setting, Patients, and Interventions Randomized, triple-blind, single-center trial at a tertiary care center in Norway. Primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB. Main Outcome Measures Changes in areal bone mineral density (aBMD) and bone turnover markers. Results Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n=44) than after SG (n=48) [mean (95% CI) between group differences -2.8 % (-0.8 to -4.7), -3.0 % (-0.9 to -5.0), -4.2 % (-2.1 to -6.4), and -0.5 % (0.6 to -1.6), respectively]. The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG, (both time x group, P<0.001). The changes in femoral neck, total hip and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P<0.05) and not weight change. Conclusions RYGB was associated with greater reduction in aBMD and greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB.

• Krogstad, Veronica; Peric, Alexandra; Robertsen, Ida; Kringen, Marianne K.; Vistnes, Maria & Hjelmesæth, Jøran [Show all 15 contributors for this article] (2020). Correlation of body weight and composition with hepatic activities of cytochrome P450 enzymes . Journal of Pharmaceutical Sciences. ISSN 0022-3549. 110(1), p. 432–437. doi: 10.1016/j.xphs.2020.10.027. Full text in Research Archive
• Aakre, Kristin Moberg; Omland, Torbjørn; Nordstrand, Njord; Gjevestad, Espen Svendsen; Holven, Kirsten Bjørklund & Lyngbakken, Magnus [Show all 7 contributors for this article] (2020). Gastric bypass surgery is associated with reduced subclinical myocardial injury and greater activation of the cardiac natriuretic peptide system than lifestyle intervention. Clinical Biochemistry. ISSN 0009-9120. 86, p. 36–44. doi: 10.1016/j.clinbiochem.2020.09.006. Full text in Research Archive
• Wegler, Christine; Garcia, Luna Prieto; Klinting, Signe; Robertsen, Ida; Wisniewski, Jacek R. & Hjelmesæth, Jøran [Show all 10 contributors for this article] (2020). Proteomics‐informed prediction of rosuvastatin plasma profiles in patients with a wide range of body weight. Clinical Pharmacology and Therapeutics. ISSN 0009-9236. 109(3), p. 762–771. doi: 10.1002/cpt.2056. Full text in Research Archive
• Hjelmesæth, Jøran & Skaare, Dagfinn (2020). Covid-19 med nedsatt lukte-og smakssans som eneste symptom. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 140(7). doi: 10.4045/TIDSSKR.20.0287. Full text in Research Archive
• Skodvin, Vilde Aabel; Lekhal, Samira; Kommedal, Kristin Garpestad; Benestad, Beate; Skjåkødegård, Hanna Flækøy & Danielsen, Yngvild Sørebø [Show all 11 contributors for this article] (2020). Livsstilsbehandling av barn og ungdom med alvorlig fedme – resultater etter ett år. Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.19.0682. Full text in Research Archive Show summary

  BAKGRUNN Internasjonalt er livsstilsbehandling av barn og unge med alvorlig fedme vist å ha moderate korttidseffekter på vektreduksjon. Vi evaluerte behandlingsresultater ved to norske spesialistpoliklinikker. MATERIALE OG METODE Vi gjorde en retrospektiv analyse av innsamlede data for perioden 2012–16. Barn med alvorlig fedme som møtte til ettårskontroll, ble inkludert. I analysene inkluderte vi kroppsvektmålene prosentdel av definisjonen til overvekt (%IOTF-25), BMI-standardavviksskår, midjemålstandardavviksskår og kroppsfettprosent ved behandlingsstart og ved ettårskontroll. RESULTATER Av 568 barn som startet behandling, møtte 416 (73 %) i alderen 3–18 år til ettårskontroll og ble inkludert. Flertallet av pasientene, totalt 271 (65 %), oppnådde reduksjon i %IOTF-25, mens 228 pasienter (55 %) reduserte sin BMI-standardavviksskår. Det var en statistisk signifikant gjennomsnittlig reduksjon for alle fire registrerte kroppsvektmål. Totalt 54 av 325 barn (17 %) endret kategori fra alvorlig fedme til fedme, 8 (2 %) gikk fra alvorlig fedme til overvekt, og 8 av 91 barn (9 %) endret kategori fra fedme til overvekt eller normal vekt. Andelen deltagere med mer enn 5 % reduksjon i %IOTF-25 var 43 % (177/416), og en reduksjon i BMI-standardavviksskår på mer enn 0,25 ble observert hos 23 % (95/416). Samtlige utfallsmål viste at jenter responderte dårligere på behandling enn gutter og at det ikke var noen klinisk viktig forskjell i resultater mellom behandlingssentrene. FORTOLKNING Etter ett års behandling av barn og unge med alvorlig fedme i spesialisthelsetjenesten fant vi moderate gjennomsnittlige reduksjoner i vekt, midjemål og kroppsfettprosent, men med stor interindividuell variasjon.

• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hertel, Jens Kristoffer; Borgeraas, Heidi; Karlsen, Tor-Ivar & Kolotkin, Ronette Loganzo [Show all 12 contributors for this article] (2020). Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study. Obesity Surgery. ISSN 0960-8923. 30, p. 2667–2675. doi: 10.1007/s11695-020-04545-w. Full text in Research Archive Show summary

  Background Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM. Methods Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry. Results A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m2, and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m2, were included. The proportions of patients reporting GERD-symptoms were low (< 29%) and did not differ significantly between groups, while the proportions of patients with esophagitis were high both in the T2DM and non-T2DM group, 58% versus 47%, p = 0.16. The majority of patients with esophagitis did not have GERD-symptoms (68–80%). Further, 55% of the patients with T2DM had pathologic acid reflux. Among these, 71% also had erosive esophagitis, whereof 67% were asymptomatic. Conclusions The prevalence of GERD was similar in bariatric patients with or without T2DM, and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2DM. Accordingly, GERD may be underdiagnosed in patients not undergoing a preoperative endoscopy or acid reflux assessment

• Borgeraas, Heidi; Hofsø, Dag; Hertel, Jens Kristoffer & Hjelmesæth, Jøran (2020). Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. ISSN 1467-7881. 21(6). doi: 10.1111/obr.13011. Full text in Research Archive Show summary

  Bariatric surgery is an effective treatment option for patients with type 2 diabetes mellitus (T2DM) and obesity. This study aims to compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on remission of T2DM. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies published between database inception and 21 November 2019. A meta-analysis, using a random effects model, was performed to calculate relative risk (RR) of T2DM remission between the groups in randomized controlled trials (RCTs). Of 2650 records identified, 12 records from 10 different RCTs were finally included. The studies comprised 705 patients with follow-up from 1 to 5 years. The remission rate of T2DM at 1 year was higher among those undergoing RYGB (156/276, 57%) compared with those undergoing SG (128/275, 47%), RR (95% CI) 1.20 (1.00-1.45), P = .047, I2 = 24.9%, moderate-quality evidence. Among studies with 2- to 5-year follow-up, there was no difference in remission rates between the RYGB (132/263, 50%) and SG (121/266, 46%) groups, RR 1.06 (0.94-1.20), P = .34, I2 = 0.0%, low-quality evidence. RYGB resulted in a higher rate of T2DM remission compared with SG after 1 year. The T2DM remission rates did not differ in studies with 2- to 5-year follow-up

• Wegler, Christine; Ölander, Magnus; Wisniewski, JR; Lundquist, Patrick; Zettl, K & Åsberg, Anders [Show all 9 contributors for this article] (2020). Global variability analysis of mRNA and protein concentrations across and within human tissues. NAR Genomics and Bioinformatics. ISSN 2631-9268. 2(1), p. 1–11. doi: 10.1093/nargab/lqz010. Full text in Research Archive
• Krogstad, Veronica; Peric, Alexandra; Robertsen, Ida; Kringen, Marianne K.; Wegler, Christine & Angeles, Philip Carlo Soriano [Show all 13 contributors for this article] (2019). A Comparative Analysis of Cytochrome P450 Activities in Paired Liver and Small Intestinal Samples from Patients with Obesity. Drug Metabolism And Disposition. ISSN 0090-9556. 48(1), p. 8–17. doi: 10.1124/DMD.119.087940.
• Hofsø, Dag; Fatima, Farhat; Borgeraas, Heidi; Birkeland, Kåre I.; Gulseth, Hanne Løvdal & Hertel, Jens Kristoffer [Show all 15 contributors for this article] (2019). Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 7(12), p. 912–924. doi: 10.1016/S2213-8587(19)30344-4. Full text in Research Archive
• Berge, Jarle; Støren, Øyvind; Hertel, Jens Kristoffer; Gjevestad, Espen Svendsen; Småstuen, Milada Cvancarova & Hjelmesæth, Jøran (2019). Associations between cardiorespiratory fitness and weight loss in patients with severe obesity undergoing an intensive lifestyle intervention program: retrospective cohort study. BMC Endocrine Disorders. ISSN 1472-6823. 19(1), p. 1–9. doi: 10.1186/s12902-019-0394-z. Full text in Research Archive Show summary

  Background To assess the association between cardiorespiratory fitness (CRF) and weight changes in treatment seeking patients with severe obesity who underwent a 1-year intensive lifestyle intervention (ILI) program. Methods Retrospective cohort study conducted at a tertiary care outpatient rehabilitation center from November 1, 2013 through January 1, 2017. CRF was measured as maximal oxygen consumption during a maximal oxygen uptake (VO2max) test on a treadmill or bicycle at baseline and after 3 months. Results A total of 180 patients had a baseline mean (SD) BMI 41.1 (4.8) kg/m2 and CRF of 79.4 (14.9) mL·kg-0.75·min− 1. Patients with a baseline CRF above median achieved a greater 3-month and 1-year weight loss compared with patients with CRF below median; mean (95% CI) 2.5 kg (1.3, 3.8) and 4.0 kg (0.8, 7.2), respectively. In addition, patients with 3-month changes of CRF above median had 4.0 kg (0.9, 7.1) greater weight loss at 1-year follow-up than those below median. Conclusions Among patients with severe obesity who underwent a 1-year ILI program, higher baseline CRF was associated with significantly larger weight loss after 3 months and 1 year. In addition, those with higher initial 3-month CRF changes had greater weight loss at 1 year.

• Angeles, Philip Carlo Soriano; Robertsen, Ida; Seeberg, Lars Thomas; Krogstad, Veronica; Skattebu, Julie & Sandbu, Rune [Show all 8 contributors for this article] (2019). The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review. Obesity Reviews. ISSN 1467-7881. 20(9), p. 1299–1311. doi: 10.1111/obr.12869. Full text in Research Archive Show summary

  Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery. This review systematically examines the effects of bariatric surgery on drug pharmacokinetics, focusing especially on the mechanisms involved in restricting oral bioavailability. Studies with a longitudinal before‐after design investigating the pharmacokinetics of at least one drug were reviewed. The need for dose adjustment following bariatric surgery was examined, as well as the potential for extrapolation to other drugs subjected to coinciding pharmacokinetic mechanisms. A total of 22 original articles and 32 different drugs were assessed. The majority of available data is based on Roux‐en‐Y gastric bypass (RYGBP) (18 of 22 studies), and hence, the overall interpretation is more or less limited to RYGBP. In the case of the majority of studied drugs, an increased absorption rate was observed early after RYGBP. The effect on systemic exposure allows for a low degree of extrapolation, including between drugs subjected to the same major metabolic and transporter pathways. On the basis of current understanding, predicting the pharmacokinetic change for a specific drug following RYGBP is challenging. Close monitoring of each individual drug is therefore recommended in the early postsurgical phase. Future studies should focus on the long‐term effects of bariatric surgery on drug disposition, and they should also aim to disentangle the effects of the surgery itself and the subsequent weight loss.

• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Solberg Nes, Lise ; Wentzel, Jobke; Varsi, Cecilie & Hjelmesæth, Jøran [Show all 7 contributors for this article] (2019). Persuasive system design principles and behavior change techniques to stimulate motivation and adherence in electronic health interventions to support weight loss maintenance: Scoping review. Journal of Medical Internet Research. ISSN 1438-8871. 21(6). doi: 10.2196/14265. Full text in Research Archive
• Løkling, Hanne Lund; Roelants, Mathieu; Kommedal, Kristin Garpestad; Skjåkødegård, Hanna Flækøy; Apalset, Ellen M & Benestad, Beate [Show all 9 contributors for this article] (2019). Monitoring children and adolescents with severe obesity: body mass index (BMI), BMI z-score or percentage above the International Obesity Task Force overweight cut-off? Acta Paediatrica. ISSN 0803-5253. 108(12), p. 2261–2266. doi: 10.1111/apa.14898. Full text in Research Archive
• Borgeraas, Heidi; Hjelmesæth, Jøran; Birkeland, Kåre I.; Fatima, Farhat; Grimnes, John Olav & Gulseth, Hanne Løvdal [Show all 22 contributors for this article] (2019). Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study . BMJ Open. ISSN 2044-6055. 9(6). doi: 10.1136/bmjopen-2018-024573. Full text in Research Archive Show summary

  Introduction Bariatric surgery is increasingly recognised as an effective treatment option for subjects with type 2 diabetes and obesity; however, there is no conclusive evidence on the superiority of Roux-en-Y gastric bypass or sleeve gastrectomy. The Oseberg study was designed to compare the effects of gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function. Methods and analysis Single-centre, randomised, triple-blinded, two-armed superiority trial carried out at the Morbid Obesity Centre at Vestfold Hospital Trust in Norway. Eligible patients with type 2 diabetes and obesity were randomly allocated in a 1:1 ratio to either gastric bypass or sleeve gastrectomy. The primary outcome measures are (1) the proportion of participants with complete remission of type 2 diabetes (HbA1c≤6.0% in the absence of blood glucose-lowering pharmacologic therapy) and (2) β-cell function expressed by the disposition index (calculated using the frequently sampled intravenous glucose tolerance test with minimal model analysis) 1 year after surgery. Ethics and dissemination The protocol of the current study was reviewed and approved by the regional ethics committee on 12 September 2012 (ref: 2012/1427/REK sør-øst B). The results will be disseminated to academic and health professional audiences and the public via publications in international peer-reviewed journals and conferences. Participants will receive a summary of the main findings. Trial registration number NCT01778738;Pre-results. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial

• Svanevik, Marius; Risstad, Hilde; Hofsø, Dag; Høgestøl, Ingvild Kristine; Kristinsson, Jon Adalsteinn & Sandbu, Rune [Show all 10 contributors for this article] (2019). Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial. Obesity Surgery. ISSN 0960-8923. 29(9), p. 2886–2895. doi: 10.1007/s11695-019-03909-1.
• Benestad, Beate; Karlsen, Tor-Ivar; Småstuen, Milada Cvancarova; Lekhal, Samira; Hertel, Jens Kristoffer & Steinsbekk, Silje [Show all 9 contributors for this article] (2019). Health-related quality of life after camp-based family obesity treatment: an RCT . BMJ Paediatrics Open. ISSN 2399-9772. 3(1). doi: 10.1136/bmjpo-2018-000413. Full text in Research Archive
• Borgeraas, Heidi; Ha, Lisa Ah Fung; Lund, Randi Størdal; Fredheim, Jan Magnus; Hertel, Jens Kristoffer & Hjelmesæth, Jøran (2018). Association of time of obesity onset with comorbidities in treatment-seeking men and women with severe obesity. Obesity Science & Practice. ISSN 2055-2238. doi: 10.1002/osp4.298. Full text in Research Archive
• Benestad, Beate; Juliusson, Petur Benedikt; Siegfried, Wolfgang; Lekhal, Samira; Småstuen, Milada Cvancarova & Hertel, Jens Kristoffer [Show all 10 contributors for this article] (2018). Cardiometabolic risk factors differ among adolescents with obesity in three European countries - a cross sectional study. Acta Paediatrica. ISSN 0803-5253. 108(3), p. 493–501. doi: 10.1111/apa.14542. Full text in Research Archive
• Munkhaugen, John; Hjelmesæth, Jøran; Otterstad, Jan Erik; Helseth, Ragnhild; Sollid, Stina Therese & Gjertsen, Erik [Show all 11 contributors for this article] (2018). Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study. BMC Cardiovascular Disorders. ISSN 1471-2261. 18(1). doi: 10.1186/s12872-018-0896-z. Full text in Research Archive
• Hjelmesæth, Jøran; Rosenvinge, Jan H; Gade, Hege & Friborg, Oddgeir (2018). Effects of cognitive behavior therapy on eating behaviors, affective symptoms, and weight loss after bariatric surgery: a randomized clinical trial. Obesity Surgery. ISSN 0960-8923. 29, p. 61–69. doi: 10.1007/s11695-018-3471-x. Full text in Research Archive Show summary

  Background The long-term effects of presurgical sychological interventions on weight loss, eating behaviors, affective symptoms, and health-related quality of life remain uncertain. This study aimed to assess the 4-year effects of cognitive behavioral therapy (CBT) before bariatric surgery on these outcomes. Methods Single-center randomized controlled parallel-group trial. Patients were assessed after CBT before bariatric surgery (n = 98) and 1 year (n = 80) and 4 years (n = 61) after surgery. The intervention group received a 10-week preoperative individual CBT focusing on self-monitoring to identify triggers of dysfunctional eating behaviors in order to improve regulation of eating as well as the breaking of the interrelationship between eating behaviors, negative mood, and dysfunctional cognitions. Results The 61 patients (70% women) had a mean (SD) age of 42.4 (10.1) years and BMI 43.5 (4.4) kg/m2. Preoperative CBTwas not associated with 1- and 4-year reduction of dysfunctional eating behaviors, affective symptoms and body weight, or improved health-related quality of life. Patients with minor or considerable symptoms of depression receiving CBT had lower mean BMI than controls, both before surgery, − 1.1 kg/m2, and − 1.5 kg/m2, and 4-years after surgery, − 2.9 kg/m2 and − 7.5 kg/m2, respectively. Conclusion Presurgical CBT was not associated with better long-termoutcomes. However, in patients with minor or considerable symptoms of depression, CBT was associated with lower body weight before and 4 years after surgery. Additional studies are required to verify whether patients with symptoms of depression should be offered CBT before and/or after bariatric surgery, and which clinical aspects the CBT should address.

• Hjelmesæth, Jøran; Åsberg, Anders; Andersson, Shalini; Sandbu, Rune; Robertsen, Ida & Johnson, Line Kristin [Show all 16 contributors for this article] (2018). Impact of body weight, low energy diet and gastric bypass on drug bioavailability, cardiovascular risk factors and metabolic biomarkers: protocol for an open, non-randomised, three-armed single centre study (COCKTAIL). BMJ Open. ISSN 2044-6055. 8:e021878(5), p. 1–10. doi: 10.1136/bmjopen-2018-021878. Full text in Research Archive
• Ha, Lisa Ah Fung; Juliusson, Petur Benedikt; Johnson, Line Kristin; Hertel, Jens Kristoffer; Lekhal, Samira & Hjelmesæth, Jøran (2018). Gender-related differences in cardiometabolic risk factors and lifestyle behaviors in treatment-seeking adolescents with severe obesity. BMC Pediatrics. ISSN 1471-2431. 18:61, p. 1–8. doi: 10.1186/s12887-018-1057-3. Full text in Research Archive
• Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag & Lindberg, Morten [Show all 8 contributors for this article] (2018). Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities. Journal of the American Medical Association (JAMA). ISSN 0098-7484. 319(3), p. 291–301. doi: 10.1001/jama.2017.21055. Full text in Research Archive
• Busetto, Luca; Dicker, Dror; Azran, Carmil; Batterham, Rachel L; Farpour-Lambert, Nathalie & Fried, Martin [Show all 13 contributors for this article] (2017). Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obesity Facts. ISSN 1662-4025. 10(6), p. 597–632. doi: 10.1159/000481825. Full text in Research Archive

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• Asbjørnsen, Rikke Aune; Børøsund, Elin; Hjelmesæth, Jøran Sture; Smedsrød, Mirjam Lien; Ollivier, Marianne & Clark, Matthew [Show all 9 contributors for this article] (2024). System Use Findings from a Pilot Trial with the Digital Weight Loss Maintenance Intervention eCHANGE.
• Hjelmesæth, Jøran Sture; Torheim, Live Elin & Arnesen, Erik Kristoffer (2023). J. Hjelmesæth og medarbeidere svarer. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(13). doi: 10.4045/tidsskr.23.0589.
• Pfabigan, Daniela Melitta; Hertel, Jens Kristoffer; Svanevik, Marius; Lindberg, Morten; Sailer, Uta & Hjelmesæth, Jøran Sture (2023). Single-centre, non-randomised clinical trial at a tertiary care centre to investigate 1-year changes in social experiences and biomarkers of well-being after bariatric surgery in individuals with severe obesity: protocol for the Bariatric Surgery and Social Experiences (BaSES) study. BMJ open gastroenterology. ISSN 2054-4774. doi: 10.1136/bmjopen-2022-071332.
• Hjelmesæth, Jøran Sture; Torheim, Liv Elin & Arnesen, Erik Kristoffer (2023). Hva kreves av kunnskap før man gir kostholdsråd? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(11). doi: 10.4045/tidsskr.23.0451.
• Asbjørnsen, Rikke Aune; Børøsund, Elin; Hjelmesæth, Jøran Sture; Smedsrød, Mirjam Lien; Ollivier, Marianne & Wentzel, Jobke [Show all 8 contributors for this article] (2023). Engaging with eCHANGE - Users’ Experiences with an App-based Weight Loss Maintenance Intervention: A Pilot-Trial.
• Ødegård, Rønnaug Astri; Juliusson, Pétur Benedikt; Kokkvoll, Ane Sofie; Kristiansen, Hege; Köpp, Unni Mette Stamnes & Rolin, Johannes [Show all 9 contributors for this article] (2023). Ungdom med alvorlig fedme bør få legemiddel på blå resept. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 143(3), p. 1–4. doi: 10.4045/tidsskr.23.0069.
• Asbjørnsen, Rikke Aune; Børøsund, Elin; Hjelmesæth, Jøran Sture; Ollivier, Marianne; Smedsrød, Mirjam Lien & Wentzel, Jobke [Show all 9 contributors for this article] (2023). Long-term Weight Maintenance After Weight Loss: Preliminary Findings from the eCHANGE Pilot Trial . Show summary

  Annals of Behavioral Medicine, Volume 57, Issue Supplement_1, April 2023

• Rolin, Johannes; Ødegård, Rønnaug; Amundsen, Viktoria Vedeler; Køpp, Unni Mette; Kokkvoll, Ane Sofie & Juliusson, Pétur Benedikt [Show all 7 contributors for this article] (2022). Medikamentell tilleggsbehandling for vektreduksjon hos ungdom med alvorlig fedme. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 142(14), p. 1–3. doi: 10.4045/tidsskr.22.0540.
• Borgeraas, Heidi; Hofsø, Dag; Svanevik, Marius & Hjelmesæth, Jøran Sture (2022). Comment on “Effectiveness of Roux‑en‑Y Gastric Bypass vs Sleeve Gastrectomy on Lipid Levels in Type 2 Diabetes: a Meta‑analysis”. Journal of Gastrointestinal Surgery. ISSN 1091-255X. 26(9), p. 2031–2032. doi: 10.1007/s11605-022-05419-5.
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hofsø, Dag; Svanevik, Marius; Seip, Birgitte Karen Berggreen & Hjelmesæth, Jøran Sture (2022). Letter to the Editor regarding the article «Gerd symptoms after laparoscopic Roux-en-Y gastric bypass: an emerging scenario» by Antonella Santonicola, Luigi Ruggiero, Rossella Palma, Luigi Angrisani and Paola Iovino. International Journal of Obesity (2022) 46:1076–1078. International Journal of Obesity. ISSN 0307-0565. 46(10), p. 1936–1937. doi: 10.1038/s41366-022-01200-5.
• Hjelmesæth, Jøran Sture; Lund, Randi Størdal; Sagen, Jørn Vegard & Valderhaug, Tone Gretland (2022). Vektreduserende medisiner – for hvem, hvordan, hvor lenge? Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.22.0115. Show summary

  Medikamentell behandling av fedme gjennomgår en faglig revolusjon, og det kan være vanskelig å følge med. To relativt nye medikamenter som demper sult og øker metthetsfølelsen, kan nå forskrives av alle leger.

• Borgeraas, Heidi; Hofsø, Dag; Hertel, Jens Kristoffer & Hjelmesæth, Jøran Sture (2022). Addendum to: Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. ISSN 1467-7881. doi: 10.1111/obr.13432.
• Asbjørnsen, Rikke Aune; Ollivier, Marianne; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran Sture; Wentzel, Jobke & Clark, Matthew M. [Show all 8 contributors for this article] (2022). Design Features for Long Term Weight Loss Maintenance: User Experiences and Preferences from the eCHANGE Pilot Trial.
• Asbjørnsen, Rikke Aune; Wentzel, Jobke; Smedsrød, Mirjam Lien; Ollivier, Marianne; Hjelmesæth, Jøran & Gemert-Pijnen, Lisette Van [Show all 7 contributors for this article] (2021). Co-creating with patients and other stakeholders: design of an eHealth intervention to support long-term behavior change and weight loss maintenance (eCHANGE).
• Hjelmesæth, Jøran; Fatima, Farhat; Birkeland, Kåre I.; Svanevik, Marius & Hofsø, Dag (2020). Metabolic surgery: one size fits all? - Authors' reply . The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 8, p. 273–273. doi: 10.1016/S2213-8587(20)30027-9.
• Hjelmesæth, Jøran & Hertel, Jens Kristoffer (2020). Kommentar til "Den kvasse samtalen". Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.20.0199.
• Borgeraas, Heidi; Hofsø, Dag & Hjelmesæth, Jøran (2020). Comment on "Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis of Weight Loss, Comorbidities, and Biochemical Outcomes From Randomized Controlled Trials". Annals of Surgery. ISSN 0003-4932. 274(6). doi: 10.1097/SLA.0000000000003899.
• Barstad, Lisa Ha; Lund, Randi Størdal; Flakstad, Inger Marie; Johnson, Line Kristin; Aarvik, Andreas & Hertel, Jens Kristoffer [Show all 7 contributors for this article] (2020). Livsstilsendringskurs som fedmebehandling i spesialisthelsetjenesten - kvalitetssikring i praksis. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034.
• Asbjørnsen, Rikke Aune; Wentzel, Jobke; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Clark, Matthew & Van Gemert-Pijnen, Lisette [Show all 7 contributors for this article] (2020). Personalized eHealth technology for weight maintenance and long term behavior change.
• Asbjørnsen, Rikke Aune; Wentzel, Jobke; Smedsrød, Mirjam Lien; Ollivier, Marianne; Hjelmesæth, Jøran & Gemert-Pijnen, Lisette Van [Show all 7 contributors for this article] (2020). Co-creating with patients and other stakeholders: Design of an eHealth intervention to support long-term behavior change and weight loss maintenance .
• Mathisen, Therese Fostervold; Sundfør, Tine Mejlbo; Hjelmesæth, Jøran; Kaalstad, Jørn E. & Arnesen, Erik Kristoffer (2020). 5 eksperter: Slik holder du vekten nede. [Internet]. Vg.no.
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Wentzel, Jobke & Johnson, Line Kristin [Show all 15 contributors for this article] (2020). eHealth design: Which persuasive and behavior change techniques meet the user needs for weight maintenance support? Show summary

  Conference Theme: Finding Innovative Solutions for Tomorrow's Health Challenges

• Svanevik, Marius; Salte, Odd Bjørn; Risstad, Hilde; Hjelmesæth, Jøran; Høgestøl, Ingvild Kristine & Hertel, Jens Kristoffer [Show all 10 contributors for this article] (2019). BMI loss and resolution of diabetes five years after standard and distal roux-en-y gastric bypass. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 15, p. S115–S115.
• Johnson, Line Kristin; Sandbu, Rune; Robertsen, Ida; Åsberg, Anders; Andersson, Tommy & Andersson, Shalini [Show all 8 contributors for this article] (2019). Effect of gastric bypass and very-low energy diet on cardiometabolic risk factors. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 15, p. S114–S114. doi: 10.1016/j.soard.2019.08.232.
• Seeberg, Kathrine; Borgeraas, Heidi; Hertel, Jens Kristoffer; Grimnes, John Olav; Kvan, Nils Petter & Fatima, Farhat [Show all 10 contributors for this article] (2019). Gastric bypass and sleeve gastrectomy for hepatic steatosis in type 2 diabetes – a randomized controlled trial. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 15, p. S27–S28. doi: 10.1016/j.soard.2019.08.085.
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hertel, Jens Kristoffer; Karlsen, Tor-Ivar; Borgeraas, Heidi & Sandbu, Rune [Show all 10 contributors for this article] (2019). Gastroesophageal reflux disease in patients With severe obesity and type 2 diabetes one year after sleeve gastrectomy or roux-en-y gastric bypass. A Randomized controlled trial. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 15, p. S3–S3. doi: 10.1016/j.soard.2019.08.052.
• Angeles, Philip Carlo Soriano; Robertsen, Ida; Seeberg, Lars Thomas; Krogstad, Veronica; Sandbu, Rune & Åsberg, Anders [Show all 7 contributors for this article] (2019). Reply to letter: “What about drug bioavailability in patients who had bariatric surgery and dependent on immunosuppressives?”. Obesity Reviews. ISSN 1467-7881. 21(2). doi: 10.1111/obr.12954.
• Salte, O.B.; Svanevik, Marius; Risstad, H.; Hjelmesæth, Jøran; Høgestøl, Ingvild Kristine & Hertel, Jens Kristoffer [Show all 10 contributors for this article] (2019). Body mass index 5 years after standard and distal Roux-en-Y gastric bypass-preliminary results from a randomized controlled trial . Obesity Surgery. ISSN 0960-8923. 29.
• Mathisen, Therese Fostervold; Hjelmesæth, Jøran & Westeng, Kjersti (2019). Følger du «CICO-dietten», går du ned i vekt. Men ekspertene advarer klart mot å gjøre det. [Internet]. Nettavisen.
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Van Gemert-Pijnen, Lisette & Varsi, Cecilie [Show all 23 contributors for this article] (2019). eCHANGE - E-helseverktøy for å støtte opp om langvarig vedlikehold av vekttap.
• Skaug, Therese Doksheim; Mathisen, Therese Fostervold; Hjelmesæth, Jøran & Svihus, Birger (2019). Unngå magefett-fellene. [Newspaper]. Dagbladet.
• Meltzer, Helle Margrete; Torheim, Liv Elin; Arnesen, Erik Kristoffer; Øverby, Nina Cecilie; Mortensen, Kari Hege & Hjelmesæth, Jøran (2019). Påstander om EAT-Lancet-rapporten: Imøtegåelse eller illustrasjon? www.forskning.no.
• Meltzer, Helle Margrete; Torheim, Liv Elin; Arnesen, Erik Kristoffer; Øverby, Nina Cecilie; Mortensen, Kari Hege & Hjelmesæth, Jøran (2019). Mye av kritikken og fordømmelsen av EAT-Lancet-rapporten er basert på misforståelser. www.forskning.no.
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Solberg Nes, Lise ; Wentzel, Jobke; Varsi, Cecilie & Hjelmesæth, Jøran [Show all 7 contributors for this article] (2019). Weight maintenance: Finding effective combinations of persuasive and behavior change techniques stimulating motivation and adherence. Show summary

  Obesity and weight-loss maintenance (WM) is a major health challenge that requires novel solutions, as three out of four regain lost weight. Combining persuasive design principles (PSDs) with behavior change techniques(BCTs) in eHealth development could contribute to facilitate the behavior change needed.

• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Hjelmesæth, Jøran; Hertel, Jens Kristoffer; Gemert-Pijnen, Lisette Van & Varsi, Cecilie [Show all 21 contributors for this article] (2019). Building an eHealth intervention for weight maintenance after weight loss: Identifying behavioral design elements & user needs.
• Hjelmesæth, Jøran; Jakobsen, Gunn Signe & Nordstrand, Njord (2018). Bariatric surgery and hypertension. Journal of the American Medical Association (JAMA). ISSN 0098-7484. 319(23), p. 2441–2441. doi: 10.1001/jama.2018.4446.
• Busetto, Luca; Dicker, Dror; Azran, Carmil; Batterham, Rachel L.; Farpour-Lambert, Nathalie & Fried, Martin [Show all 13 contributors for this article] (2018). Obesity Management Task Force of the European Association for the Study of Obesity Released “Practical recommendations for the post-bariatric surgery medical management”. Obesity Surgery. ISSN 0960-8923. 28, p. 2117–2121. doi: 10.1007/s11695-018-3283-z.
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Sieverink, Floor; Hjelmesæth, Jøran; Hertel, Jens Kristoffer & Varsi, Cecilie [Show all 8 contributors for this article] (2018). Enabling and supporting behavior change through persuasive health technology.
• Asbjørnsen, Rikke Aune; Smedsrød, Mirjam Lien; Sieverink, Floor; Hjelmesæth, Jøran; Hertel, Jens Kristoffer & Varsi, Cecilie [Show all 8 contributors for this article] (2018). Supporting health by technology - an innovative service design approach using eHealth to engage users, improve health and health services.
• Hjelmesæth, Jøran; Arnesen, Erik Kristoffer; Retterstøl, Kjetil & Torheim, Liv Elin (2017). Statens kostråd forebygger overvekt. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116.
• Torheim, Liv Elin; Arnesen, Erik Kristoffer & Hjelmesæth, Jøran (2017). Norske kostråd er helsefremmende og trygge. Dagbladet. ISSN 0805-3766.
• Hjelmesæth, Jøran & Johnson, Line Kristin (2017). Indremedisin I & II, Indremedisin I & II. Forlaget Vett & Viten AS. ISSN 9788241207402. p. 143–152.
• Juliusson, Petur Benedikt; Hjelmesæth, Jøran; Bjerknes, Robert & Roelants, Mathieu (2017). Nye kurver for kroppsmasseindeks blant barn og unge. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 137(18), p. 1397–1398. doi: 10.4045/tidsskr.17.0570.
• Arnesen, Erik Kristoffer; Hjelmesæth, Jøran Sture; Torheim, Liv Elin; Holven, Kirsten Bjørklund; Mortensen, Kari Hege & Korsæth, Audun (2021). Ekspertuttalelse om fett fra Nasjonalt råd for ernæring. Helsedirektoratet.
• Giske, Liv; Stoinska-Schneider, Anna; Hjelmesæth, Jøran; Mala, Tom; Arentz-Hansen, Eva Helene & Elvsaas, Ida-Kristin Ørjasæter [Show all 10 contributors for this article] (2018). Fedmekirurgi ved diabetes type 2 og kroppsmasseindeks under 35 - fullstendig metodevurdering. Folkehelseinstituttet. ISSN 978‐82‐8082‐910‐8. Full text in Research Archive

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