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All print, broadcast and online journalists who receive the Obesity embargo alert agree to abide by the embargo and may not publish, post, broadcast or distribute embargoed news releases or details of the embargoed studies before the embargo date and time.

When writing about these studies, journalists are asked to attribute the source as the journal Obesity and to include the online link to the Obesity articles as provided below. Links become active when articles post at 3:00 a.m. (EST) on March 23, 2020, unless indicated differently below.

Editors' Choice 1 -How Does Mental Health Influence Surgery Selection and Outcomes?, Michael D. Morledge and Walter J. Pories, poriesw@ecu.edu 

Editors' Choice 2 - Highly Selective SGLT2 Inhibitor in Patients with Obesity, T2DM, Steven B. Heymsfield, Annaswamy Raji, Silvina Gallo, Jie Liu, Annpey Pong, Hakima Hannachi, and Steven G. Terra, steven.g.terra@pfizer.com 

Editors' Choice 3 -New Meta-Analysis on Antibiotics During Pregnancy and Infancy, Shengrong Wan, Man Guo, Ting Zhang, Qing Chen, Maoyan Wu, Fangyuan Teng, Yang Long, Zongzhe Jiang, Jiangzongzhe555@126.com, and Yong Xu, xywyll@aliyun.com

Editors' Choice 4 -Biobehavioral Regulation and Childhood Growth Trajectories, Lori A. Francis, laf169@psu.edu, Brandi Y. Rollins, Crystal I. Bryce, and Douglas A. Granger 

ADDITIONAL EMBARGOED RESEARCH

Incidence of Depression and First-line Antidepressant Therapy in People with Obesity and Depression in Primary Care, Freya Tyrer, fct2@le.ac.uk, Francesco Zaccardi, Kamlesh Khunti, and Richard Moriss - embargo lifts April 8 at 3:00 a.m. (EST)

Scroll down to find abstracts for each of the above papers. To request the full text of any of these studies and agree to the embargo policy, or to arrange an interview with a study's author or an obesity expert, please contact communications@obesity.org.

Editors' Choice Abstracts

Editors' Choice 1 - Mental Health in Bariatric Surgery: Selection, Access, and Outcomes

Severe obesity has many psychiatric consequences that can be influenced by bariatric surgery. The goal of this article is to review these challenges, including the mental health status of patients with severe obesity, the evaluation of surgical candidates, and the early and late effects of the operations, and to offer some recommendations to manage these challenges. The failure of the insurance-mandated preoperative psychosocial evaluation is also discussed.

Editors' Choice 2 - Efficacy and Safety of Ertugliflozin in Patients with Overweight and Obesity with Type 2 Diabetes Mellitus

Objective: This study aimed to evaluate ertugliflozin in patients with overweight and obesity with type 2 diabetes mellitus.

Methods: Data from three placebo-controlled, randomized, Phase 3 studies were pooled. Patients with baseline BMI ≥ 25 (1,377/1,544; 89%) were assessed with stratification by BMI subgroup.

Results: At week 26, reductions from baseline in glycated hemoglobin A1c (HbA1c), fasting plasma glucose, body weight (BW), and systolic blood pressure (SBP) were greater with ertugliflozin versus placebo. For placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively, the least-squares mean change was 0.1%, -0.8%, and -0.9% for HbA1c and -1.2 kg, -3.1 kg, and -3.2 kg for BW. HbA1c reductions were consistent across BMI subgroups. For ertugliflozin 5 mg and 15 mg, the least-squares mean change (placebo adjusted) in absolute BW was -1.4 kg and -1.2 kg for BMI 25 to < 30, -1.8 kg and -1.9 kg for BMI 30 to < 35, and -2.5 kg and -2.9 kg for BMI ≥ 35. Percent BW changes were similar across BMI subgroups. The incidence of adverse events was 52.5%, 44.6%, and 50.1% with placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg, respectively.

Conclusions: Meaningful reductions in HbA1c, fasting plasma glucose, BW, and SBP were observed with ertugliflozin in patients with overweight and obesity with type 2 diabetes mellitus. Ertugliflozin improved HbA1c and SBP and reduced BW across BMI subgroups. Ertugliflozin was generally well tolerated.

Editors' Choice 3 - Impact of Exposure to Antibiotics During Pregnancy and Infancy on Childhood Obesity: A Systematic Review and Meta-Analysis

Objective: This study aimed to investigate whether antibiotic exposure during pregnancy and infancy was associated with childhood overweight or obesity.

Methods: PubMed, Embase, and Cochrane Library databases were searched from the inception date to April 18, 2019, to identify observational studies that investigated the association between antibiotic exposure during pregnancy and infancy and childhood overweight or obesity. After study selection and data extraction, the meta-analysis was conducted using Stata software version 12.0 (StataCorp LP, College Station, Texas). The evaluation of the methodological quality was carried out by AMSTAR 2 (Bruyère Research Institute, Ottawa, Ontario, Canada).

Results: A total of 23 observational studies involving 1,253,035 participants were included. The meta-analysis showed that prenatal exposure to antibiotics was not significantly associated with childhood overweight or obesity, whereas an increased risk of overweight or obesity was seen in a subgroup analysis of the second trimester (risk ratio = 1.13; 95% CI: 1.06-1.22; P = 0.001). In contrast, antibiotic exposure during infancy could increase the risk of childhood overweight or obesity (risk ratio = 1.14; 95% CI: 1.06-1.23; P = 0.001).

Conclusions: This meta-analysis found that antibiotic exposure during the second trimester and infancy could increase the risk of childhood overweight or obesity.

Editors' Choice 4 - Biobehavioral Dysregulation and its Association with Obesity and Severe Obesity Trajectories from 2 to 15 Years of Age: A Longitudinal Study

Objective: This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership.

Methods: A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between the ages of 15 months and 15 years. Behavioral self-regulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years.

Results: Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self-regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years.

Conclusions: Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand the resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.

ADDITIONAL EMBARGOED RESEARCH

Incidence of Depression and First‐line Antidepressant Therapy in People with Obesity and Depression in Primary Care

Objective: The aim of this study was to describe age‐ and gender‐specific incidence of depression, the dose‐response relationship between BMI and risk of depression (Cox proportional hazards), an antidepressant drug prescribing in adults who have overweight or obesity.

Methods: A retrospective electronic health record study using the Clinical Practice Research Datalink was conducted to identify adults with overweight and obesity (≥ 18 years) with incident depression (no prior depression diagnosis in their records), followed up from 2000 to 2019.

Results: Among 519,513 adults, the incidence of depression was 9.2 per 1,000 person‐years and was higher in women and in 40‐ to 59‐year‐old men who had severe obesity. Compared with having overweight, the hazard of depression increased with each BMI category as follows: 1.13 (30‐34 kg/m2; 95% CI: 1.10‐1.16), 1.34 (35‐39 kg/m2; 1.29‐1.40), 1.51 (40‐44 kg/m2; 1.41‐1.61), and 1.67 (45‐49 kg/m2; 1.48‐1.87), attenuating at BMI 50+ kg/m2 (1.54; 2.91‐1.84). Antidepressants were prescribed as first‐line therapy in two‐thirds (66.3%) of cases. Prescriptions for fluoxetine reduced over time (20.4% [2000]; 8.8% [2018]), and prescriptions for sertraline increased (4.3% [2000]; 38.9% [2018]).

Conclusions: We recommend guidance on antidepressant drug prescribing and specific services for people with obesity and depression that address both symptoms and behaviors.