Objective The aim of this study was to compare changes in gastrointestinal hormones and appetite ratings after a similar weight loss induced by a very low‐energy diet alone or in combination with sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB). Methods Patients with severe obesity scheduled for SG (n = 15) and RYGB (n = 14) and 15 controls (very low‐energy diet alone) were recruited. Body weight/composition, plasma concentrations of ß‐hydroxybutyric acid, acylated ghrelin, total glucagon‐like peptide‐1, total peptide YY, cholecystokinin, and ratings of hunger, fullness, desire to eat, and prospective food consumption were measured pre‐ and postprandially, before and after 10 weeks of intervention. Results Changes in body weight/composition and level of ketosis were similar across groups. In SG and RYGB, basal and postprandial acylated ghrelin declined, and postprandial glucagon‐like peptide‐1 increased, both significantly more compared with controls. Postprandial peptide YY increased in all groups. Overall, postprandial hunger decreased, and postprandial fullness increased. But ratings of desire to eat and prospective food consumption were more favorable after both surgeries compared with controls. Conclusions Weight loss with SG and RYGB leads to more favorable changes in gastrointestinal hormones compared with diet alone, although ratings of appetite were reduced across all groups.

Objective The aim of this study was to compare changes in hedonic hunger and food reward in individuals with severe obesity achieving 10% to 15% weight loss with a very low‐energy diet (VLED) alone or VLED and bariatric surgery. Methods Patients scheduled for sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB) initiated a VLED 2 weeks prior to surgery and continued the diet for 8 weeks postoperatively. BMI‐matched controls underwent a VLED for 10 weeks. Hedonic hunger was assessed with the Power of Food Scale, and food reward with the Leeds Food Preference Questionnaire, pre and post intervention. Results A total of 44 participants completed the study: 15 SG, 14 RYGB, and 15 controls (61%, 79% and 69% females, respectively; BMI: 40.5 ± 0.5 kg/m2; age: 43.9 ± 1.4 years). Average weight loss was 18.3 ± 0.6 kg (16%), comprising 13.5 ± 0.5 kg fat mass, with no significant differences between groups. Similar reductions in hedonic hunger were observed in all groups. Overall, food reward was similarly reduced in SG and RYGB groups, whereas controls showed little or no change. Conclusions Independent of modality, weight loss seems to reduce hedonic hunger, but bariatric surgery leads to several additional favorable changes in food reward and preferences.

Background One kind of overutilization of diagnostic imaging is low-value imaging, i.e., imaging that does not lead to altered clinical pathways or improved health outcomes. Despite having well-documented extension and consequences, low-value imaging is still widespread. The objective of this study was to identify the drivers for the use of low-value imaging in the Norwegian healthcare services. Methods We conducted individual, semi-structured interviews among representatives from the health authorities, general practitioners, specialists working in hospitals, radiologists, radiographers, and managers of imaging departments. Data analysis was carried out in line with framework analysis consisting of five steps: Familiarization, indexing, charting, mapping, and interpretation. Results The analysis included 27 participants and resulted in two themes. The stakeholders identified drivers in the healthcare system and in the interaction between radiologists, referrers, and patients. The identified drivers were categorized in sub-themes, such as organization, communication, competence, expectations, defensive medicine, roles and responsibilities, and referral quality and time constraints. The drivers interact with each other and may strengthen the effect of other drivers. Conclusions Several drivers for low-value imaging in Norway were identified at all levels of the healthcare system. The drivers work simultaneously and synergistically. To free resources for high-value imaging, drivers should be targeted by appropriate measures at several levels to reduce low-value imaging.

Background Even though imaging is essential to modern medicine, some examinations are of low value as they do not lead to any change in the management of the patient. The Choosing Wisely (CW) campaign aims to reduce the use of such services. In the Norwegian version of CW, specific magnetic resonance imaging (MRI) of the head, lower back, and knee are amongst others identified as potential low-value examinations. However, referral practice and access to imaging may drive low-value utilisation. By using registry data from 2019 and descriptive analysis, this study aimed to examine the role of referral practice and access to imaging on the use of specific CW-examinations in one representative area in Norway. Results A total of 237,554 examinations were performed by four public and two private imaging facilities located within the area. Forty-two percent (19,210/45,289) of all MRI examinations were related to CW. Private imaging centres performed most of the CW-imaging. A total of 3700 referrers were identified, and 2.3% were identified as “high-referrers,” accounting for 33% of all CW-examinations. Referrers’ experience did not influence imaging utilisation. A subset of referrers (“super-referrers,” 0.5%) accounted for 10% of CW-examinations. Distance to service had no impact on the use of CW-examinations. Conclusions This study provides valuable insight into the use of imaging and referral practice in one representative area in Norway. A great variation in referral practice was observed. Therefore, targeting referrers with high referral rates may be a promising strategy for reducing the use of low-value imaging.

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