She studies life after weight loss surgery

As a general practitioner, Karin Mossberg meets patients with a wide range of conditions. Continuity of care – following patients over time – was one reason she chose to specialise in general practice.

“I enjoy having a lot of patient contact. Seeing the whole person, not just a single diagnosis, and building a relationship over time. That’s what makes this profession so meaningful to me,” she says. 

One group of patients she sees regularly are those who have undergone bariatric surgery, commonly known as weight-loss surgery. Around 5,000 procedures are performed in Sweden each year. The most common methods are gastric bypass, where part of the stomach and small intestine are bypassed, and gastric sleeve, where a large portion of the stomach is removed.

Patients are followed at a surgical clinic for the first two years. After that, they should receive lifelong follow-up in primary care. Among other things, they risk deficiencies in iron and calcium, which could eventually lead to anaemia and osteoporosis. Other potential side effects include poor oral health and mental health issues – but more research is needed.

A wide-ranging study

It was the lack of knowledge that prompted Karin Mossberg to begin researching the field.

“It started with a clinical frustration. Previously, it was unclear to me how to handle the follow-up after weight-loss surgery. Quite a few of the patients are young. In Sweden, children from the age of 15 undergo surgery,” she says.

In 2015, the BASUN study was launched, for which Karin Mossberg is now the principal investigator. The study follows nearly a thousand individuals who have received either medical or surgical treatment for obesity. 

Originally focused on nutritional deficiencies, the study has expanded to include everything from care demands, bone health and eating behaviours, to mental health, substance abuse and suicide risk. The study will also investigate if obesity-related conditions decrease, such as diabetes and high blood pressure.

“We’ve found that 12–15 per cent developed anaemia, despite half of them taking iron supplements, which is quite remarkable. We have several articles based on our five-year data under review, which I hope will be published this autumn or early next year,” she says.

Image

Collaborating with Mayo Clinic

Karin Mossberg is also running two smaller studies related to follow-up after bariatric surgery. One is an exploratory study reviewing medical records to examine what patients seek care for.

“My clinical impression is that patients sometimes seek help for quite unspecific issues. The aim is to see whether there’s something we need to identify and investigate further, so we don’t miss anything important,” she says. 

The second study focuses on primary care staff and explores their experiences and knowledge in following up with these patients. It’s a joint effort between researchers at Karolinska Institutet and the Mayo Clinic in the United States. The study also includes later weight regain.

“International research shows that quite a few patients regain part of the weight they initially lost. The proportion and amount vary across studies. Some patients regain all the weight. It’s important that healthcare professionals know how to follow this up in a way that isn’t stigmatising,” she says.

Strong societal forces

Karin Mossberg works clinically at Herrestad Healthcare Centre in Uddevalla. Nowadays, however, she spends most of her time in Gothenburg. Last year, she was appointed senior lecturer in general practice, which includes responsibility for semester 12 of the new medical programme. She is also active in several clinical associations and has contributed to the development of a new national knowledge support for obesity care, to be published later this year.

“It’s a bit unclear where to draw the line for obesity. Everyone agrees that BMI is a poor measure, but we currently don’t have a better alternative. That means different countries set the BMI threshold somewhat differently,” she says.

The new obesity drugs introduced in recent years may reshape how care is delivered. But deciding who should have access remains a challenge. Karin Mossberg points to some concerning calculations. If the drugs were offered to everyone with a BMI over 27 who has a related condition – as suggested by pharmaceutical companies – it would consume most of the healthcare budget.

“We have a responsibility to treat the patients who need care the most and who will benefit from it. The challenge is identifying them. There are many factors to consider and powerful forces at play, not least pharmaceutical companies and societal norms around what a body should look like.”

Started with preclinical research

Karin Mossberg describes herself as curious and developed an early interest in research. She began conducting research during medical school and was offered a PhD position at the end of her studies.

In her dissertation, she investigated a protein linked to an increased risk of blood clots at elevated levels, commonly seen in obesity, high blood pressure, and type 2 diabetes. The protein is normally produced in platelets, but she demonstrated that it’s also produced in fat tissue when levels are high.

She initially considered specializing in internal medicine but changed direction during her medical internship. Transitioning from preclinical research to general practice wasn’t easy. 

“It was quite tough. Suddenly, I was on my own and had to start over. At times, it felt like everything was working against me. I didn’t receive any grants and considered giving up research,” she shares.

With support from the R&D unit for Primary and Healthcare in Region Västra Götaland, she gradually managed to build a new platform.

“If I were to give younger researchers one piece of advice, it would be to invest early in building a strong network. It really pays off. Most people want to grow by collaborating with others,” she says.

A broader view of health

The BASUN study will conclude in 2027. Karin Mossberg is currently reflecting on how she wants to shape her future research. She plans to continue working in the field of obesity and follow up on the new obesity medications, while also broadening her focus within general medicine.

Image

Research has changed Karin Mossberg’s view of health – including her own. At the core, she believes it’s about finding one’s personal balance in life and avoiding extremes. She emphasizes that quality of life involves many aspects, not least relationships.

“When we talk about health, it often becomes somewhat superficial. Health is so much more than how you eat, exercise, and sleep. That’s something you truly come to understand as a general practitioner. Sometimes, when I read health guidelines, I feel they don’t match the reality of people’s everyday lives. As a doctor, I must meet people where they are — and that also means meeting myself where I am,” she says.

TEXT: KARIN ALLANDER