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Courcoulas AP, Stefater MA, Shirley E, Gourash WF, Stylopoulos N. The Feasibility of Examining the Effects of Gastric Bypass Surgery on Intestinal Metabolism: Prospective, Longitudinal Mechanistic Clinical Trial. JMIR Res Protoc 2019; 8:e12459. [PMID: 30679147 PMCID: PMC6483060 DOI: 10.2196/12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/01/2023] Open
Abstract
Background Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), is the best treatment for severe obesity and its complications including type 2 diabetes mellitus (T2DM). Understanding the mechanisms responsible for the beneficial metabolic effects will help to engineer ways to improve the procedure or produce these effects without surgery. Objective The aim is to present data on recruitment and feasibility of a translational study designed to collect intestinal samples before and after bariatric surgery. The goal of biobanking is to allow future studies to test the hypothesis that the mechanism of action of RYGB involves specific changes in the postsurgical short- and long-term metabolism and morphology of the jejunum (Roux limb). Specifically, to test whether the intestine enhances its metabolism and activity after RYGB and increases its fuel utilization, we designed a prospective, longitudinal study, which involved the recruitment of candidates for RYGB with and without T2DM. We describe the tissue bank that we have generated, and our experience, hoping to further facilitate the performance of longitudinal mechanistic studies in human patients undergoing bariatric surgery and especially those involving post-RYGB intestinal biology. Methods We conducted a trial to characterize the effects of RYGB on intestinal metabolism. Intestinal tissue samples were collected from the jejunum at surgery, 1, 6, and 12 months postoperatively for the analysis of intestinal gene expression and metabolomic and morphologic changes. The target number of patients who completed at least the 6-month follow-up was 26, and we included a 20% attrition rate, increasing the total number to 32. Results To enroll 26 patients, we had to approach 79 potential participants. A total of 37 agreed to participate and started the study; 33, 30, and 26 active participants completed their 1-month, 6-month, and 12-month studies, respectively. Three participants withdrew, and 30 participants are still active. Altruism and interest in research were the most common reasons for participation. Important factors for feasibility and successful retention included (1) large volume case flow, (2) inclusion and exclusion criteria broad enough to capture a large segment of the patient population but narrow enough to ensure the completion of study aims and protection of safety concerns, (3) accurate assessment of willingness and motivation to participate in a study, (4) seamless integration of the recruitment process into normal clinical flow, (5) financial reimbursement and nonfinancial rewards and gestures of appreciation, and (6) nonburdensome follow-up visits and measures and reasonable time allotted. Conclusions Human translational studies of the intestinal mechanisms of metabolic and weight changes after bariatric surgery are important and feasible. A tissue bank with unique samples has been established that could be used by investigators in many research fields, further enabling mechanistic studies on the effects of bariatric surgery. Trial Registration ClinicalTrials.gov NCT02710370; https://clinicaltrials.gov/ct2/show/NCT02710370 (Archived by WebCite at http://www.webcitation.org/75HrQT8Dl)
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Affiliation(s)
| | | | - Eleanor Shirley
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - William F Gourash
- University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Takemoto E, Wolfe BM, Nagel CL, Boone-Heinonen J. Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients. Obesity (Silver Spring) 2018; 26:1807-1814. [PMID: 30358155 PMCID: PMC6817972 DOI: 10.1002/oby.22312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study sought to determine changes in the prevalence of comorbid disease following bariatric surgery in Medicaid patients compared with commercially insured patients. METHODS Data were obtained from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery at one of six geographically diverse centers in the United States. A total of 1,201 patients who underwent Roux-en-Y gastric bypass with 5 years of follow-up were identified. Poisson mixed models were used to estimate relative risks (RRs) and compare changes in common comorbidities between insurance groups within 0-1 and 1-5 years post surgery. Propensity scores were used to achieve balance in the baseline comorbidity burden between Medicaid and commercial patients. RESULTS In the first year, risk of all six comorbidities decreased substantially over time in both groups, ranging from a 32% to a 69% decrease from baseline. After 1 year post surgery, the risk of disease was stable in both groups (RRs ranged from 1.0 to 1.1). After propensity score weighting, the RRs in the first year were more similar in magnitude, while the RRs in the 1- to 5-year period were unchanged. CONCLUSIONS These results suggest that Medicaid patients experience a medium-term reduction in comorbid disease after bariatric surgery.
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Affiliation(s)
- Erin Takemoto
- Oregon Health & Science University—Portland State University School of Public Health 3181 SW Sam Jackson Park Rd., Mail Code CB669 Portland, OR 97239-3098
| | - Bruce M. Wolfe
- Oregon Health & Science University School of Medicine Department of Surgery, Portland, OR
| | - Corey L. Nagel
- University of Arkansas for Medical Sciences School of Nursing Little Rock, AR
| | - Janne Boone-Heinonen
- Oregon Health & Science University—Portland State University School of Public Health 3181 SW Sam Jackson Park Rd., Mail Code CB669 Portland, OR 97239-3098
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Martin WP, Docherty NG, le Roux CW. Impact of bariatric surgery on cardiovascular and renal complications of diabetes: a focus on clinical outcomes and putative mechanisms. Expert Rev Endocrinol Metab 2018; 13:251-262. [PMID: 30231777 PMCID: PMC6773600 DOI: 10.1080/17446651.2018.1518130] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cardiovascular and renal disease accounts for a substantial proportion of the morbidity and mortality associated with obesity and type 2 diabetes mellitus (T2DM). Bariatric surgery is associated with improved long-term cardiovascular and renal outcomes. AREAS COVERED All major case-control, cohort, and randomized controlled trial studies of bariatric surgery in adults with T2DM were screened and data on prespecified cardiovascular and renal outcomes collated. Bariatric surgery reduces all-cause mortality and risk of cardiovascular disease, albuminuria and progressive chronic kidney disease. Patients with poorer glycemic control and established microvascular disease preoperatively may stand to benefit the most from the surgical approach. Reduced sympathetic drive, remission of glomerular hypertension, enhanced natriuresis, gut microbiota shifts, reduced systemic and renal inflammation, improved lipoprotein profiles, and reductions in chronic cardiac remodeling may all be implicated. EXPERT COMMENTARY Ongoing RCTs of bariatric surgery selectively recruiting patients with class 1 obesity and established microvascular complications of diabetes will help to better characterize which subgroups of patients benefit most from this effective therapy.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Neil G. Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Investigative Science, Imperial College London, UK
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Ahmed B, King WC, Gourash W, Belle SH, Hinerman A, Pomp A, Dakin G, Courcoulas AP. Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study. Surgery 2018; 164:774-783. [PMID: 30139560 DOI: 10.1016/j.surg.2018.06.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Data from a US multicenter longitudinal study of bariatric surgery were used to compare weight change (primary outcome) and comorbidities (secondary outcome) in patients who underwent sleeve gastrectomy versus Roux-en-Y gastric bypass. METHODS This study includes participants who underwent sleeve gastrectomy and matched participants who underwent Roux-en-Y gastric bypass from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. Adults undergoing initial bariatric surgical procedures between 2006 and 2009 were enrolled. Participants who underwent sleeve gastrectomy were high-risk or superobese and intended to have a second-stage procedure. Mixed models were used to evaluate percent weight change from baseline through 7 years, and diabetes, dyslipidemia, and hypertension prevalence through 5 years. RESULTS Fifty-seven of 59 participants who underwent sleeve gastrectomy were matched one to one. Most were female (68%) and white (81%), and had a median age of 49 (37-56) years and median body mass index of 56.4 (35.5-76.8) kg/m2 presurgery. Weight loss was significantly less 1 to 7 years after sleeve gastrectomy versus matched Roux-en-Y gastric bypass (eg, year 7 mean weight loss was 23.6% vs 30.4%, respectively; P = .001). For both surgical groups, prevalence of diabetes, low high-density lipoprotein, and hypertension were significantly (P < .05) lower 5 years postsurgery versus baseline. CONCLUSION Higher-risk or super-obese participants after sleeve gastrectomy lost less weight than did matched Roux-en-Y gastric bypass counterparts throughout 7 years. Both groups exhibited improvements in comorbidities from presurgery through 5 years.
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Affiliation(s)
- Bestoun Ahmed
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Wendy C King
- Graduate School of Public Health, Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - William Gourash
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Steven H Belle
- Graduate School of Public Health, Epidemiology & Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Amanda Hinerman
- Graduate School of Public Health, Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Alfons Pomp
- Department of Surgery, Division of GI, Metabolic & Bariatric Surgery, Weill Cornell Medicine, New York, NY
| | - Greg Dakin
- Department of Surgery, Division of GI, Metabolic & Bariatric Surgery, Weill Cornell Medicine, New York, NY
| | - Anita P Courcoulas
- Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Davidson LE, Yu W, Goodpaster BH, DeLany JP, Widen E, Lemos T, Strain GW, Pomp A, Courcoulas AP, Lin S, Janumala I, Thornton JC, Gallagher D. Fat-Free Mass and Skeletal Muscle Mass Five Years After Bariatric Surgery. Obesity (Silver Spring) 2018; 26:1130-1136. [PMID: 29845744 PMCID: PMC6014876 DOI: 10.1002/oby.22190] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated changes in fat-free mass (FFM) and skeletal muscle 5 years after surgery in participants from the Longitudinal Assessment of Bariatric Surgery-2 trial. METHODS A three-compartment model assessed FFM, and whole-body magnetic resonance imaging (MRI) quantified skeletal muscle mass prior to surgery (T0) and 1 year (T1), 2 years (T2), and 5 years (T5) postoperatively in 93 patients (85% female; 68% Caucasian; age 44.2 ± 11.6 years) who underwent gastric bypass (RYGB), sleeve gastrectomy, or adjustable gastric band. Repeated-measures mixed models were used to analyze the data. RESULTS Significant weight loss occurred across all surgical groups in females from T0 to T1. FFM loss from T0 to T1 was greater after RYGB (mean ± SE: -6.9 ± 0.6 kg) than adjustable gastric band (-3.5 ± 1.4 kg; P < 0.05). Females with RYGB continued to lose FFM (-3.3 ± 0.7 kg; P < 0.001) from T1 to T5. A subset of males and females with RYGB and MRI-measured skeletal muscle showed similar initial FFM loss while maintaining FFM and skeletal muscle from T1 to T5. CONCLUSIONS Between 1 and 5 years following common bariatric procedures, FFM and skeletal muscle are maintained or decrease minimally. The changes observed in FFM and muscle during the follow-up phase may be consistent with aging.
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Affiliation(s)
- Lance E. Davidson
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - Wen Yu
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Bret H. Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - James P. DeLany
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Widen
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX
| | - Thaisa Lemos
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Gladys W. Strain
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alfons Pomp
- GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Anita P. Courcoulas
- General Surgery, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Lin
- Center for Family and Community Medicine, Columbia University Medical Center, New York, New York, USA
| | - Isaiah Janumala
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | | | - Dympna Gallagher
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
- Institute of Human Nutrition, Columbia University, New York, New York, USA
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Ribeiro GANDA, Giapietro HB, Belarmino LB, Salgado-Junior W. DEPRESSION, ANXIETY, AND BINGE EATING BEFORE AND AFTER BARIATRIC SURGERY: PROBLEMS THAT REMAIN. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1356. [PMID: 29947690 PMCID: PMC6050001 DOI: 10.1590/0102-672020180001e1356] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the number of surgeries increases and the elapsed time of the realization increases as well, the postoperative evaluations would become increasingly necessary. AIM To assess the psychological profile before and after surgery. METHODS Were evaluated 281 patients from the public service of bariatric surgery. In this study, 109 patients completed the evaluations before surgery (T0) and up to 23 months after surgery (T1); 128 completed the evaluations in T0 and between 24 months and 59 months after surgery (T2); and 44 completed the evaluations in T0 and 60 months after surgery (T3). A semi-structured interview, the Beck Depression Inventory (BDI), Beck Anxiety (BAI), and the Binge Eating Scale (BES) were used. RESULTS There was a higher prevalence of female (83%), patients with less than 12 years of education (83%), and patients who have a partner (64%). Analyzing all times of evaluation, regarding anxiety, depression, and binge eating, there was a reduction in all symptoms in T1, pointing to significant improvements in the first 23 months after surgery. Already, in T2 and T3, there was an increase in all indicators of anxiety, depression, and binge eating pointing to the transient impact of weight loss or bariatric surgery on these symptoms. CONCLUSIONS This study shows the importance of the continuous psychological evaluation and needs for the appropriate interventions for these patients who have undergone bariatric surgery, even after weight loss.
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Affiliation(s)
| | - Helenice Brizolla Giapietro
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| | - Lídia Barbieri Belarmino
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| | - Wilson Salgado-Junior
- Service of Bariatric Surgery, Hospital das Clínicas, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
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Takemoto E, Wolfe BM, Nagel CL, Pories W, Flum DR, Pomp A, Mitchell J, Boone-Heinonen J. Insurance status differences in weight loss and regain over 5 years following bariatric surgery. Int J Obes (Lond) 2018; 42:1211-1220. [PMID: 29892045 DOI: 10.1038/s41366-018-0131-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/14/2018] [Accepted: 05/09/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effectiveness of bariatric surgery among Medicaid beneficiaries, a population with a disproportionately high burden of obesity, remains unclear. We sought to determine if weight loss and regain following bariatric surgery differed in Medicaid patients compared to commercial insurance. SUBJECTS/METHODS Data from the Longitudinal Assessment of Bariatric Surgery, a ten-site observational cohort of adults undergoing bariatric surgery (2006-2009) were examined for patients who underwent Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Band (LAGB), or Sleeve Gastrectomy (SG). Using piecewise spline linear mixed-effect models, weight change over 5 years was modeled as a function of insurance type (Medicaid, N = 190; commercially insured, N = 1448), time, procedure type, and sociodemographic characteristics; additionally, interactions between all time, insurance, and procedure type indicators allowed time- and procedure-specific associations with insurance type. For each time-spline, mean (kg) difference in weight change in commercially insured versus Medicaid patients was calculated. RESULTS Medicaid patients had higher mean weight at baseline (138.3 kg vs. 131.2 kg). From 0 to 1 year post-operatively, Medicaid patients lost similar amounts of weight to commercial patients following all procedure types (mean weight Δ difference [95% CI]: RYGB: -0.9 [-3.2, 1.4]; LAGB: -1.5 [-6.7, 3.8]; SG: 5.1 [-4.0, 14.2]). From 1 to 3 years post-operatively Medicaid and commercial patients continued to experience minimal weight loss or began to slowly regain weight (mean weight Δ difference [95% CI]: RYGB: 0.9 [0.0, 2.0]; LAGB: -2.1 [-4.2, 0.1]; SG: 0.7 [-3.0, 4.3]). From 3 to 5 years post-operatively, the rate of regain tended to be faster among commercial patients compared to Medicaid patients (mean weight Δ difference [95% CI]: RYGB: 1.1 [0.1, 2.0]; LAGB: 1.5 [-0.5, 3.5]; SG: 1.0 [-2.5, 4.5]). CONCLUSIONS Although Medicaid patients had a higher baseline weight, they achieved similar amounts of weight loss and tended to regain weight at a slower rate than commercial patients.
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Affiliation(s)
- Erin Takemoto
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.
| | - Bruce M Wolfe
- Oregon Health & Science University School of Medicine Department of Surgery, Portland, OR, USA
| | - Corey L Nagel
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA
| | - Walter Pories
- East Carolina University School of Medicine Department of Surgery, Greenville, NC, USA
| | - David R Flum
- University of Washington Department of Surgery, Seattle, WA, USA
| | - Alfons Pomp
- Weill Cornell Medical College Department of Surgery, New York, NY, USA
| | | | - Janne Boone-Heinonen
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA
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Ames GE, Heckman MG, Diehl NN, Shepherd DM, Holgerson AA, Grothe KB, Kellogg TA, Bowers SP, Clark MM. Guiding Patients Toward the Appropriate Surgical Treatment for Obesity: Should Presurgery Psychological Correlates Influence Choice Between Roux-en-Y Gastric Bypass and Vertical Sleeve Gastrectomy? Obes Surg 2018; 27:2759-2767. [PMID: 28815388 DOI: 10.1007/s11695-017-2876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Helping patients determine which type of bariatric surgery, Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG), may be the best treatment can be challenging. This study investigated psychological correlates and their influence on weight loss for patients who underwent RYGB or VSG. METHODS Four hundred twenty-two patients (RYGB = 305; VSG = 117) completed screening questionnaires presurgery and underwent surgery between August 2012 and April 2015. Associations between demographics and questionnaires with percentage weight change were evaluated using multivariable linear regression models. RESULTS Median age was 48 years and median BMI 45.3 kg/m2 presurgery. Median percentage changes in weight from baseline to years 1 and 2 follow-up were - 31.5% (range - 52.2 to - 9.2%) and - 31.2% (range - 50.0 to - 1.2%) for RYGB and 25.3% (range - 49.8 to - 4.7%) and - 23.3% (range - 58.9 to - 1.6%) for VSG, respectively. Linear regression models revealed that younger patients lost more weight than older patients at years 1 (RYGB p < 0.0001; VSG p = 0.0001) and 2 (RYGB p = 0.005; VSG p = 0.002). No psychological correlates were significantly associated with weight loss outcomes. Post hoc analyses comparing patients who had surgery to those in the same cohort who did not have surgery revealed significantly higher rates of depression (p < 0.001), anxiety (p < 0.001), binge eating (p = 0.003), night eating (p < 0.001), food addiction (p = 0.042), and lower self-efficacy (p < 0.001) among patients who did not have surgery. DISCUSSION Patients who are psychologically higher functioning are more likely to complete the evaluation process and undergo bariatric surgery. For patients who had surgery, psychological correlates were not associated with weight loss outcome for either RYGB or VSG. Implications for surgical choice are discussed.
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Affiliation(s)
- Gretchen E Ames
- Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Michael G Heckman
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Nancy N Diehl
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Dustin M Shepherd
- Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Allison A Holgerson
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Karen B Grothe
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Steven P Bowers
- Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
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Sarwer DB, Wadden TA, Spitzer JC, Mitchell JE, Lancaster K, Courcoulas A, Gourash W, Rosen RC, Christian NJ. 4-Year Changes in Sex Hormones, Sexual Functioning, and Psychosocial Status in Women Who Underwent Bariatric Surgery. Obes Surg 2018; 28:892-899. [PMID: 29164510 PMCID: PMC5882499 DOI: 10.1007/s11695-017-3025-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Initial weight loss after bariatric surgery has been associated with improvements in reproductive hormones and sexual functioning in women. Few studies have investigated the durability of these changes. OBJECTIVES The objective of this paper is to investigate changes in sex hormones, sexual functioning, and relevant psychosocial constructs over 4 years in women who underwent bariatric surgery. SETTING The setting is a prospective cohort of 106 women from the Longitudinal Assessment of Bariatric Surgery consortium. METHODS Changes in sex hormones were assessed by blood assay. Sexual functioning, quality of life (QOL), body image, depressive symptoms, and marital adjustment were assessed by psychometric measures. RESULTS Women lost on average (95% confidence interval) 32.3% (30.4%, 34.3%) at postoperative year 3 and 30.6% (28.5%, 32.8%) at postoperative year 4. Compared to baseline, women experienced significant changes at 4 years in all hormones assessed, except estradiol. Women reported significant improvements in sexual functioning (i.e., arousal, desire, and satisfaction) through year 3, but these changes were not maintained through year 4. Changes in relationship quality followed a similar pattern. Improvements in physical aspects of QOL, body image, and depressive symptoms were maintained through 4 years. CONCLUSIONS Improvements in reproductive hormones and physical aspects of QOL, body image, and depressive symptoms were maintained 4 years after bariatric surgery. Improvements in sexual functioning, relationship satisfaction, and mental components of QOL eroded over time.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA, 19140, USA.
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathy Lancaster
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | | | - William Gourash
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Novikov AA, Afaneh C, Saumoy M, Parra V, Shukla A, Dakin GF, Pomp A, Dawod E, Shah S, Aronne LJ, Sharaiha RZ. Endoscopic Sleeve Gastroplasty, Laparoscopic Sleeve Gastrectomy, and Laparoscopic Band for Weight Loss: How Do They Compare? J Gastrointest Surg 2018; 22:267-273. [PMID: 29110192 DOI: 10.1007/s11605-017-3615-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a novel endobariatric procedure. Initial studies demonstrated an association of ESG with weight loss and improvement of obesity-related comorbidities. Our aim was to compare ESG to laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). METHODS We included 278 obese (BMI > 30) patients who underwent ESG (n = 91), LSG (n = 120), or LAGB (n = 67) at our tertiary care academic center. Primary outcome was percent total body weight loss (%TBWL) at 3, 6, 9, and 12 months. Secondary outcome measures included adverse events (AE), length of stay (LOS), and readmission rate. RESULTS At 12-month follow-up, LSG achieved the greatest %TBWL compared to LAGB and ESG (29.28 vs 13.30 vs 17.57%, respectively; p < 0.001). However, ESG had a significantly lower rate of morbidity when compared to LSG or LAGB (p = 0.01). The LOS was significantly less for ESG compared to LSG or LAGB (0.34 ± 0.73 vs 3.09 ± 1.47 vs 1.66 ± 3.07 days, respectively; p < 0.01). Readmission rates were not significantly different between the groups (p = 0.72). CONCLUSION Although LSG is the most effective option for weight loss, ESG is a safe and feasible endobariatric option associated with low morbidity and short LOS in select patients.
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Affiliation(s)
- Aleksey A Novikov
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Cheguevara Afaneh
- Division of Metabolic and Bariatric Surgery, 520 East 70th Street, Starr 8, New York, NY, 10021, USA
| | - Monica Saumoy
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | | | - Alpana Shukla
- Division of Endocrinology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, 10021, USA
| | - Gregory F Dakin
- Division of Metabolic and Bariatric Surgery, 520 East 70th Street, Starr 8, New York, NY, 10021, USA
| | - Alfons Pomp
- Division of Metabolic and Bariatric Surgery, 520 East 70th Street, Starr 8, New York, NY, 10021, USA
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Shawn Shah
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA
| | - Louis J Aronne
- Division of Endocrinology, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, 10021, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
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Friedman AN, Wahed AS, Wang J, Courcoulas AP, Dakin G, Hinojosa MW, Kimmel PL, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, le Roux C, Spaniolas K, Steffen KJ, Thirlby R, Wolfe B. Effect of Bariatric Surgery on CKD Risk. J Am Soc Nephrol 2018; 29:1289-1300. [PMID: 29335242 DOI: 10.1681/asn.2017060707] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022] Open
Abstract
Obesity is linked to the development and progression of CKD, but whether bariatric surgery protects against CKD is poorly understood. We, therefore, examined whether bariatric surgery influences CKD risk. The study included 2144 adults who underwent bariatric surgery from March of 2006 to April of 2009 and participated in the Longitudinal Assessment of Bariatric Surgery-2 Study cohort. The primary outcome was CKD risk categories as assessed by the Kidney Disease Improving Global Outcomes (KDIGO) consortium criteria using a combination of eGFR and albuminuria. Patients were 79% women and 87% white, with a median age of 46 years old. Improvements were observed in CKD risk at 1 and 7 years after surgery in patients with moderate baseline CKD risk (63% and 53%, respectively), high baseline risk (78% and 56%, respectively), and very high baseline risk (59% and 23%, respectively). The proportion of patients whose CKD risk worsened was ≤10%; five patients developed ESRD. Sensitivity analyses using year 1 as baseline to minimize the effect of weight loss on serum creatinine and differing eGFR equations offered qualitatively similar results. Treatment with bariatric surgery associated with an improvement in CKD risk categories in a large proportion of patients for up to 7 years, especially in those with moderate and high baseline risk. These findings support consideration of CKD risk in evaluation for bariatric surgery and further study of bariatric surgery as a treatment for high-risk obese patients with CKD.
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Affiliation(s)
- Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis Indiana;
| | - Abdus S Wahed
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Junyao Wang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory Dakin
- Department of Surgery, Weill Cornell Medical College, New York, New York
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine Medical Center, Irvine, California
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic diseases, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Alfons Pomp
- Department of Surgery, University of California, Irvine Medical Center, Irvine, California
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, Greenville, North Carolina
| | - Jonathan Q Purnell
- Department of Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Carel le Roux
- Department of Pathology, University College Dublin, Dublin, Ireland
| | | | - Kristine J Steffen
- Department of Pharmaceutical Sciences, North Dakota State University College of Health Professions, Fargo, North Dakota
| | - Richard Thirlby
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington; and
| | - Bruce Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
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Twells LK, Driscoll S, Gregory DM, Lester K, Fardy JM, Pace D. Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada. BMC OBESITY 2017; 4:40. [PMID: 29238600 PMCID: PMC5725939 DOI: 10.1186/s40608-017-0176-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
Background In Canada, severe obesity (BMI ≥ 35 kg/m2) affects 5% or 1.2 million adults. Bariatric surgery is the only effective treatment for severe obesity, but the demand for publicly funded procedures is high and capacity limited. Little is known in Canada about the types of patients undergoing these procedures, especially laparoscopic sleeve gastrectomy (LSG). The study objective is to examine the socio-demographic profile, morbidity and HRQoL of patients accessing LSG in one Canadian province. Methods Health status and HRQoL were examined in patients (n = 195) undergoing LSG. HRQoL was assessed using the EQ-5D-3L, SF-12v2 and the Impact of Weight on Quality of Life-lite questionnaire. Results Mean age and BMI were 44 and 49 kg/m2 and most were women (82%). Pre-surgery, comorbidities were sleep apnea (65%), dyslipidemia (48%), hypertension (47%) and osteoarthritis (44%). Patients reported impaired HRQoL with 44-67% reporting problems in mobility, usual activities, pain and anxiety/depression. Physical health was impaired more than mental health. There were few socio-demographic differences between women and men, but significant differences in comorbid conditions such as sleep apnea, dyslipidemia, hypertension and gout exist (p < .05). Women reported fewer problems with self-care (9.5% vs. 25.0%, p < .05), and better overall health (VAS 61.5 vs. 52.0, p < .05) and General Health (39.3 vs. 32.9, p < .05), but greater impairment in self-esteem (27.3 vs. 44.1, p < .01) and sexual life (49.2 vs. 63.6, p < .05). Conclusions Before LSG, patients reported significant morbidity and impaired HRQoL. Although baseline characteristics were similar between men and women, gender specific differences were observed in comorbid profile and HRQoL.
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Affiliation(s)
- Laurie K Twells
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive Newfoundland and Labrador, St. John's, A1B 3V6 Canada
| | - Shannon Driscoll
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Kendra Lester
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - John M Fardy
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Dave Pace
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
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A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery. Obes Surg 2017; 26:2433-41. [PMID: 26964997 DOI: 10.1007/s11695-016-2125-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. METHODS A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. RESULTS The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02 % throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. CONCLUSIONS These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.
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Menke MN, King WC, White GE, Gosman GG, Courcoulas AP, Dakin GF, Flum DR, Orcutt MJ, Pomp A, Pories WJ, Purnell JQ, Steffen KJ, Wolfe BM, Yanovski SZ. Contraception and Conception After Bariatric Surgery. Obstet Gynecol 2017; 130:979-987. [PMID: 29016506 PMCID: PMC5679259 DOI: 10.1097/aog.0000000000002323] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine contraceptive practices and conception rates after bariatric surgery. METHODS The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies. RESULTS Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception. CONCLUSIONS Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00465829.
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Affiliation(s)
- Marie N Menke
- University of Pittsburgh School of Medicine, the University of Pittsburgh Graduate School of Public Health, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Weill Cornell University Medical Center, New York, New York; the University of Washington, Seattle, Washington; the Neuropsychiatric Research Institute, Fargo, North Dakota; Brody School of Medicine, East Carolina University, Greenville, North Carolina; Oregon Health & Science University, Portland, Oregon; North Dakota State University, Fargo, North Dakota; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Becnel JN, Zeller MH, Noll JG, Sarwer DB, Reiter-Purtill J, Michalsky M, Peugh J, Biro FM. Romantic, sexual, and sexual risk behaviours of adolescent females with severe obesity. Pediatr Obes 2017; 12:388-397. [PMID: 27237983 PMCID: PMC6108433 DOI: 10.1111/ijpo.12155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/08/2016] [Accepted: 04/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an increasing adolescent population with severe obesity with impairments in social and romantic relationships that are seeking clinical weight management, including weight loss surgery (WLS). OBJECTIVE To document romantic, sexual and sexual risk behaviours in a clinical sample of adolescent females with severe obesity (BMI > 40 kg/m2 ) compared to those of healthy weight (HW). METHODS This multi-site study-an ancillary to a prospective longitudinal observational study documenting health in adolescents having WLS-presents pre-operative/baseline data from 108 females undergoing WLS, 68 severely obese seeking lifestyle intervention and 118 of HW. Romantic and sexual risk behaviour and birth control information sources were assessed using the Sexual Activities and Attitudes Questionnaire (SAAQ). RESULTS Severely obese females reported engaging in fewer romantic and sexual behaviours compared to HW. Similar to HW, a subgroup (25%) of severely females were engaging in higher rates of sexual risk behaviours and reported pregnancies and sexually transmitted infections (STIs). A considerable number (28-44%) reported receiving no birth control information from physicians. CONCLUSIONS Discussion topics with the adolescent patient should extend beyond reproductive health needs (e.g. contraception, unintended pregnancies) to include guidance around navigating romantic and sexual health behaviours that are precursors to these outcomes.
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Affiliation(s)
- Jennifer N. Becnel
- University of Arkansas, School of Human Environmental Sciences, Human Development and Family Science, Fayetteville, Arkansas, USA
| | - Meg H. Zeller
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Jennie G. Noll
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - David B. Sarwer
- University of Pennsylvania Perelman School of Medicine, Center for Weight and Eating Disorders, Philadelphia, Pennsylvania, USA
| | - Jennifer Reiter-Purtill
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Marc Michalsky
- Nationwide Children’s Hospital, Department of Pediatric Surgery, Columbus, Ohio, USA
| | - James Peugh
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Frank M. Biro
- Cincinnati Children’s Hospital Medical Center, Division of Adolescent and Transition Medicine, Cincinnati, Ohio, USA
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Mitchell JE, Christian NJ, Flum DR, Pomp A, Pories WJ, Wolfe BM, Courcoulas AP, Belle SH. Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery. JAMA Surg 2017; 151:752-7. [PMID: 27096225 DOI: 10.1001/jamasurg.2016.0395] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Severe obesity (body mass index ≥35 [calculated as weight in kilograms divided by height in meters squared]) is associated with significant medical comorbidity and increased mortality. Bariatric surgery induces weight loss, the extent of which can vary. Postoperative predictors of weight loss have not been adequately examined. OBJECTIVE To describe postoperative eating behaviors and weight control and their effects on 3-year change in weight. DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing first-time bariatric surgical procedures as part of routine clinical care were recruited between 2006 and 2009 and followed up until September 2012. Participants completed detailed surveys regarding eating and weight control behaviors prior to surgery and then annually after surgery for 3 years. MAIN OUTCOMES AND MEASURES Twenty-five postoperative behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs. Behaviors examined were divided into those that were never present (preoperatively or postoperatively), those that were always present (preoperatively and postoperatively), and those that underwent a healthy change after surgery (development of a positive behavior or omission of a negative behavior). RESULTS The sample included a total of 2022 participants (median age, 47 years [interquartile range, 38-55 years]; median BMI, 46 [interquartile range, 42-51]; 78% women): 1513 who had undergone Roux-en-Y gastric bypass and 509 who had undergone laparoscopic adjustable gastric banding. If we consider the cumulative effects of the 3 behaviors that explain most of the variability (16%) in 3-year percent weight change following Roux-en-Y gastric bypass, ie, weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day, a participant who postoperatively started to self-weigh, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose a mean (SE) of 38.8% (0.8%) of their baseline weight. This average is about 14% greater weight loss compared with participants who made no positive changes in these variables (mean [SE], -24.6% [1.6%]; mean difference, -14.2%; 95% CI, -18.7% to -9.8%; P < .001) and 6% greater weight loss compared with participants who always reported positive on these healthy behaviors (mean [SE], -33.2% [0.6%]; mean difference, -5.7%; 95% CI, -7.8% to -3.5%; P < .001). CONCLUSIONS AND RELEVANCE The results suggest the importance of assessing behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs in bariatric surgery candidates and patients who have undergone bariatric surgery, and they suggest that the utility of programs to modify problematic eating behaviors and eating patterns should be addressed in research.
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Affiliation(s)
- James E Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota2University of North Dakota School of Medicine and Health Sciences, Grand Forks
| | - Nicholas J Christian
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David R Flum
- Department of Surgery, University of Washington, Seattle
| | - Alfons Pomp
- Department of Surgery, Weill-Cornell Medical Center, New York, New York
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health and Science University, Portland
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven H Belle
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res 2017; 118:1844-55. [PMID: 27230645 DOI: 10.1161/circresaha.116.307591] [Citation(s) in RCA: 361] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/29/2016] [Indexed: 12/11/2022]
Abstract
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.
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Affiliation(s)
- Bruce M Wolfe
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.).
| | - Elizaveta Kvach
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
| | - Robert H Eckel
- From the Department of Surgery, Oregon Health and Science University, Portland (B.M.W., E.K.); and Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora (R.H.E.)
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King WC, Chen JY, Belle SH, Courcoulas AP, Dakin GF, Flum DR, Hinojosa MW, Kalarchian MA, Mitchell JE, Pories WJ, Spaniolas K, Wolfe BM, Yanovski SZ, Engel SG, Steffen KJ. Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis 2017; 13:1337-1346. [PMID: 28579202 DOI: 10.1016/j.soard.2017.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain. OBJECTIVE To determine if use of prescribed opioid analgesics changes in the short and long term after bariatric surgery and to identify factors associated with continued and postsurgery initiated use. SETTING Ten U.S. hospitals. METHODS The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted presurgery, 6 months postsurgery, and annually postsurgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly, or "as needed" use of a prescribed medication classified as an opioid analgesic. RESULTS Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index: 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased after surgery from 14.7% (95% CI: 13.3-16.2) at baseline to 12.9% (95% CI: 11.5-14.4) at month 6 but then increased to 20.3%, above baseline levels, as time progressed (95% CI: 18.2-22.5) at year 7. Among participants without baseline opioid use (n = 1892), opioid use prevalence increased from 5.8% (95% CI: 4.7-6.9) at month 6 to 14.2% (95% CI: 12.2-16.3) at year 7. Public versus private health insurance, more pain presurgery, undergoing subsequent surgeries, worsening or less improvement in pain, and starting or continuing nonopioid analgesics postsurgery were significantly associated with higher risk of postsurgery initiated opioid use. CONCLUSION After bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased but then increased to surpass baseline prevalence, suggesting the need for alternative methods of pain management in this population.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh School of Medicine, and Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | | | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Konstantinos Spaniolas
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up. Surg Obes Relat Dis 2017; 13:1562-1571. [PMID: 28579205 DOI: 10.1016/j.soard.2017.03.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/27/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Having accurate information on bariatric surgery-related gastrointestinal (GI) symptoms is critical for patient care. OBJECTIVE To report on surgery-related GI symptoms over the first 3 years following Roux-en-Y gastric bypass and laparoscopic adjustable gastric band. SETTING Three academic medical centers in the United States. METHODS As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 183 participants (pre-surgery median body mass index = 45.1 kg/m2; median age = 46 yr; 83.1% female). completed the Eating Disorder Examination-Bariatric Surgery Version interview at≥1 annual assessment. Patients self-reported frequency of dysphagia, dumping syndrome, and spontaneous vomiting. RESULTS Prevalence of dysphagia at least once weekly decreased post-laparoscopic adjustable gastric band surgery from 43.9% (95% confidence interval [CI], 32.2-55.6) in year 1 to 27.5% (95% CI, 15.2-39.9) in year 3 (P = .02). Dysphagia and dumping at least once weekly also appeared to decrease in years 1-3 post-Roux-en-Y gastric bypass (i.e., from 16.7% [95% CI, 9.4-24.1] to 10.9% [95% CI, 4.0-17.8] and from 9.9% [95% CI, 4.3-15.5] to 6.3% [95% CI, 1.7-10.9], respectively), but power was limited to evaluate trends. Vomiting at least once weekly was rare (<6%) in years 1-3 following both procedures. Controlling for potential confounders and surgical procedure, loss of control eating at least once weekly was associated with higher risk of at least once weekly dysphagia (relative risk = 2.01, 95% CI, 1.36-2.99, P = .001). CONCLUSIONS The prevalence of bariatric surgery-related GI symptoms appears to decrease across follow-up. Symptoms were associated with loss of control eating, suggesting a target for clinical intervention.
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Sharaiha RZ, Kumta NA, Saumoy M, Desai AP, Sarkisian AM, Benevenuto A, Tyberg A, Kumar R, Igel L, Verna EC, Schwartz R, Frissora C, Shukla A, Aronne LJ, Kahaleh M. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol 2017; 15:504-510. [PMID: 28017845 DOI: 10.1016/j.cgh.2016.12.012] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Endoscopic sleeve gastroplasty (ESG) is an incisionless, minimally invasive bariatric procedure that reduces the length and width of the gastric cavity to facilitate weight loss. We performed a prospective study to evaluate the effects of ESG on total body weight loss and obesity-related comorbidities. METHODS We collected data from 91 consecutive patients (mean age, 43.86 ± 11.26 years; 68% female) undergoing ESG from August 2013 through March 2016. All patients had a body mass index (BMI) greater than 30 kg/m2 and had failed noninvasive weight-loss measures or had a BMI greater than 40 kg/m2 and were not considered as surgical candidates or refused surgery. All procedures were performed with a cap-based flexible endoscopic suturing system to facilitate a triangular pattern of sutures to imbricate the greater curvature of the stomach. Patients were evaluated after 6 months (n = 73), 12 months (n = 53), and 24 months (n = 12) for anthropometric features (BMI, weight, waist circumference, blood pressure) and underwent serologic (hemoglobin A1c), lipid panel, serum triglycerides, and liver function tests. The primary outcomes were total body weight loss at 6, 12, and 24 months. Secondary outcomes were the effects of ESG on metabolic factors (blood pressure, diabetes, hyperlipidemia, steatohepatitis) and safety. RESULTS The patients' mean BMI before the procedure was 40.7 ± 7.0 kg/m2. Patients had lost 14.4% of their total body weight at 6 months (80% follow-up rate), 17.6% at 12 months (76% follow-up rate), and 20.9% at 24 months (66% follow-up rate) after ESG. At 12 months after ESG, patients had statistically significant reductions in levels of hemoglobin A1c (P = .01), systolic blood pressure (P = .02), waist circumference (P < .001), alanine aminotransferase (P < .001), and serum triglycerides (P = .02). However, there was no significant change in low-density lipoprotein after vs before ESG (P = .79). There was one serious adverse event (1.1%) (perigastric leak) that occurred that was managed non-operatively. CONCLUSIONS ESG is a minimally invasive and effective endoscopic weight loss intervention. In addition to sustained total body weight loss up to 24 months, ESG reduced markers of hypertension, diabetes, and hypertriglyceridemia.
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Affiliation(s)
- Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York.
| | - Nikhil A Kumta
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Monica Saumoy
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amit P Desai
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alex M Sarkisian
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Andrea Benevenuto
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Amy Tyberg
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Rekha Kumar
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Leon Igel
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Elizabeth C Verna
- Department of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Robert Schwartz
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Christina Frissora
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
| | - Alpana Shukla
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Louis J Aronne
- Department of Endocrinology, Weill Cornell Medicine, New York, New York
| | - Michel Kahaleh
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York
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King WC, Chen JY, Courcoulas AP, Dakin GF, Engel SG, Flum DR, Hinojosa MW, Kalarchian MA, Mattar SG, Mitchell JE, Pomp A, Pories WJ, Steffen KJ, White GE, Wolfe BM, Yanovski SZ. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis 2017; 13:1392-1402. [PMID: 28528115 DOI: 10.1016/j.soard.2017.03.021] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited. OBJECTIVE To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. SETTING 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015. RESULTS Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]). CONCLUSIONS Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh School of Medicine, and Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Samer G Mattar
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon
| | | | - Alfons Pomp
- Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
| | - Gretchen E White
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Bruce M Wolfe
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Abstract
Diet, exercise, cognitive behavioral therapy and pharmacotherapy are some of the means of assisting patients to lose weight, with bariatric surgery being the most effective. Over the last two decades, the increased awareness of the systemic benefits of bariatric surgery, as well as the improved safety and the wider use of the laparoscopic approach, has made bariatric surgery flourish. In the United Kingdom, the adjustable gastric band (10%), vertical sleeve gastrectomy (37%) and Roux-en-Y gastric bypass (45%) are the three most common procedures. Obesity-associated mortality and co-morbidities such as type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, renal dysfunction and depression improve significantly with bariatric surgery. The mechanisms of weight loss extend beyond restriction and malabsorption and include changes in hunger and satiety, food preferences, and possibly energy expenditure. Despite its safety and efficacy, bariatric surgery is underutilized as less than 1% of adults with obesity receive it. In view of the evolution of obesity into a global threat, access to bariatric surgery should be increased, whilst developing safer and less invasive weight loss treatments.
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Affiliation(s)
- E Panteliou
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
| | - A D Miras
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
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73
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Zeller MH, Washington GA, Mitchell JE, Sarwer DB, Reiter-Purtill J, Jenkins TM, Courcoulas AP, Peugh JL, Michalsky MP, Inge TH. Alcohol use risk in adolescents 2 years after bariatric surgery. Surg Obes Relat Dis 2017; 13:85-94. [PMID: 27567561 PMCID: PMC5123970 DOI: 10.1016/j.soard.2016.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Problematic alcohol use and increased sensitivity postoperatively in adult weight loss surgery patients heightens concerns. No data have characterized these behaviors in adolescents-a gap, given adolescent alcohol use and heavy drinking are public health concerns. OBJECTIVE To examine alcohol use behavior in adolescents who underwent weight loss surgery across the first two post-operative years in comparison to nonsurgical adolescents. SETTING Five academic medical centers. METHODS Utilizing a prospective controlled design, adolescents undergoing weight loss surgery (n = 242) and nonsurgical adolescents with severe obesity (n = 83) completed the Alcohol Use Disorders Test. Analyses included 216 surgical (Mage = 17.1 ± 1.5, MBMI = 52.9 ± 9.3, 91.8% female, 67.6% white) and 79 nonsurgical participants (Mage = 16.2 ± 1.4, MBMI = 46.9 ± 6.1, 82.3% female, 53.2% white), with baseline data and at 12 or 24 months postoperatively. RESULTS The majority reported never consuming alcohol within the year before surgery (surgical, 92%; nonsurgical, 91%) or by 24 months (surgical, 71%; nonsurgical, 74%), when alcohol use disorder approached 9%. Among alcohol users at 24 months (n = 52 surgical, 17 nonsurgical), 35% surgical and 29% nonsurgical consumed 3+drinks on a typical drinking day; 42% surgical and 35% nonsurgical consumed 6+drinks on at least 1 occasion. For the surgical group, alcohol use changed as a function of older age (odds ratio [OR] = 2.47, P = .01) and lower body mass index (OR = .94, P<.001). Greater percent change in weight (0-24 mo) was associated with increased odds of alcohol use at 24 months (OR = 1.01, 95% confidence interval: 1.002-1.02). CONCLUSION Alcohol use was lower than national base rates. Alcohol use disorder rates and harmful consumption raise concerns given extant adult literature. Alcohol education focused on harm reduction (i.e., lower consumption, managing situations conducive to alcohol-related harm) and monitoring by healthcare providers as patients mature is indicated.
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Affiliation(s)
- Meg H Zeller
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Gia A Washington
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - James E Mitchell
- Department of Neuroscience, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - David B Sarwer
- University of Pennsylvania, Philadelphia, Pennsylvania; College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Jennifer Reiter-Purtill
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd M Jenkins
- Bariatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anita P Courcoulas
- Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James L Peugh
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marc P Michalsky
- Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas H Inge
- Division of Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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74
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Devlin MJ, King WC, Kalarchian MA, White GE, Marcus MD, Garcia L, Yanovski SZ, Mitchell JE. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up. Int J Eat Disord 2016; 49:1058-1067. [PMID: 27425771 PMCID: PMC5161707 DOI: 10.1002/eat.22578] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV). METHOD Participants (N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3. RESULTS The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) (P for all <0.01), and regular evening hyperphagia (16.5-5.0%, P = 0.01), but not cravings (P = 0.93). Mean EDE global score, and hunger and enjoyment scores, also declined (P for all <0.01). These metrics remained lower than baseline through year-3 (P for all <0.01). Presurgery eating variables were not related to weight loss (P for all ≥0.05). However, postsurgery higher EDE global score and greater hunger were independently associated with less weight loss postsurgery (P for both ≤0.01), while cravings were associated with greater weight loss (P = 0.03). DISCUSSION Pathological eating behaviors and experiences are common presurgery and improve markedly following surgery. Postsurgery pathological eating-related experiences and attitudes and hunger may contribute to suboptimal weight loss. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1058-1067).
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Affiliation(s)
- Michael J. Devlin
- Columbia University College of Physicians and Surgeons / New York State Psychiatric Institute, New York, NY, United States
| | - Wendy C. King
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | | | - Gretchen E. White
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States
| | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Luis Garcia
- Sanford Health System, Fargo, ND, United States
| | - Susan Z. Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
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Fleming J, Wood GC, Seiler C, Cook A, Lent MR, Still CD, Benotti PN, Irving BA. Electronically captured, patient-reported physical function: an important vital sign in obesity medicine. Obes Sci Pract 2016; 2:399-406. [PMID: 28090345 PMCID: PMC5192538 DOI: 10.1002/osp4.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Impaired physical function (i.e., inability to walk 200 feet, climb a flight of stairs or perform activities of daily living) predicts poor clinical outcomes and adversely impacts medical and surgical weight management. However, routine assessment physical function is seldom performed clinically. The PROMIS Physical Function Short Form 20a (SF-20a) is a validated questionnaire for assessing patient reported physical function, which includes published T-score percentiles adjusted for gender, age and education. However, the effect that increasing levels of obesity has on these percentiles is unclear. We hypothesized that physical function would decline with increasing level of obesity independent of gender, age, education and comorbidity. MATERIALS AND METHODS This study included 1,627 consecutive weight management patients [(mean ± SEM), 44.7 ± 0.3 years and 45.1 ± 0.2 kg/m2] that completed the PROMIS SF-20a during their initial consultation. We evaluated the association between obesity level and PROMIS T-score percentiles using multiple linear regression adjusting for gender, age, education and Charlson Comorbidity Index (CCI). RESULTS Multiple linear regression T-score percentiles were lower in obesity class 2 (-12.4%tile, p < 0.0001), class 3 (-17.0%tile, p < 0.0001) and super obesity (-25.1%tile, p < 0.0001) compared to class 1 obesity. CONCLUSION In patients referred for weight management, patient reported physical function was progressively lower in a dose-dependent fashion with increasing levels of obesity, independent of gender, age, education and CCI.
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Affiliation(s)
- J. Fleming
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - G. C. Wood
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - C. Seiler
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - A. Cook
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - M. R. Lent
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - C. D. Still
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - P. N. Benotti
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
| | - B. A. Irving
- Obesity InstituteGeisinger Health SystemDanvillePAUSA
- School of KinesiologyLouisiana State UniversityBaton RougeLAUSA
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76
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Zeller MH, Hunsaker S, Mikhail C, Reiter-Purtill J, McCullough MB, Garland B, Austin H, Washington G, Baughcum A, Rofey D, Smith K. Family factors that characterize adolescents with severe obesity and their role in weight loss surgery outcomes. Obesity (Silver Spring) 2016; 24:2562-2569. [PMID: 27753228 PMCID: PMC5379472 DOI: 10.1002/oby.21676] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To comprehensively assess family characteristics of adolescents with severe obesity and whether family factors impact weight loss outcomes following weight loss surgery (WLS). METHODS Multisite prospective data from 138 adolescents undergoing WLS and primary caregivers (adolescent: Mage = 16.9; MBMI = 51.5 kg/m2 ; caregiver: Mage = 44.5; 93% female) and 83 nonsurgical comparators (NSComp: adolescent: Mage = 16.1; MBMI = 46.9 kg/m2 ; caregiver: Mage = 43.9; 94% female) were collected using standardized measures at presurgery/baseline and at 1 and 2 years. RESULTS The majority (77.3%) of caregivers had obesity, with rates of caregiver WLS significantly higher in the WLS (23.8%) versus NSComp group (3.7%, P < 0.001). Family dysfunction was prevalent (≈1 in every two to three families), with rates higher for NSComp than the WLS group. For the WLS group, preoperative family factors (i.e., caregiver BMI or WLS history, dysfunction, social support) were not significant predictors of adolescent weight loss at 1 and 2 years postoperatively, although change in family functioning over time emerged as a significant correlate of percent weight loss. CONCLUSIONS Rates of severe obesity in caregivers as well as family dysfunction were clinically noteworthy, although not related to adolescent weight loss success following WLS. However, change in family communication and emotional climate over time emerged as potential targets to optimize weight loss outcomes.
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Affiliation(s)
- Meg H. Zeller
- Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Sanita Hunsaker
- Cincinnati Children’s Hospital Medical Center, Cincinnati OH
| | - Carmen Mikhail
- Texas Children’s Hospital, Houston, TX
- Baylor College of Medicine, Houston, TX
| | | | | | - Beth Garland
- Texas Children’s Hospital, Houston, TX
- Baylor College of Medicine, Houston, TX
| | | | - Gia Washington
- Texas Children’s Hospital, Houston, TX
- Baylor College of Medicine, Houston, TX
| | | | - Dana Rofey
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kevin Smith
- Nationwide Children’s Hospital, Columbus, OH
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77
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Steffen KJ, King WC, White GE, Subak LL, Mitchell JE, Courcoulas AP, Flum DR, Strain G, Sarwer DB, Kolotkin RL, Pories W, Huang AJ. Sexual functioning of men and women with severe obesity before bariatric surgery. Surg Obes Relat Dis 2016; 13:334-343. [PMID: 27986585 DOI: 10.1016/j.soard.2016.09.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity may impair sexual function through multiple mechanisms, but little is known about sexual dysfunction among adults with severe obesity seeking bariatric procedures. OBJECTIVES To describe sexual function and associated factors before bariatric surgery. SETTING Ten U.S. clinical facilities. METHODS Before bariatric surgery, 2225 of 2458 Longitudinal Assessment of Bariatric Surgery-2 study participants (79% female, median age 45 years and median body mass index 46 kg/m2) completed a survey about sexual function over the past month. Mixed effects ordinal logistic regression models were used to identify factors independently related to 4 domains of sexual function. RESULTS One third of women (34%) and one quarter of men (25%) were not sexually active, alone or with a partner, in the past month. Twenty-six percent of women and 12% of men reported no sexual desire. Physical health limited sexual activity at least moderately in 38% of women and 44% of men. About one half of the women (49%) and the men (54%) were moderately or very dissatisfied with their sexual life. Among women, older age, being Caucasian, urinary incontinence, depressive symptoms, and antidepressant medication use were associated with poorer sexual function in multiple domains. In men, older age, not being married, depressive symptoms, and antidepressant medication use were associated with poorer sexual function in multiple domains. CONCLUSION Before bariatric surgery, approximately one half of women and men with severe obesity are dissatisfied with their sexual life. Older age, severity of depressive symptoms, and antidepressant medication use are associated with poorer sexual function in both sexes.
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Affiliation(s)
- Kristine J Steffen
- North Dakota State University, Fargo ND; Neuropsychiatric Research Institute, Fargo, ND.
| | - Wendy C King
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Gretchen E White
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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78
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King WC, Chen JY, Belle SH, Courcoulas AP, Dakin GF, Elder KA, Flum DR, Hinojosa MW, Mitchell JE, Pories WJ, Wolfe BM, Yanovski SZ. Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity. JAMA 2016; 315:1362-71. [PMID: 27046364 PMCID: PMC4856477 DOI: 10.1001/jama.2016.3010] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described. OBJECTIVES To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement. DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported. EXPOSURES Bariatric surgery as clinical care. MAIN OUTCOMES AND MEASURES Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]). RESULTS Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3. CONCLUSIONS AND RELEVANCE Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Wendy C King
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jia-Yuh Chen
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | - Katherine A Elder
- Oregon Health and Science University, Portland5Now with Pacific University, Forest Grove, Oregon, and the Oregon Health and Science University, Portland
| | | | | | | | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Abstract
OBJECTIVES To document changes in Axis I psychiatric disorders after bariatric surgery and examine their relationship with postsurgery weight loss. METHODS As part of a three-site substudy of the Longitudinal Assessment of Bariatric Surgery Research Consortium, 199 patients completed the Structured Clinical Interview for DSM-IV before Roux-en-Y gastric bypass or laparoscopic adjustable gastric band. At 2 or 3 years after surgery, 165 (83%) patients completed a follow-up assessment (presurgery median body mass index = 44.8 kg/m, median age = 46 years, 92.7% white, 81.1% female). Linear-mixed modeling was used to test change in prevalence of psychiatric disorders over time, report remission and incidence, and examine associations between psychiatric disorders and weight loss. RESULTS Compared with status presurgery, the prevalence of any Axis I psychiatric disorder was significantly lower at 2 and 3 years after surgery (30.2% versus 16.8% [p = .003] and 18.4% [p = .012], respectively). Adjusting for site, age, sex, race, presurgery body mass index, and surgical procedure, presurgery mood, anxiety, eating or substance use disorders (lifetime or current) were not related to weight change, nor were postsurgery mood or anxiety disorders (p for all > .05). However, having a postsurgery eating disorder was independently associated with less weight loss at 2 or 3 years (β = 6.7%, p = .035). CONCLUSIONS Bariatric surgery was associated with decreases in psychiatric disorders through 3 years after surgery. Postsurgical eating disorders were associated with less weight loss after surgery, adding to the literature suggesting that disordered eating after surgery is related to suboptimal weight loss.
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Spitznagel MB, Alosco M, Inge TH, Rochette A, Strain G, Devlin M, Crosby RD, Mitchell JE, Gunstad J. Adolescent weight history and adult cognition: before and after bariatric surgery. Surg Obes Relat Dis 2016; 12:1057-1064. [PMID: 27178608 DOI: 10.1016/j.soard.2016.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cognitive deficits occur in a subset of individuals with obesity. Deficits can be reversed with bariatric surgery, though cognitive recovery is not equally exhibited across patients. Recent work has found that obesity during adolescence portends medical complications in adulthood; it is unknown if obesity in adolescence predicts adult cognition or cognitive recovery after weight loss surgery. OBJECTIVES The present study examines the relationship between weight history and cognitive function in obese adults undergoing bariatric surgery. SETTING Academic medical centers with bariatric care services. METHODS Seventy-eight bariatric surgery patients (mean age = 43.2 years) enrolled in an ancillary study to the Longitudinal Assessment of Bariatric Surgery (LABS) project completed a questionnaire recalling weight history at age 18. Cognitive testing was completed preoperatively and at 12-month follow-up. RESULTS Weight status at age 18 was linked to performance in several aspects of cognition. Higher body mass index at age 18 predicted poorer preoperative verbal fluency (B = -.26, P = .045) as well as postoperative cognitive recovery in attention (B = -.30, P = .01) at 12-month follow-up. CONCLUSION Higher body mass index at age 18 predicts verbal fluency performance in adults with obesity, as well as postoperative recovery of attention after bariatric surgery. The mechanisms underlying this connection are not fully clear, though findings may reflect effects of obesity on the brain during a crucial period of neural maturation or duration of obesity and cumulative impact of co-morbidities on cognition. Future work examining possible causal factors involved in these relationships is needed.
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Affiliation(s)
| | | | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | - Michael Devlin
- Columbia University College of Physicians & Surgeons, New York, New York
| | - Ross D Crosby
- Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - James E Mitchell
- Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - John Gunstad
- Kent State University, Kent, Ohio; Summa Health System, Akron, Ohio
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81
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Gourash WF, Lockhart JS, Kalarchian MA, Courcoulas AP, Nolfi D. Retention and attrition in bariatric surgery research: an integrative review of the literature. Surg Obes Relat Dis 2016; 12:199-209. [DOI: 10.1016/j.soard.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
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82
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Ribeiro GANDA, Giampietro HB, Belarmino LB, Salgado-Júnior W. PSYCHOLOGICAL PROFILE OF PATIENTS ELIGIBLE FOR BARIATRIC SURGERY. ACTA ACUST UNITED AC 2016; 29Suppl 1:27-30. [PMID: 27683771 PMCID: PMC5064267 DOI: 10.1590/0102-6720201600s10008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/13/2016] [Indexed: 11/26/2022]
Abstract
Background: The psychologist who works in bariatric surgery has a role to receive, evaluate,
prepare and educate the patient who will undergo the surgical procedure.
Psychological evaluation becomes important in so far as allows us to obtain data
on personal and familiar history and allow tracing of possible psychopathology.
Aim: To collect data on psychological evaluations of patients in a bariatric surgery
service of a public hospital in order to describe the psychological profile of
patients in this service. Method: Data were collected from 827 patients between 2001 and 2015, using data from an
interview, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Binge
Eating Scale (BES). Results: The mean age of patients before surgery was 39 years+/- 10, the mean BMI was 51
kg/m²+7, and most patients (81%) were female. The average score on the BDI was
14.8+8 and women had significantly higher scores than men. On the BAI the average
score was 11+8 and on the ECAP was 14+8, both with no difference between groups.
Conclusions: Psychosocial characteristics of the patients points to the significant presence of
indicators of depression, with low levels of anxiety and binge eating.
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Affiliation(s)
| | - Helenice Brizolla Giampietro
- Bariatric Surgery Clinic, Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lídia Barbieri Belarmino
- Bariatric Surgery Clinic, Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Wilson Salgado-Júnior
- Bariatric Surgery Clinic, Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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83
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Further statistical and clinical validity for the Weight Efficacy Lifestyle Questionnaire-Short Form. Eat Behav 2015; 18:115-9. [PMID: 26042918 DOI: 10.1016/j.eatbeh.2015.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/05/2015] [Accepted: 05/13/2015] [Indexed: 12/17/2022]
Abstract
Identifying barriers to long-term adherence to reduced energy intake and increased physical activity level is critically important for obese patients seeking weight loss treatment. Previous research has identified that one such barrier is low eating self-efficacy or poor confidence in one's ability to control eating behavior in the presence of challenging situations. Accordingly, a valid, brief measure of eating self-efficacy for longitudinal assessment of weight loss and regain is needed. The purpose of this study was to test the internal consistency and clinical validity of the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Participants were 1740 consecutive obese patients who presented for a psychological evaluation in consideration for bariatric surgery. Median BMI was 44.9 (range: 35.0-111.9), age 48.7years (range: 18.9-77.3years), and patients were predominantly female (71.1%) and Caucasian (90.8%). The median WEL-SF total score was 56 (range: 0-80) and Cronbach's alpha measuring internal consistency was 0.92 with a one-factor structure. In terms of clinical validation, lower WEL-SF total scores were significantly associated with higher rates of binge eating episodes (P<0.0001), food addiction severity and dependence (P<0.0001), night eating syndrome (P<0.0001), depression (P<0.0001), and anxiety (P<0.0001). In contrast, higher WEL-SF total scores were associated with higher weight management self-efficacy (P<0.0001) and motivation to make positive lifestyle changes (P<0.0001). Taken together, these findings suggest that the WEL-SF is a psychometrically valid clinically meaningful measure of eating self-efficacy.
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84
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Subak LL, King WC, Belle SH, Chen JY, Courcoulas AP, Ebel FE, Flum DR, Khandelwal S, Pender JR, Pierson SK, Pories WJ, Steffen KJ, Strain GW, Wolfe BM, Huang AJ. Urinary Incontinence Before and After Bariatric Surgery. JAMA Intern Med 2015; 175:1378-87. [PMID: 26098620 PMCID: PMC4529061 DOI: 10.1001/jamainternmed.2015.2609] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking. OBJECTIVES To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012). INTERVENTION Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter. MAIN OUTCOMES AND MEASURES The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up. RESULTS Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation. CONCLUSIONS AND RELEVANCE Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.
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Affiliation(s)
- Leslee L Subak
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco3Department of Urology, University of California, San Francisco4S
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania6Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Faith E Ebel
- GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York
| | - David R Flum
- Department of Surgery, University of Washington, Seattle
| | | | - John R Pender
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Sheila K Pierson
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Kristine J Steffen
- Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks
| | - Gladys W Strain
- GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland
| | - Alison J Huang
- Department of Medicine, University of California, San Francisco
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Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg 2015; 24:847-54. [PMID: 24464517 DOI: 10.1007/s11695-014-1182-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies have validated bioelectrical impedance analysis (BIA) following bariatric surgery. METHODS We examined agreement of BIA (Tanita 310) measures of total body water (TBW) and percent body fat (%fat) before (T0) and 12 months (T12) after bariatric surgery, and change between T0 and T12 with reference measures: deuterium oxide dilution for TBW and three-compartment model (3C) for %fat in a subset of participants (n = 50) of the Longitudinal Assessment of Bariatric Surgery-2. RESULTS T0 to T12 median (IQR) change in deuterium TBW and 3C %fat was -6.4 L (6.4 L) and -14.8% (13.4%), respectively. There were no statistically significant differences between deuterium and BIA determined TBW [median (IQR) difference: T0 -0.1 L (7.1 L), p = 0.75; T12 0.2 L (5.7 L), p = 0.35; Δ 0.35 L(6.3 L), p = 1.0]. Compared with 3C, BIA underestimated %fat at T0 and T12 [T0 -3.3 (5.6), p < 0.001; T12 -1.7 (5.2), p = 0.04] but not change [0.7 (8.2), p = 0.38]. Except for %fat change, Bland-Altman plots indicated no proportional bias. However, 95% limits of agreement were wide (TBW 15-22 L, %fat 19-20%). CONCLUSIONS BIA may be appropriate for evaluating group level response among severely obese adults. However, clinically meaningful differences in the accuracy of BIA between individuals exist.
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86
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Mitchell JE, King WC, Pories W, Wolfe B, Flum DR, Spaniolas K, Bessler M, Devlin M, Marcus MD, Kalarchian M, Engel S, Khandelwal S, Yanovski S. Binge eating disorder and medical comorbidities in bariatric surgery candidates. Int J Eat Disord 2015; 48:471-6. [PMID: 25778499 PMCID: PMC4980070 DOI: 10.1002/eat.22389] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. METHOD The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from six clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days before their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1,875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal p-values (p < .05). Holm's-adjusted p-values were also reported. RESULTS After adjusting for age, sex, education, and body mass index, BED status was found to be independently associated with four of the 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR] = 1.45 (95% confidence interval [CI]: 1.12-1.87)), high triglycerides (OR = 1.28 (95% CI: 1.002-1.63)), and urinary incontinence (OR = 1.30 (95% CI: 1.02-1.66)), all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR = 0.53 (95% CI: 0.29-0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with three comorbidities (impaired glucose levels (OR = 1.36 (95% CI: 1.04-1.79)), cardiovascular disease (OR = 0.50 (95% CI: 0.30-0.86)), and severe walking limitations (OR = 0.38 (95% CI: 0.19-0.77)). However, Holm's-adjusted p-values for all variables were greater than .05. DISCUSSION The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults.
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Affiliation(s)
| | - Wendy C. King
- Data Coordinating Center, Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, PA
| | | | - Bruce Wolfe
- Oregon Health and Science University, Portland, OR
| | | | | | - Mark Bessler
- Columbia University Medical Center, New York, NY
| | | | | | | | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND
| | | | - Susan Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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87
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King WC, Chen JY, Bond DS, Belle SH, Courcoulas AP, Patterson EJ, Mitchell JE, Inabnet WB, Dakin GF, Flum DR, Cook B, Wolfe BM. Objective assessment of changes in physical activity and sedentary behavior: Pre- through 3 years post-bariatric surgery. Obesity (Silver Spring) 2015; 23:1143-50. [PMID: 26010326 PMCID: PMC4445467 DOI: 10.1002/oby.21106] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate change in sedentary behavior (SB) and physical activity (PA) over 3 years following bariatric surgery. METHODS A subset of participants in an observational study (n = 473 of 2,458; 79% female, median body mass index 45 kg m(-2) ) wore an activity monitor presurgery and at 1-3 annual postsurgery assessments. RESULTS Over the first year, on average, sedentary time decreased from 573 (95% CI: 563-582) to 545 (95% CI: 534-555) min days(-1) and moderate- to vigorous-intensity PA (MVPA) increased from 77 (95% CI: 71-84) to 106 (95% CI: 98-116) min week(-1) , or 7 (95% CI: 5-10) to 24 (95% CI: 18-29) min week(-1) in MVPA bouts ≥10 min. There were no changes in these parameters from years 1 to 3 (P for all > 0.05). The percentage of participants achieving ≥150 min week(-1) of bout-related MVPA was not different at year 3 [6.5% (95% CI: 3.1-12.7)] vs. presurgery [3.4% (95% CI: 1.8-5.0); P = 0.45]. Most participants followed SB and PA trajectories that paralleled mean change and were consistent with their presurgery position in relation to the group. CONCLUSIONS On average, bariatric surgical patients make small reductions in SB and increases in PA during the first postsurgery year, which are maintained through 3 years. Still, postsurgery PA levels fall short of PA guidelines for general health or weight control.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jia-Yuh Chen
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Dale S Bond
- Department of Psychiatry and Behavioral Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Anita P Courcoulas
- Department of Minimally Invasive General and Bariatric Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Emma J Patterson
- Department of Surgery, Legacy Good Samaritan Weight Management Institute, Portland, Oregon, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute and the Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - William B Inabnet
- Department of Surgery, Mount Sinai Hospital, New York, New York, USA
| | - George F Dakin
- Department of Surgery, Weill Cornell Medical Center, New York, New York, USA
| | - David R Flum
- School of Medicine, Department of General Surgery, University of Washington, Seattle, Washington, USA
| | - Brian Cook
- Neuropsychiatric Research Institute and the Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Bruce M Wolfe
- Department of General Surgery, Oregon Health and Science University, Portland, Oregon, USA
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88
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Zeller MH, Noll JG, Sarwer DB, Reiter-Purtill J, Rofey DL, Baughcum AE, Peugh J, Courcoulas AP, Michalsky MP, Jenkins TM, Becnel JN. Child Maltreatment and the Adolescent Patient With Severe Obesity: Implications for Clinical Care. J Pediatr Psychol 2015; 40:640-8. [PMID: 25774054 DOI: 10.1093/jpepsy/jsv011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/29/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To characterize prevalence and correlates of child maltreatment (CM) in a clinical sample of adolescents with severe obesity. METHOD Multicenter baseline data from 139 adolescents undergoing weight loss surgery (Mage = 16.9; 79.9% female, 66.2% White; Mbody mass index [BMI] = 51.5 kg/m(2)) and 83 nonsurgical comparisons (Mage = 16.1; 81.9% female, 54.2% White; MBMI = 46.9 kg/m(2)) documented self-reported CM (Childhood Trauma Questionnaire) and associations with psychopathology, quality of life, self-esteem and body image, high-risk behaviors, and family dysfunction. RESULTS CM prevalence (females: 29%; males: 12%) was similar to national adolescent base rates. Emotional abuse was most prevalent. One in 10 females reported sexual abuse. For females, CM rates were higher in comparisons, yet correlates were similar for both cohorts: greater psychopathology, substance use, and family dysfunction, and lower quality of life. CONCLUSION While a minority of adolescents with severe obesity reported a CM history, they carry greater psychosocial burden into the clinical setting.
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Affiliation(s)
- Meg H Zeller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center,
| | - Jennie G Noll
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Department of Human Development and Family Studies, The Pennsylvania State University
| | - David B Sarwer
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania
| | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Dana L Rofey
- Department of Psychiatry, University of Pittsburgh Medical Center
| | - Amy E Baughcum
- Department of Pediatrics, Nationwide Children's Hospital
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, and
| | - Todd M Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center
| | - Jennifer N Becnel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
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89
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Zeller MH, Inge TH, Modi AC, Jenkins TM, Michalsky MP, Helmrath M, Courcoulas A, Harmon CM, Rofey D, Baughcum A, Austin H, Price K, Xanthakos SA, Brandt ML, Horlick M, Buncher R. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr 2015; 166:651-9.e4. [PMID: 25556022 PMCID: PMC4344894 DOI: 10.1016/j.jpeds.2014.11.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care. STUDY DESIGN Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids). RESULTS WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL. CONCLUSIONS WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.
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Affiliation(s)
- Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Carroll M Harmon
- University of Alabama at Birmingham, Birmingham, AL; University at Buffalo, Buffalo, NY
| | - Dana Rofey
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | | | | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD
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90
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Mitchell JE, King WC, Courcoulas A, Dakin G, Elder K, Engel S, Flum D, Kalarchian M, Khandelwal S, Pender J, Pories W, Wolfe B. Eating behavior and eating disorders in adults before bariatric surgery. Int J Eat Disord 2015; 48:215-22. [PMID: 24719222 PMCID: PMC4192110 DOI: 10.1002/eat.22275] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/07/2014] [Accepted: 03/02/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe eating patterns, prevalence of problematic eating behaviors, and determine factors associated with binge eating disorder (BED), before bariatric surgery. METHOD Before surgery, 2,266 participants (median age 46 years; 78.6% female; 86.9% white; median body mass index 45.9 kg/m(2) ) of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study completed eating behavior survey items in the self-administered LABS-2 Behavior form. Other measures included the Alcohol Use Disorder Identification Test, the LABS-2 Psychiatric and Emotional Test Survey, the Beck Depression Inventory, the Interpersonal Support Evaluation List-12, the Short Form-36 Health Survey, and Impact of Weight Quality of Life-Lite Survey. RESULTS The majority (92.1%) of participants reported eating dinner regularly, whereas just over half (54.0%) reported eating breakfast regularly. Half of the participants reported eating at least four meals/week at restaurants; two meals/week were fast food. Loss of control eating was reported by 43.4%, night eating syndrome by 17.7%; 15.7% satisfied criteria for binge eating disorder (BED), 2% for bulimia nervosa. Factors that independently increased the odds of BED were being a college graduate, eating more times per day, taking medication for psychiatric or emotional problems, and having symptoms of alcohol use disorder, lower self-esteem and greater depressive symptoms. DISCUSSION Before undergoing bariatric surgery a substantial proportion of patients report problematic eating behaviors. Several factors associated with BED were identified, most suggesting other mental health problems, including higher levels of depressive symptomotology. The strengths of this study include the large sample size, the multi-center design and use of standardized assessment practices.
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Affiliation(s)
| | | | | | - George Dakin
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - David Flum
- University of Washington School of Medicine, Seattle, Washington
| | | | | | - John Pender
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Walter Pories
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Bruce Wolfe
- Oregon Health and Science University, Portland, Oregon
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Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium. Surg Obes Relat Dis 2015; 11:1109-18. [PMID: 25824474 DOI: 10.1016/j.soard.2015.01.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change. SETTING Ten hospitals in 6 geographically diverse clinical centers in the United States. METHODS Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively. RESULTS The median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%-38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%-23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m(2) for RYGB and 44 kg/m(2) for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band circumference had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex. CONCLUSIONS Few baseline variables were associated with 3-year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual's chance of a successful weight loss outcome after bariatric surgery. TRIAL REGISTRATION NCT00465829, ClinicalTrials.gov.
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92
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Toro-Ramos T, Goodpaster BH, Janumala I, Lin S, Strain GW, Thornton JC, Kang P, Courcoulas AP, Pomp A, Gallagher D. Continued loss in visceral and intermuscular adipose tissue in weight-stable women following bariatric surgery. Obesity (Silver Spring) 2015; 23:62-9. [PMID: 25384375 PMCID: PMC4308947 DOI: 10.1002/oby.20932] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess changes in total (TAT), subcutaneous (SAT), visceral (VAT), and intermuscular (IMAT) adipose tissue by whole-body MRI before surgery and at 12 months and 24 months post-surgery in a subset of participants of the Longitudinal Assessment of Bariatric Surgery-2. METHODS From 0 to 12 months, n = 20 females and 3 males; from 12 to 24 months, n = 42 females and 7 males. Paired t-tests and GLM repeated measures examined changes in TAT, SAT, VAT, and IMAT at 12 and 24 months, with sex and age as covariates. RESULTS Changes from 0 to 12 months included weight (-41.9 ± 12.1 kg; -36%), TAT (-33.5 ± 9.6 kg; -56%), SAT (-29.2 ± 8.2 kg; -55%), VAT (-3.3 ± 1.6 kg; -73%), and IMAT (-0.99 ± 0.68 kg; -50%), all P < 0.001. In females, from 12 to 24 months, despite relative weight stability (-1.8 ± 6.5 kg, -2%; P = 0.085), VAT (-0.5 ± 0.7 kg; -30%; P < 0.001) and IMAT (-0.2 ± 0.4 kg; -14%; P = 0.012) decreased further. In males, from 12 to 24 months, weight increased (5.1 ± 5.2 kg; 6%; P = 0.04) with no significant changes in TAT or sub-depots. CONCLUSIONS Bariatric surgery continues to induce favorable changes in body composition, i.e., persistent adipose tissue loss at 24 months in the absence of further significant weight loss.
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Affiliation(s)
- Tatiana Toro-Ramos
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Institute of Human Nutrition & Dept. of Medicine, College of Physicians and Surgeons, Columbia University Medical Center
| | - Bret H. Goodpaster
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Isaiah Janumala
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
| | - Susan Lin
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Center for Family and Community Medicine, Columbia University Medical Center
| | - Gladys W. Strain
- Laparoscopic and Bariatric Surgery Division, Weill Cornell Medical College, New York, New York
| | - John C. Thornton
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
| | - Patrick Kang
- Department of Radiology, St. Luke’s-Roosevelt Hospital, New York, New York
| | - Anita P. Courcoulas
- General Surgery-Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alfons Pomp
- Laparoscopic and Bariatric Surgery Division, Weill Cornell Medical College, New York, New York
| | - Dympna Gallagher
- New York Obesity Nutrition Research Center, St. Luke’s-Roosevelt Hospital
- Institute of Human Nutrition & Dept. of Medicine, College of Physicians and Surgeons, Columbia University Medical Center
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93
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Sexual functioning and sex hormones in men who underwent bariatric surgery. Surg Obes Relat Dis 2014; 11:643-51. [PMID: 25868832 DOI: 10.1016/j.soard.2014.12.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/10/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The relationship between obesity and impairments in male sexual functioning is well documented. Relatively few studies have investigated changes in sexual functioning and sex hormones in men who achieve significant weight loss with bariatric surgery. The objective of this study was to assess changes in sexual functioning, sex hormones, and relevant psychosocial constructs in men who underwent bariatric surgery. METHODS A prospective cohort study of 32 men from the Longitudinal Assessment of Bariatric Surgery-2 (LABS) investigation who underwent a Roux-en-Y gastric bypass (median body mass index [25th percentile, 75th percentile] 45.1 [42.0, 52.2]) and completed assessments between 2006 and 2012. Bariatric surgery was performed by a LABS-certified surgeon. Sexual functioning was assessed by the International Index of Erectile Functioning (IIEF). Hormones were assessed by blood assay. Quality of life (QoL), body image, depressive symptoms and marital adjustment were assessed by questionnaire. RESULTS Men lost, on average, (95% confidence interval) 33.3% (36.1%, 30.5%) of initial weight at postoperative year 1, 33.6% (36.8%, 30.5%) at year 2, 31.0% (34.1%, 27.9%) at year 3, and 29.4% (32.7%, 26.2%) at year 4. Participants experienced significant increases in total testosterone (P<.001) and sex hormone binding globulin (SHBG) (P<.001) through postoperative year 4. Although men reported improvements in sexual functioning after surgery, these changes did not significantly differ from baseline, with the exception of overall satisfaction at postoperative year 3 (P = .008). Participants reported significant improvements in physical domains of health-related quality of life (HRQoL), all domains of weight-related QOL, and body image, but not in the mental health domains of HRQoL or relationship satisfaction. CONCLUSIONS Men who lost approximately one third of their weight after Roux-en-Y gastric bypass experienced significant increases in total testosterone and SHBG. They did not, however, report significant improvements in sexual functioning, relationship satisfaction, or mental health domains of HRQoL. This pattern of results differs from that of women who have undergone bariatric surgery, who reported almost uniform improvements in sexual functioning and psychosocial status.
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94
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Mitchell JE, Steffen K, Engel S, King WC, Chen JY, Winters K, Sogg S, Sondag C, Kalarchian M, Elder K. Addictive disorders after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2014; 11:897-905. [PMID: 25862182 DOI: 10.1016/j.soard.2014.10.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular after Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called "behavioral addictions," although prevalence data on the latter have not been published. The objective of this study was to establish the prevalence of addictive behaviors in adults after RYGB. METHODS Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status before surgery and in the first 3 postoperative years. RESULTS Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within 3 years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a postsurgery disorder, 6 (31.6%) of whom had no history. CONCLUSION These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.
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Affiliation(s)
- James E Mitchell
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota.
| | - Kristine Steffen
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota
| | - Scott Engel
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota
| | - Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jia-Yuh Chen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken Winters
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Cindy Sondag
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota
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95
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Alhosaini M, Leehey D, Kramer H. Bariatric Surgery: The Solution to a Big Problem? Am J Kidney Dis 2014; 64:332-4. [DOI: 10.1053/j.ajkd.2014.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 12/28/2022]
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Abstract
This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.
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Affiliation(s)
- David E Arterburn
- Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA
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97
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Mitchell JE, King WC, Chen JY, Devlin MJ, Flum D, Garcia L, Pender JR, Kalarchian MA, Khandelwal S, Marcus MD, Schrope B, Strain G, Wolfe B, Yanovski S. Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity (Silver Spring) 2014; 22:1799-806. [PMID: 24634371 PMCID: PMC4115026 DOI: 10.1002/oby.20738] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/11/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine changes in depressive symptoms and treatment in the first 3 years following bariatric surgery. METHODS The longitudinal assessment of bariatric surgery-2 (LABS-2) is an observational cohort study of adults (n = 2,458) who underwent a bariatric surgical procedure at 1 of 10 US hospitals between 2006 and 2009. This study includes 2,148 participants who completed the Beck depression inventory (BDI) at baseline and ≥ one follow-up visit in years 1-3. RESULTS At baseline, 40.4% self-reported treatment for depression. At least mild depressive symptoms (BDI score ≥ 10) were reported by 28.3%; moderate (BDI score 19-29) and severe (BDI score ≥30) symptoms were uncommon (4.2 and 0.5%, respectively). Mild-to-severe depressive symptoms independently increased the odds (OR = 1.75; P = 0.03) of a major adverse event within 30 days of surgery. Compared with baseline, symptom severity was significantly lower at all follow-up time points (e.g., mild-to-severe symptomatology was 8.9%, 6 months; 8.4%, 1year; 12.2%, 2 years; 15.6%, 3 years; ps < 0.001), but increased between 1 and 3 years postoperatively (P < 0.01). Change in depressive symptoms was significantly related to change in body mass index (r = 0.42; P < 0001). CONCLUSION Bariatric surgery has a positive impact on depressive features. However, data suggest some deterioration in improvement after the first postoperative year. LABS-2, #NCT00465829, http://www.clinicaltrials.gov/ct2/show/NCT00465829.
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Affiliation(s)
- James E. Mitchell
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Wendy C. King
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jia-Yuh Chen
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael J. Devlin
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - David Flum
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Luis Garcia
- Neuropsychiatric Research Institute and the University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - John R. Pender
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | | | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Beth Schrope
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Gladys Strain
- Weill Cornell Medical School, New York, New York, USA
| | - Bruce Wolfe
- Oregon Health and Science University, Portland, Oregon, USA
| | - Susan Yanovski
- National Institute of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA
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98
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Kleiner DE, Berk PD, Hsu JY, Courcoulas AP, Flum D, Khandelwal S, Pender J, Pomp A, Roerig J, Machado LL, Wolfe BM, Belle SH. Hepatic pathology among patients without known liver disease undergoing bariatric surgery: observations and a perspective from the longitudinal assessment of bariatric surgery (LABS) study. Semin Liver Dis 2014; 34:98-107. [PMID: 24782263 PMCID: PMC4139971 DOI: 10.1055/s-0034-1371083] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver biopsy is not routine during bariatric surgery. Alanine aminotransferase (ALT) is widely used to screen for liver disease. We assessed the relationship between ALT and pathology in biopsies from Longitudinal Assessment of Bariatric Surgery (LABS) patients with normal preoperative ALTs. Biopsies from the LABS-1 and LABS-2 studies were scored using the NASH CRN and Ishak systems. Diagnosis and histology were examined in relation to alanine aminotransferase (ALT) values. Six-hundred ninety-three suitable biopsies were evaluated. Biopsied patients had a median age of 45 years; 78.6% were female and 35.1% diabetic; median body mass index was 46 kg/m(2). Six-hundred thirty-five biopsied patients had preoperative ALTs. Median ALT was 25 IU/L (interquartile range [IQR] 19-36 IU/L); 26.6% had an ALT > 35 IU/L and 29.9% exceeded the more restrictive Prati criteria for normal. Using the Prati criteria, 7.9% of participants with normal ALT had steatohepatitis and 5.3% had ≥ stage 2 fibrosis. Logistic regression models were used to predict the probabilities of having bridging fibrosis/cirrhosis or a diagnosis of borderline/definite steatohepatitis in the unbiopsied LABS-2 sample. The proportion of biopsied participants with these findings was very similar to the modeled results from the unbiopsied cohorts. We estimated that 86.0% of participants with advanced fibrosis and 88.1% of participants with borderline/definite steatohepatitis were not biopsied and went undiagnosed. As ALT did not reliably exclude significant obesity-related liver disease in bariatric surgery patients, consideration should be given to routine liver biopsy during bariatric surgery and medical follow-up of significant hepatic pathology.
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Affiliation(s)
- David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | | | - Jesse Y. Hsu
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | | | | | | | | | | | | | | | | | - Steven H. Belle
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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99
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Purnell JQ, Selzer F, Smith MD, Berk PD, Courcoulas AP, Inabnet WB, King WC, Pender J, Pomp A, Raum WJ, Schrope B, Steffen KJ, Wolfe BM, Patterson EJ. Metabolic syndrome prevalence and associations in a bariatric surgery cohort from the Longitudinal Assessment of Bariatric Surgery-2 study. Metab Syndr Relat Disord 2013; 12:86-94. [PMID: 24380645 DOI: 10.1089/met.2013.0116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. METHODS Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. RESULTS The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. CONCLUSIONS Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes.
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Affiliation(s)
- Jonathan Q Purnell
- 1 Department of Medicine, Oregon Health & Science University , Portland, Oregon
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Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L, Horlick M, Kalarchian MA, King WC, Mitchell JE, Patterson EJ, Pender JR, Pomp A, Pories WJ, Thirlby RC, Yanovski SZ, Wolfe BM. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310:2416-25. [PMID: 24189773 PMCID: PMC3955952 DOI: 10.1001/jama.2013.280928] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Severe obesity (body mass index [BMI] ≥35) is associated with a broad range of health risks. Bariatric surgery induces weight loss and short-term health improvements, but little is known about long-term outcomes of these operations. OBJECTIVE To report 3-year change in weight and select health parameters after common bariatric surgical procedures. DESIGN AND SETTING The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. PARTICIPANTS AND EXPOSURE: Adults undergoing first-time bariatric surgical procedures as part of routine clinical care by participating surgeons were recruited between 2006 and 2009 and followed up until September 2012. Participants completed research assessments prior to surgery and 6 months, 12 months, and then annually after surgery. MAIN OUTCOMES AND MEASURES Three years after Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), we assessed percent weight change from baseline and the percentage of participants with diabetes achieving hemoglobin A1c levels less than 6.5% or fasting plasma glucose values less than 126 mg/dL without pharmacologic therapy. Dyslipidemia and hypertension resolution at 3 years was also assessed. RESULTS At baseline, participants (N = 2458) were 18 to 78 years old, 79% were women, median BMI was 45.9 (IQR, 41.7-51.5), and median weight was 129 kg (IQR, 115-147). For their first bariatric surgical procedure, 1738 participants underwent RYGB, 610 LAGB, and 110 other procedures. At baseline, 774 (33%) had diabetes, 1252 (63%) dyslipidemia, and 1601 (68%) hypertension. Three years after surgery, median actual weight loss for RYGB participants was 41 kg (IQR, 31-52), corresponding to a percentage of baseline weight lost of 31.5% (IQR, 24.6%-38.4%). For LAGB participants, actual weight loss was 20 kg (IQR, 10-29), corresponding to 15.9% (IQR, 7.9%-23.0%). The majority of weight loss was evident 1 year after surgery for both procedures. Five distinct weight change trajectory groups were identified for each procedure. Among participants who had diabetes at baseline, 216 RYGB participants (67.5%) and 28 LAGB participants (28.6%) experienced partial remission at 3 years. The incidence of diabetes was 0.9% after RYGB and 3.2% after LAGB. Dyslipidemia resolved in 237 RYGB participants (61.9%) and 39 LAGB participants (27.1%); remission of hypertension occurred in 269 RYGB participants (38.2%) and 43 LAGB participants (17.4%). CONCLUSIONS AND RELEVANCE Among participants with severe obesity, there was substantial weight loss 3 years after bariatric surgery, with the majority experiencing maximum weight change during the first year. However, there was variability in the amount and trajectories of weight loss and in diabetes, blood pressure, and lipid outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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