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Giannopoulos S, AbuHasan Q, Connors JDN, Athanasiadis DI, Hilgendorf W, Gardiner R, Martine V, Baumgartner TC, Stefanidis D. Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey. Surg Endosc 2024; 38:2252-2259. [PMID: 38409612 DOI: 10.1007/s00464-023-10664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known. OBJECTIVES Assess patient needs, goals, and preferences regarding WR treatment. SETTING Single MBSAQIP-accredited academic center, and online recruitment. METHODS An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations. RESULTS Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively. CONCLUSIONS Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Qais AbuHasan
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - William Hilgendorf
- General Surgery, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Robin Gardiner
- Indiana University Health North Hospital, Carmel, IN, USA
| | - Victoria Martine
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
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Miller-Matero LR, Haley EN, Loree AM, Braciszewski JM, Maye M, Sehgal M, Carlin AM. Post-surgical psychiatric symptoms, maladaptive eating patterns, and lifestyle behaviors associated with weight recurrence after bariatric surgery. Surg Obes Relat Dis 2024; 20:297-303. [PMID: 37923621 DOI: 10.1016/j.soard.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A significant proportion of patients who undergo bariatric surgery experience weight recurrence; however, the most important areas to target to prevent weight recurrence remain unknown. OBJECTIVES The purpose was to examine whether psychiatric symptoms, maladaptive eating behaviors, and lifestyle factors were associated with weight recurrence. SETTING Single healthcare system. METHODS Individuals who underwent bariatric surgery were invited to complete a web-based survey in which they reported their current weight and completed measures of psychiatric symptoms, maladaptive eating behaviors, and lifestyle behaviors. Participants were included if they were at least 2 years postsurgery. Weight recurrence was measured from the 1-year follow-up to the survey date. RESULTS Participants (n = 169) were predominantly female and White or Black, with a mean age of 45 years. The rate of significant weight recurrence was 23.1%. Those who underwent sleeve gastrectomy were more likely to experience weight recurrence (odds ratio [OR] = 12.99; P = .01). In bivariate analyses, anxiety and depressive symptoms, emotional eating, loss of control eating, binge eating, and night eating were associated with weight recurrence (P < .05). Those who did not eat mindfully, take 20 minutes to eat, or get adequate sleep were also more likely to have weight recurrence (P < .05). In a multivariate model, only a lack of mindful eating (OR = 4.84; P = .03) and inadequate sleep (OR = 7.30; P = .02) remained statistically significant predictors. CONCLUSION Engaging in mindful eating and obtaining adequate sleep may protect against weight recurrence following bariatric surgery. Clinicians may want to screen and monitor these behaviors.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Monica Sehgal
- Behavioral Health, Henry Ford Health, Detroit, Michigan
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Skeldon M, Harris D, Dent R, Shiau JY. A comparison of virtual and in person delivery of a full meal replacement program for obesity. Obes Sci Pract 2024; 10:e718. [PMID: 38259352 PMCID: PMC10801667 DOI: 10.1002/osp4.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 01/24/2024] Open
Abstract
Objective Full meal replacement (FMR) Intensive Lifestyle Interventions (ILI) have been used for weight management. However, predictors of efficacy with these programs are less clear. The primary objective was to assess weight loss predictors in a community-based FMR ILI program. A secondary objective was to determine if weight loss was different between virtual and in person ILI. Methods This was a retrospective cohort study involving 234 patients who started the program between 1 January 2016 and 3 March 2021. In the 24-week program, patients spent 12 weeks on FMR and then transitioned back to food for the remainder, with weekly follow up with a physician and group sessions with a dietitian. Visits were in person prior to March 2020 and virtual afterward. Results Patients' average age was 47.5 years (SD = 12.0) and 73.5% were female. Average weight loss was 14.3% (SD = 6.2%). There was no significant difference in weight loss between virtual and in person programs. Patients on a Glucagon-like Peptide-1 Receptor Agonist prior lost less weight. Other significant associations between groups were baseline Hemoglobin A1C, classes attended, as well as the age since peak weight. Conclusion Weight loss from virtual ILI was not significantly different from person ILI. More research is needed to determine how to best stratify care as virtual or in person using FMR programs.
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Affiliation(s)
- Matthew Skeldon
- Division of General Internal MedicineDepartment of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - David Harris
- LEAF Weight Management ClinicDivision of Endocrinology and MetabolismUniversity of OttawaOttawaOntarioCanada
- Richmond Metabolic & Bariatric Surgery ProgramRichmondBritish ColumbiaCanada
| | - Robert Dent
- LEAF Weight Management ClinicDivision of Endocrinology and MetabolismUniversity of OttawaOttawaOntarioCanada
- The Ottawa Hospital Weight Management ClinicUniversity of OttawaOttawaOntarioCanada
| | - Judy Y. Shiau
- LEAF Weight Management ClinicDivision of Endocrinology and MetabolismUniversity of OttawaOttawaOntarioCanada
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Forouhar V, Edache IY, Salas XR, Alberga AS. Weight bias internalization and beliefs about the causes of obesity among the Canadian public. BMC Public Health 2023; 23:1621. [PMID: 37620795 PMCID: PMC10463458 DOI: 10.1186/s12889-023-16454-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Explicit weight bias is known as negative attitudes and beliefs toward individuals due to their weight status and can be perpetuated through misconceptions about the causes of obesity. Individuals may also experience weight bias internalization (WBI) when they internalize negative weight-related attitudes and self-stigmatize. There is a paucity of research on the beliefs about the causes of obesity and the prevalence of WBI among public Canadian samples. The aim of this study was to describe these attitudes and beliefs about obesity among a large Canadian sample across the weight spectrum. METHODS A Canadian sample of adults (N = 942; 51% Women; mean age group = 45-54 years; mean body mass index [BMI] = 27.3 ± 6.7 kg/m2) completed an online questionnaire. Participants completed the Modified Weight Bias Internalization Scale, the Anti-Fat Attitudes Questionnaire, and the Causes of Obesity Questionnaire. RESULTS Mean WBI score within the entire sample was 3.38 ± 1.58, and females had higher mean scores as compared to males (p < 0.001). Mean scores were also higher among individuals with a BMI of > 30 kg/m2 (4.16 ± 1.52), as compared to individuals with a BMI of 25-30 kg/m2 (3.40 ± 1.50), and those with a BMI of 20-25 kg/m2 or below 18.5 kg/m2 (2.81 ± 1.44) (p < 0.001 for all). Forty four percent of Canadians believed behavioural causes are very or extremely important in causing obesity, 38% for environmental causes, 28% for physiological and 27% for psychosocial causes. Stronger beliefs in behavioural causes were associated with higher levels of explicit weight bias. No BMI differences were reported on the four different subscales of the Causes of Obesity Questionnaire. CONCLUSIONS Weight bias internalization is prevalent among Canadians across all body weight statuses, and the public endorses behavioural causes of obesity, namely physical inactivity and overeating, more than its other causes. Findings warrant the reinforcement of efforts aimed at mitigating weight bias by educating the public about the complexity of obesity and by highlighting weight bias as a systemic issue that affects all Canadians living in diverse body weight statuses.
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Affiliation(s)
- Vida Forouhar
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Iyoma Y Edache
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Angela S Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada.
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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Nicanor-Carreón JG, Seyedsadjadi N, Rowitz B, Pepino MY. Weight Regain and Ingestive Behavior in Women after Metabolic Surgery. Nutrients 2023; 15:3670. [PMID: 37686704 PMCID: PMC10490188 DOI: 10.3390/nu15173670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated associations between maladaptive ingestive behaviors and weight regain in women who underwent metabolic surgery 2-10 years ago. Using a web-based survey, we assessed emotional, external, and restrained eating (Dutch Eating Behavior Questionnaire-DEBQ), food cravings (Food-Craving Inventory-FCI), and other behaviors (e.g., Eating Disorder Examination Questionnaire-EDE-Q; Alcohol Use Disorder Identification Test-Concise-AUDIT-C) in 36 women (42.9 ± 9.5 years old) post-surgery. We found that weight regain was specifically associated with increased frequency of cravings for sweets (r = 0.43), higher global scores in the EDE-Q (r = 0.38), and time elapsed since surgery (r = 0.35; all p's < 0.04). Multiple regression analysis revealed that the association between weight regain and sweet cravings interacted with time after surgery (p = 0.04), with the strongest association observed in women assessed closer to the surgery (i.e., 2.0-2.8 years). The combination of time after surgery and its interaction with sweet cravings accounted for 31% of the individual variations in weight regain (p = 0.005). Notably, among participants who reported alcohol consumption (31 of 36), 55% had an AUDIT-C score indicating hazardous drinking. These findings highlight the relevance of attending to patients' reports of frequent sweet cravings and screening for alcohol use to enhance strategies tailored to prevent weight regain and alcohol-related health problems post-surgery.
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Affiliation(s)
- Jessica G. Nicanor-Carreón
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
| | - Neda Seyedsadjadi
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Blair Rowitz
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
- Department of Surgery, Carle Foundation Hospital, Urbana, IL 61801, USA
| | - Marta Yanina Pepino
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
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Miller-Matero LR, Ross K, DePascale E, Arellano C, Zelenak L, Braciszewski JM, Hecht LM, Haley EN, Loree AM, Carlin AM. Post-surgical cannabis use is associated with weight loss among individuals up to 4 years after bariatric surgery. Surg Endosc 2023:10.1007/s00464-023-10126-6. [PMID: 37202524 DOI: 10.1007/s00464-023-10126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Although cannabis is known to stimulate appetite, it is not clear whether cannabis use may impact weight loss outcomes following bariatric surgery. Although some work has suggested that pre-surgical cannabis use is not associated with post-surgical weight loss, the role of post-surgical cannabis use has not yet been examined. The purpose of this study was to measure pre- and post-surgical cannabis use and determine whether cannabis use was associated with weight loss outcomes following bariatric surgery. METHODS Patients who underwent bariatric surgery over a 4-year period at a single health care system were invited to complete a survey regarding pre- and post-surgical cannabis use and report their current weight. Pre-surgical weight and BMI were extracted from medical records to calculate change in BMI (ΔBMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), whether participants experienced a successful weight loss outcome, and whether participants had weight recurrence. RESULTS Among all participants (N = 759), 10.7% and 14.5% engaged in pre- and post-surgical cannabis use, respectively. Pre-surgical cannabis use was not associated with any weight loss outcomes (p > 0.05). Any post-surgical cannabis use was associated with lower %EWL (p = 0.04) and greater likelihood of weight recurrence (p = 0.04). Weekly cannabis use was associated with lower %EWL (p = 0.003), lower %TWL (p = 0.04), and a lower likelihood of having a successful weight loss outcome (p = 0.02). CONCLUSIONS Although pre-surgical cannabis use may not predict weight loss outcomes, post-surgical cannabis was associated with poorer weight loss outcomes. Frequent use (i.e., weekly) may be especially problematic. Providers should consider screening patients for cannabis use and educate them about the potential impact of postoperative cannabis use on weight loss following bariatric surgery.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA.
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
| | - Kaitlin Ross
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Eve DePascale
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | | | - Logan Zelenak
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Leah M Hecht
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Arthur M Carlin
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
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Ben-Porat T, Bacon SL, Woods R, Fortin A, Lavoie KL. Childhood Maltreatment in Patients Undergoing Bariatric Surgery: Implications for Weight Loss, Depression and Eating Behavior. Nutrients 2023; 15:2046. [PMID: 37432188 DOI: 10.3390/nu15092046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 07/12/2023] Open
Abstract
We aimed to explore the relationships between childhood maltreatment and changes in weight, depressive symptoms and eating behavior post-bariatric surgery (BS). Participants (n = 111, 85% females) were evaluated pre-surgery, and at 6 months (6 M) and 12 months (12 M) post-BS. History of maltreatment was assessed at baseline (Childhood Trauma Questionnaire), and depressive symptoms (Beck Depression Inventory-II) and eating behavior (Dutch Eating Behavior Questionnaire) were assessed at all time points. Participants' mean age and median BMI were 45.1 ± 11.7 years and 46.7 (IQR 42.4-51.9) kg/m2, respectively. Histories of emotional (EA), physical (PA) and sexual abuse (SA) and emotional (EN) and physical (PN) neglect were reported by 47.7%, 25.2%, 39.6%, 51.4% and 40.5%, respectively, with 78.4% reporting at least one form of maltreatment. Changes in weight and depressive symptoms were not different between patients with vs. without a history of maltreatment. However, those with vs. without SA demonstrated limited changes in emotional eating (EE) at 12 M, while those without showed improvements. Conversely, patients with vs. without EN showed greater improvements in external eating (ExE) at 6 M, but differences were no longer observed by 12 M. Results indicate that histories of SA and EN are associated with changes in eating behaviors post-BS and have implications for assessment, monitoring and potential intervention development.
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Affiliation(s)
- Tair Ben-Porat
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC H4J 1C5, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC H4J 1C5, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Robbie Woods
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC H4J 1C5, Canada
- Department of Psychology, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Annabelle Fortin
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC H4J 1C5, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC H4J 1C5, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada
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Grieco A, Greene ME, Ko CY, Cohen ME, Evans-Labok K, Fraker T, Hutter MM. Evaluating agreement between clinic- and patient-reported outcomes for weight and co-morbidities at 1 year after bariatric surgery. Surg Obes Relat Dis 2023; 19:309-317. [PMID: 36400692 DOI: 10.1016/j.soard.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Development of patient-reported outcomes (PROs) to include traditionally clinic-reported data has the potential to decrease the data-collection burden for patients and clinicians and increase follow-up rates. However, replacing clinic report by patient report requires that the data reasonably agree. OBJECTIVE To assess agreement between PROs and clinical registry data at 1 year after bariatric surgery. SETTING Not-for-profit organization, bariatric surgery data registry, PROs platform. METHODS Patient- and clinic-reported 1-year postoperative weight and co-morbidities were compared for matched PROs and registry records. The co-morbidities evaluated were diabetes, sleep apnea, hypertension, gastroesophageal reflux disease, and hyperlipidemia. Weight difference in pounds and nominal groupings (binary, 4-level) for co-morbidities were assessed for agreement between data sources using descriptive statistics, Bland-Altman plots, multiple regression, and kappa coefficients. Sensitivity analyses and follow-up by response method were examined. RESULTS Among 1130 patients with both 1-year PROs and registry weights, 95% of patient-reported weights were within 13 lb of the registry-recorded weight, and patients underreported their weight by ∼2 lb, on average. Percent agreement and kappa coefficients were highest for diabetes (n = 999; binary: 94%, κ = .72; 4-level: 86%, κ = .71) and lowest for gastroesophageal reflux disease (n = 1032; binary: 75%, κ = .40; 4-level: 57%, κ = .35). Of patients eligible for both PROs and registry 1-year follow-up, 21% had PROs only. CONCLUSIONS One-year patient- and clinic-reported weights and disease status for patients with diabetes and hypertension showed high agreement. The degree of bias from patient report was low. Patient report is a viable alternative to clinic report for certain objective measurements and may increase follow-up.
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Affiliation(s)
| | - Meridith E Greene
- Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois; Department of Surgery, University of California Los Angeles David Geffen School of Medicine and Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Matthew M Hutter
- Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Lau T, Cook J, Archid R, Stengel A, Zipfel S, Mack I. Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis. Obes Facts 2023; 16:1-10. [PMID: 36209729 PMCID: PMC9889730 DOI: 10.1159/000526945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/15/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To fulfill the requirements for bariatric surgery, patients often need to participate in mandatory preoperative lifestyle interventions. Currently, the efficacy of multi-month preoperative lifestyle intervention programs on body mass index (BMI) reduction from the start of the program (T0) through the immediate preoperative time point (T1) to 1 year post-surgery (T2) and how the amount of preoperative BMI reduction affects postoperative outcome (T1 to T2) is unclear. The aim of this meta-analysis was to analyze the effects of preoperative lifestyle interventions on BMI 1 year post-surgery. METHOD A systematic literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Randomized controlled trials that implemented preoperative lifestyle interventions lasting 1-8 months before bariatric surgery were included. The BMI of the intervention group was compared with that of a control group before participation in the preoperative lifestyle interventions (T0), after completion of the program before surgery (T1), and 1 year post-surgery (T2). Finally, the impact of successful BMI reduction at T1 on BMI at T2 was analyzed. RESULTS N = 345 patients derived from 4 studies undergoing preoperative lifestyle interventions reduced their BMI at T1 by 1.5 units compared to the control group (95% CI: -2.73, -0.28). One year post-surgery, both groups had lost comparable BMI points. The influence of reduced BMI at T1 on weight status at T2 is unclear due to the lack of available studies. Other endpoints and subgroup analyses were rarely examined. CONCLUSIONS Preoperative lifestyle interventions reduce BMI before bariatric surgery more effectively than usual care. These differences are not detectable 1 year post-surgery. Although a short-term energy reduction period before surgery is clearly important to minimize surgery risks, it is currently unclear whether, and if so, under what circumstances, participation in a preoperative lifestyle intervention is beneficial.
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Affiliation(s)
- Teresa Lau
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany,
| | - Jessica Cook
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Rami Archid
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine, Charité - University Medicin Berlin, Berlin, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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10
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Kennedy C, Podkameni D, King WC. Letter to the Editor. Surg Obes Relat Dis 2022; 18:1254-1255. [DOI: 10.1016/j.soard.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
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11
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Gordon EL, Terrill AL, Smith TW, Ibele AR, Martinez P, McGarrity LA. Overvaluation of Shape and Weight (Not BMI) Associated with Depressive Symptoms and Binge Eating Symptoms Pre- and Post-bariatric Surgery. Obes Surg 2022; 32:2272-2279. [DOI: 10.1007/s11695-022-06062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
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12
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Majid SF, Davis MJ, Ajmal S, Podkameni D, Jain-Spangler K, Guerron AD, King N, Voellinger DC, Northup CJ, Kennedy C, Archer SB. Current state of the definition and terminology related to weight recurrence after metabolic surgery: review by the POWER Task Force of the ASMBS. Surg Obes Relat Dis 2022; 18:957-963. [DOI: 10.1016/j.soard.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/17/2022] [Indexed: 12/17/2022]
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13
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Gourash WF, King WC, Shirley E, Hinerman A, Ebel F, Pomp A, Pories WJ, Courcoulas AP. Five-year attrition, active enrollment, and predictors of level of participation in the Longitudinal Assessment of Bariatric Surgery (LABS-2) study. Surg Obes Relat Dis 2021; 18:394-403. [PMID: 35027321 DOI: 10.1016/j.soard.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reporting high-quality bariatric surgery outcomes depends on participant attrition and level of study participation among enrolled participants. OBJECTIVES Our aims are to report participant attrition, active enrollment, and level of participation, and to evaluate pre-surgery sociodemographic, physical health, and psychosocial factors as predictors of attrition and level of participation through 5 years. SETTING The Longitudinal Assessment of Bariatric Surgery-2 study which enrolled 2458 adults undergoing a first bariatric surgical procedure at 1 of 6 US cites from 2006 through 2009. METHODS In-person research assessments were conducted pre-surgery and annually for five years. Extensive retention strategies including offering remote assessments (telephone, email, mail, or a combination) were fully implemented in 2009. Among living participants, including those inactivated, annual follow-up assessments were categorized as in-person, remote or missed through 5 years. RESULTS By year 5, 1.7% of participants had died and 3.2% had withdrawn or were inactivated by the study staff; thus, attrition was 4.9% (n = 121). Controlling for site and calendar year, missed assessments increased from 14.7%-21.8% between years 1 and 2 and then stayed relatively stable (20.8%-19.6%) for years 3-5. Younger age, male sex, White race, lower body mass index, smoking, illicit drug use, and higher weight loss expectations preoperatively were independently associated with a higher likelihood of a missed versus in-person assessment across follow-up. CONCLUSION The LABS-2 participant attrition was low. The percentage of missed assessments did not increase after year 2, perhaps due to implementation of a comprehensive retention plan. Predictors of missed assessments highlight subgroups to target for focused retention efforts.
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Affiliation(s)
- William F Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor Shirley
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amanda Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faith Ebel
- Department of Surgery, Division of GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, New York
| | - Alfons Pomp
- Department of Surgery, University of Montreal, Montreal, Canada
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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14
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Kerver GA, Bond DS, Crosby RD, Cao L, Engel SG, Mitchell JE, Steffen KJ. Pain is adversely related to weight loss maintenance following bariatric surgery. Surg Obes Relat Dis 2021; 17:2026-2032. [PMID: 34600842 DOI: 10.1016/j.soard.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pain and obesity are frequently co-morbid health conditions; thus, it is unsurprising that pain is commonly experienced by individuals seeking bariatric surgery. While pain is generally reduced in the short-term after surgery, there is also variability in pain outcomes and less is known about how unresolved or recurring pain may relate to long-term weight loss and weight loss maintenance. OBJECTIVES This study evaluated trajectories of pain scores through 7 years following bariatric surgery and whether higher pain levels related to poorer weight loss and greater weight regain. SETTING Data were collected from 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. METHODS Self-report measures of pain and weight change data were utilized for 1702 adults seeking Roux-en-Y gastric bypass surgery from the Longitudinal Assessment for Bariatric Surgery (LABS) cohort. A series of linear mixed models examined trajectories of pain scores and the concurrent predictive relationship between pain and weight outcomes from pre-surgery through 7 years post-surgery. RESULTS Overall bodily-, hip-, and knee-pain improved through 2 years, deteriorated from 2-5 years, and then slightly improved from 5-7 years following surgery (P < .001). Greater pain was concurrently associated with less weight loss and greater weight regain over time (P ≤ .006). CONCLUSION Pain is evident in the long-term following bariatric surgery and associated with suboptimal weight outcomes. More research is needed to identify mechanisms underlying this relationship, which may ultimately help develop appropriate pain assessment and treatment strategies to ensure optimal post-surgery outcomes.
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Affiliation(s)
- Gail A Kerver
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
| | - Dale S Bond
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, Rhode Island
| | - Ross D Crosby
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Li Cao
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
| | - Scott G Engel
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - James E Mitchell
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Kristine J Steffen
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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15
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Herb Neff KM, Schuh LM, Saules KK, Creel DB, Stote JJ, Schuh KM, Inman M. Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery. J Clin Psychol Med Settings 2021; 28:833-843. [PMID: 34324141 DOI: 10.1007/s10880-021-09807-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.
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Affiliation(s)
| | - Leslie M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Karen K Saules
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA. .,Community Behavioral Health Clinic, Eastern Michigan University, 1075 North Huron River Drive, Ypsilanti, MI, 48197, USA.
| | - David B Creel
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Cleveland Clinic, Cleveland, OH, USA
| | - Joseph J Stote
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Kristen M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Inman
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
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16
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Lawson JL, Schuh LM, Creel DB, Blackinton RM, Giambrone SA, Grilo CM, Ivezaj V. Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3498-3505. [PMID: 33866532 DOI: 10.1007/s11695-021-05418-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating). METHODS A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight. RESULTS IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight. CONCLUSIONS Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.
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Affiliation(s)
- Jessica L Lawson
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.,VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Leslie M Schuh
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA
| | - David B Creel
- St. Vincent Bariatric Center, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA.,Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | | | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, CT, 06511, USA.
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17
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Alvarez R, Stricklen A, Buda CM, Ross R, Bonham AJ, Carlin AM, Varban OA, Ghaferi AA, Finks JF. Factors associated with completion of patient surveys 1 year after bariatric surgery. Surg Obes Relat Dis 2020; 17:538-547. [PMID: 33334677 DOI: 10.1016/j.soard.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/05/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcomes (PRO) obtained from follow-up survey data are essential to understanding the longitudinal effects of bariatric surgery. However, capturing data among patients who are well beyond the recovery period of surgery remains a challenge, and little is known about what factors may influence follow-up rates for PRO. OBJECTIVES To assess the effect of hospital practices and surgical outcomes on patient survey completion rates at 1 year after bariatric surgery. SETTING Prospective, statewide, bariatric-specific clinical registry. METHODS Patients at hospitals participating in the Michigan Bariatric Surgery Collaborative are surveyed annually to obtain information on weight loss, medication use, satisfaction, body image, and quality of life following bariatric surgery. Hospital program coordinators were surveyed in June 2017 about their practices for ensuring survey completion among their patients. Hospitals were ranked based on 1-year patient survey completion rates between 2011 and 2015. Multivariable regression analyses were used to identify associations between hospital practices, as well as 30-day outcomes, on hospital survey completion rankings. RESULTS Overall, patient survey completion rates at 1 year improved from 2011 (33.9% ± 14.5%) to 2015 (51.0% ± 13.0%), although there was wide variability between hospitals (21.1% versus 77.3% in 2015). Hospitals in the bottom quartile for survey completion rates had higher adjusted rates of 30-day severe complications (2.6% versus 1.7%, respectively; P = .0481), readmissions (5.0% versus 3.9%, respectively; P = .0157), and reoperations (1.5% versus .7%, respectively; P = .0216) than those in the top quartile. While most hospital practices did not significantly impact survey completion at 1 year, physically handing out surveys during clinic visits was independently associated with higher completion rates (odds ratio, 13.60; 95% confidence interval, 1.99-93.03; P =.0078). CONCLUSIONS Hospitals vary considerably in completion rates of patient surveys at 1 year after bariatric surgery, and lower rates were associated with hospitals that had higher complication rates. Hospitals with the highest completion rates were more likely to physically hand surveys to patients during clinic visits. Given the value of PRO on longitudinal outcomes of bariatric surgery, improving data collection across multiple hospital systems is imperative.
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Affiliation(s)
- Rafael Alvarez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | | | - Colleen M Buda
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Arthur M Carlin
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
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18
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Harrod CS, Elman MR, Vesco KK, Wolfe BM, Mitchell JE, Pories WJ, Pomp A, Boone-Heinonen J, Purnell JQ. Associations of Pregnancy After Bariatric Surgery with Long-Term Weight Trajectories and Birth Weight: LABS-2 Study. Obesity (Silver Spring) 2020; 28:2209-2215. [PMID: 32918404 PMCID: PMC7650043 DOI: 10.1002/oby.22944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to examine whether pregnancy following bariatric surgery affects long-term maternal weight change and offspring birth weight. METHODS Using data from the Longitudinal Assessment of Bariatric Surgery (LABS)-2 study, linear regression was used to evaluate percent change in total body weight over a 5-year follow-up period among reproductive-aged women who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding as well as evaluate the association of bariatric procedure type and offspring birth weight. RESULTS Of 727 women with preoperative age of 36.1 (6.3) years (mean [SD]) and BMI of 46.9 (7.0) kg/m2 , 80 (11%) reported at least one pregnancy. After adjusting for covariates, percent change in total body weight was not significantly different between women who became pregnant and those who did not during a 5-year follow-up period (β = 2.02; 95% CI: -1.03 to 5.07; P = 0.19). Additionally, mean birth weight was not significantly different between mothers who underwent Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding (P = 0.99). CONCLUSIONS Postoperative pregnancy did not diminish long-term weight loss in women in the LABS-2 study. The finding of comparable weight loss is relevant for providers counseling women of reproductive age on weight-loss expectations and family planning following bariatric surgery.
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Affiliation(s)
| | - Miriam R Elman
- Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Alfons Pomp
- Weill Cornell University Medical Center, New York, New York, USA
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19
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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20
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Associations between Physical Activity and Changes in Weight Across 7 Years following ROUX-en-Y Gastric Bypass Surgery: A Multicenter Prospective Cohort Study. Ann Surg 2020; 275:718-726. [PMID: 32889873 DOI: 10.1097/sla.0000000000004456] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine associations of objectively-measured physical activity (PA) with changes in weight after Roux-en-Y gastric bypass (RYGB) over 7 years. BACKGROUND The contribution of free-living PA to surgery-induced weight loss and subsequent weight regain is not well understood. METHODS Participants of a multi-center prospective cohort study of bariatric surgery were followed annually ≥7 years. Of 807 participants who underwent RYGB and were given an activity monitor, 649 (80%) had sufficient data for this report (78% female; median age 47 years; median body mass index 46 kg/m). Mean daily steps, hours/day in sedentary behavior (SB) and minutes/week in moderate-to-vigorous physical activity (MVPA) were determined at each assessment. Mixed models tested associations between PA measures and weight outcomes, controlling for sociodemographics, health status and eating behaviors. RESULTS Across follow-up, mean pre- to post-surgery changes in PA were small, and mean post-surgery PA level was below PA recommendations for health (e.g., 101 MVPA min/week 7 years post-surgery versus the ≥150 MVPA min/week recommendation). There was a dose-response association between more steps, less SB and more MVPA with greater weight loss. Steps and SB, but not MVPA, were also associated with weight regain. For example, participants in the highest versus lowest steps quartile lost 2.9% (95%CI, 1.8-4.1) more of their pre-surgery weight and regained 5.4% (95%CI, 2.4-8.3) less of their maximum weight lost across follow-up. CONCLUSION Despite only small increases in objectively-measured PA level after RYGB, PA level was independently associated with weight outcomes of bariatric surgery throughout 7 years of follow-up. REPRINTS Reprints will not be available from the authors.
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21
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Raatz SK, Johnson LK, Caliquary A, King WC, Kalarchian MA, Devlin MJ, Marcus MD, Mitchell JE. Reported nutrient intake over 7 years after Roux-en-Y gastric bypass in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis 2020; 16:1022-1029. [PMID: 32418771 PMCID: PMC7423730 DOI: 10.1016/j.soard.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/19/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss. OBJECTIVE Long-term data on postsurgical nutrient intake are lacking. SETTING The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study. METHODS Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes. RESULTS After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142. CONCLUSIONS The reduction in energy resulted in intakes below the dietary reference intakes for many micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.
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Affiliation(s)
- Susan K Raatz
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota.
| | - LuAnn K Johnson
- Division of Research and Economic Development, University of North Dakota, Grand Forks, North Dakota
| | | | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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22
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Breland JY, Joyce VR, Frayne SM, Phibbs C. Differences in body mass index based on self-reported versus measured data from women veterans. Obes Sci Pract 2020; 6:434-438. [PMID: 32874677 PMCID: PMC7448139 DOI: 10.1002/osp4.421] [Citation(s) in RCA: 2] [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: 01/15/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The objective was to compare differences in body mass index (BMI) calculated with self-reported versus clinically measured pre-conception data from women veterans in California. METHODS Veterans Health Administration (VHA) and California state birth certificate data were used to develop a cohort of women who gave birth from 2007-2012 and had VHA data available to calculate BMI (N = 1,326 mothers, 1,473 births). Weighted Kappa statistics assessed concordance between self-reported and measured BMI. A linear mixed-effects model with maximum likelihood estimation, adjusted for mother as a random effect, assessed correlates of differences in BMI. RESULTS Mean BMI was in the overweight range based on self-reported (26.2 kg/m2, SD: 5.2) and measured (26.8 kg/m2, SD: 5.2) data. Weighted Kappa statistics indicated good agreement between self-reported and measured BMI (0.73, 95% CI: 0.70, 0.76). Compared to the normal weight group, groups with overweight or obesity were significantly more likely to have lower BMIs when calculated using self-reported versus measured heights and weights, in unadjusted and adjusted models. The finding was pronounced for class 3 obesity, which was associated with a BMI underestimation of 6.4 kg/m2. CONCLUSIONS Epidemiologic research that guides the clinical care of pregnant women should account for potential under-estimation of BMI in heavier women, and perform direct measurement where feasible.
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Affiliation(s)
- Jessica Y. Breland
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care SystemMenlo ParkCAUSA
| | - Vilija R. Joyce
- VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care SystemMenlo ParkCAUSA
| | - Susan M. Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care SystemMenlo ParkCAUSA
- Division of Primary Care& Population HealthStanford University School of MedicineStanfordCAUSA
| | - Ciaran Phibbs
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care SystemMenlo ParkCAUSA
- VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care SystemMenlo ParkCAUSA
- Department of PediatricsStanford University School of MedicineStanfordCAUSA
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23
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Van Zyl N, Andrews L, Williamson H, Meyrick J. The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence. Obes Res Clin Pract 2020; 14:404-420. [PMID: 32631804 DOI: 10.1016/j.orcp.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/12/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. METHODS The review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. RESULTS Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. CONCLUSION Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.
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Affiliation(s)
- Natascha Van Zyl
- Institute for Optimum Nutrition, Paradise Road, Richmond, TW9 1SQ, UK.
| | - Lee Andrews
- Abertillery Group Practice, The Bridge Centre, Foundry Bridge, Abertillery, NP13 1BQ.
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
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Association between weight loss and serum biomarkers with risk of incident cancer in the Longitudinal Assessment of Bariatric Surgery cohort. Surg Obes Relat Dis 2020; 16:1086-1094. [PMID: 32471725 DOI: 10.1016/j.soard.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/20/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery reduces cancer risk in populations with obesity. It is unclear if weight loss alone or metabolic changes related to bariatric surgery cause this effect. OBJECTIVE We evaluated the relationship between surgical weight loss and serum biomarker changes with incident cancer in a bariatric surgery cohort. SETTING Ten U.S. clinical facilities. METHODS The Longitudinal Assessment of Bariatric Surgery 2 (LABS-2) is a prospective multicenter cohort (n = 2458, 79% female, mean age = 46). We evaluated weight and serum biomarkers, measured preoperatively and 1 year postoperatively, as predictors for incident cancer. Associations were determined using Cox proportional hazards models adjusting for weight loss, age, sex, education, and smoking history. RESULTS Over 8759 person-years of follow-up, 82 patients reported new cancer diagnosis (936 per 100,000 person-years, 95% confidence interval [CI]: 749-1156). Cancer risk was decreased by approximately 50% in participants with 20% to 34.9% total weight loss (TWL) compared with <20% TWL (hazard ratio [HR] = .49, 95%CI: .29-.83). Reduced cancer risk was observed with percent decrease from baseline for glucose (per 10%, HR = .94, 95%CI: .90-.99), proinsulin (per 20%, HR = .95, 95%CI: .93-.98), insulin (per 30%, HR = .97, 95%CI: .96-.99), and leptin (per 20%, HR = .81, 95%CI: .68-.97), and per 15% percent increase in ghrelin (HR = .94, 95%CI: .29-.83). CONCLUSIONS After bariatric surgery, cancer risk is reduced >50% when weight loss exceeds 20% TWL compared with patients with <20% TWL. Weight loss alone may not explain the observed risk reduction, as improvements in diabetes, leptin, and ghrelin were associated with decreased cancer risk.
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King WC, Hinerman AS, Courcoulas AP. Weight regain after bariatric surgery: a systematic literature review and comparison across studies using a large reference sample. Surg Obes Relat Dis 2020; 16:1133-1144. [PMID: 32446593 DOI: 10.1016/j.soard.2020.03.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/08/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
Published estimates of weight regain (WR) after bariatric surgery vary greatly. Understanding the sources of variability in the literature and clarifying the magnitude of WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are critical for informing expectations and planning interventions. A literature search through January 2019 yielded 15 English-language studies that reported WR in at least 30 participants, not selected based on weight loss or WR, at least 3 years after primary RYGB (n = 11) or SG (n = 5). Median follow-up was 5.0 (range, 3.2-10.0) years. Median sample size was 62 (range, 33-464). Samples represented a median of 54.3% (range, 10.7%-100%) of eligible participants. Nadir weight was determined by serial research assessments (n = 1), medical records (n = 7), participant recall (n = 4), or an undisclosed method (n = 4). Three continuous and 8 binary WR measures (the latter, based on various thresholds for clinically meaningful WR) were reported. To enable comparison across studies, the percentage difference in WR in each study versus a reference sample (n = 1433 RYGB), matched on time since surgery and WR measure, was calculated. Median WR in the reference sample increased from 8.2 (25th-75th percentile: 0-19.5) to 23.8 (25th-75th percentile: 9.0-33.9) percent of maximum weight lost, 3 to 6 years post RYGB surgery. Studies of RYGB versus SG, with larger versus smaller samples, with higher versus lower participation rates, that determined nadir weight via participant recall versus medical records, and reported continuous versus binary WR measures tended to have WR values closer to the reference sample and each other. Variation in WR estimates was explained by heterogeneity in WR measures, timing of assessment, surgical procedure, and study design characteristics. The best estimate of WR after RYGB likely comes from the large reference sample. WR after SG versus RYGB appears higher. However, additional high-quality studies with uniform reporting of WR by surgical procedure are needed.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Amanda S Hinerman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical CenterPittsburgh, Pennsylvania
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Lavender JM, King WC, Kalarchian MA, Devlin MJ, Hinerman A, Gunstad J, Marcus MD, Mitchell JE. Examining emotion-, personality-, and reward-related dispositional tendencies in relation to eating pathology and weight change over seven years in the Longitudinal Assessment of Bariatric Surgery (LABS) study. J Psychiatr Res 2020; 120:124-130. [PMID: 31670260 PMCID: PMC6901114 DOI: 10.1016/j.jpsychires.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/28/2022]
Abstract
This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments were conducted to evaluate eating pathology, using the Eating Disorder Examination-Bariatric Surgery Version, and percent weight change from pre-surgery. Dispositional measures were administered at the 6- or 7-year assessment and included the Affect Intensity Measure, Difficulties in Emotion Regulation Scale, UPPS-P Impulsive Behavior Scale, Adult Temperament Questionnaire-Effortful Control Scale, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Results from a series of linear mixed models revealed significant associations of emotion dysregulation, affect intensity, positive and negative urgency, effortful control, and reward sensitivity with eating pathology severity across 7 years; additionally, all but two of the subscales comprising the total scores were also significantly associated. Fewer statistically significant results were found in relation to weight change; emotion dysregulation and affect intensity (along with several subscales) were significantly associated with lower percent weight change (i.e., less weight loss), but of the reward-related and personality/temperament variables, only total effortful control emerged as significant. However, the associations of the other variables with both outcomes were consistently in the expected direction. Associations also appeared consistent across surgical procedures. Taken together, findings suggest that certain dispositional tendencies may relate to less optimal long-term outcomes following bariatric surgery and thus may be useful to assess in pre-surgical or early post-surgical evaluations to inform targeted recommendations.
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Affiliation(s)
- Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons / New York State Psychiatric Institute, New York, NY, USA
| | - Amanda Hinerman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Walker E, Elman M, Takemoto EE, Fennern E, Mitchell JE, Pories WJ, Ahmed B, Pomp A, Wolfe BM. Bariatric Surgery Among Medicare Subgroups: Short- and Long-Term Outcomes. Obesity (Silver Spring) 2019; 27:1820-1827. [PMID: 31562705 PMCID: PMC6832742 DOI: 10.1002/oby.22613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study sought to examine weight change, postoperative adverse events, and related outcomes of interest among age-qualified (AQ) and disability-qualified (DQ) Medicare recipients compared with non-Medicare (NM) patients undergoing an initial bariatric procedure. METHODS The Longitudinal Assessment of Bariatric Surgery (LABS-2) is an observational cohort study of 2,458 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) bariatric surgery. Weight, percentage body fat, functional status, and comorbidities, as well as postoperative adverse events, were assessed at baseline and annually for 5 years. The 1,943 participants who reported insurance type were categorized into the following groups: AQ, DQ, or NM. RESULTS The median preoperative BMI ranged from 45 to 48 kg/m2 across groups. For RYGB, 5-year BMI loss was approximately 30% for all groups, and for LAGB, BMI loss was 12% to 15%. Diabetes remission after 5 years was also similar across groups within procedure types (RYGB: 33%-40%; LAGB: 13%-19%). The frequency of adverse events after RYGB ranged from 4.1% for NM participants to 6.7% for DQ participants. After LAGB, there were no adverse events for the AQ group, whereas 3% of DQ participants and 1.8% of NM participants had at least one adverse event. CONCLUSIONS Medicare participants experienced substantial BMI loss and diabetes remission, with a frequency of adverse events similar to that of NM participants.
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Affiliation(s)
- Elizaveta Walker
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Miriam Elman
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin E. Takemoto
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin Fennern
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota, Chaska, MN
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Bruce M. Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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Ahmed B, King WC, Gourash W, Hinerman A, Belle SH, Pomp A, Pories WJ, Courcoulas AP. Proximal Roux-en-Y gastric bypass: Addressing the myth of limb length. Surgery 2019; 166:445-455. [PMID: 31378475 PMCID: PMC6778033 DOI: 10.1016/j.surg.2019.05.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some studies suggest that changes in weight or metabolic outcomes are affected by the lengths of the gastrointestinal limbs in the Roux-en-Y gastric bypass. METHODS Participants (N = 1,770) underwent primary Roux-en-Y gastric bypass and were followed ≤7 years in the Longitudinal Assessment of Bariatric Surgery-2, a multicenter US cohort study. Alimentary limb and biliopancreatic limb lengths were measured according to research protocol; common channel was measured in a subsample (N = 547). Aimentary limb, biliopancreatic limb, and common channel ratio to total small bowel length were calculated. RESULTS Median presurgery body mass index was 46 (25th-75th percentile: 43-51) kg/m2. Medians (25th-75th percentiles) for alimentary limb length were 125 cm (100-150), for biliopancreatic limb length were 50 cm (50-60), and common channel length were 410 cm (322-520). Statistics for ratios to the small bowel length were 0.23 (0.18-0.27) for alimentary limb, 0.09 (0.07-0.10) for biliopancreatic limb, and 0.69 (0.63-0.73) for common length. There were no significant associations between alimentary limb, biliopancreatic limb, common channel, alimentary limb ratio, biliopancreatic limb ratio or common channel ratio, and either weight loss or improvement in cardiometabolic outcomes. CONCLUSION The common channel length in Roux-en-Y gastric bypass is highly variable between individuals. None of the limb lengths in this study, nor alimentary limb, biliopancreatic limb, or common channel ratios, seem to be related to weight loss or metabolic improvements >7 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
- Department of Epidemiology, Graduate School of Public Health, 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.
| | - Amanda Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Steven H Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alfons Pomp
- Department of Surgery, Division of GI Metabolic and Bariatric Surgery, Weill Cornell Medicine, New York, NY
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC
| | - 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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Courcoulas AP, King WC, Belle SH, Berk P, Flum DR, Garcia L, Gourash W, Horlick M, Mitchell JE, Pomp A, Pories WJ, Purnell JQ, Singh A, Spaniolas K, Thirlby R, Wolfe BM, Yanovski SZ. Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA Surg 2019; 153:427-434. [PMID: 29214306 DOI: 10.1001/jamasurg.2017.5025] [Citation(s) in RCA: 414] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures. Objective To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Design, Setting, and Participants The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years. Main Outcome and Measures Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use. Results Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants. Conclusions and Relevance Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB. 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
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- Department of Epidemiology, Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Paul Berk
- Columbia University, New York, New York
| | - David R Flum
- Department of Surgery, University of Washington, Seattle
| | - Luis Garcia
- University of North Dakota, Neuropsychiatric Research Institute, Grand Forks
| | - William Gourash
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, New York, New York
| | | | - Alfons Pomp
- Weill Cornell Medical College, New York, New York
| | - Walter J Pories
- Department of Surgery, Brody School of Medicine, Greenville, North Carolina
| | | | - Ashima Singh
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | - Bruce M Wolfe
- Department of Surgery, Oregon Health and Science University, Portland
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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White GE, Courcoulas AP, King WC, Flum DR, Yanovski SZ, Pomp A, Wolfe BM, Spaniolas K, Pories W, Belle SH. Mortality after bariatric surgery: findings from a 7-year multicenter cohort study. Surg Obes Relat Dis 2019; 15:1755-1765. [PMID: 31564635 DOI: 10.1016/j.soard.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients having bariatric surgery have lower mortality compared with those with similar body mass index who do not undergo surgery. It is unclear whether mortality post-bariatric surgery is similar to the general population. The benefit of bariatric surgery would be highlighted should people previously at high risk for premature death have comparable, or better, mortality as the general population. OBJECTIVE To compare mortality after bariatric surgery to the general U.S. population of the same age, sex, and race. SETTING The Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) prospective cohort of 2458 adults who underwent bariatric surgery at 10 U.S. hospitals between 2006 and 2009. METHODS Deaths were identified via LABS-2 follow-up and the National Death Index. Standardized mortality ratios (SMR) of post-bariatric surgery mortality observed in LABS-2 versus age-, sex-, race-, and year-adjusted expected mortality in the general U.S. population were calculated and compared with 1, which results when the number of observed and expected deaths are equal. RESULTS LABS-2 median follow-up was 6.6 (interquartile range: 5.9-7.0) years postsurgery. Seventy-six deaths were observed over 15,616 person-years (PY) of observation (4.9 deaths/1000 PY). The rate expected in the general U.S. population with the same age, sex, race, and year distribution was 4.8 deaths per 1000 PY (SMR = 1.02, 95% confidence interval [CI]: .80-1.27). There were no significant differences between observed and expected mortality by surgical procedure. Compared with expected mortality in the general U.S. population, people 35-44 years old at time of surgery had significantly more deaths (SMR = 2.06, 95% CI: 1.22-3.25), while people at least 55 years of age had significantly fewer (SMR = .63, 95% CI: .42-.92). Significantly more deaths than expected occurred in the perioperative period and 5-7 years after surgery. CONCLUSIONS Mortality within 7 years of bariatric surgery is comparable to the general U.S. population, which is likely to have better survival than people with severe obesity. However, more deaths than expected were identified 5-7 years after surgery.
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Affiliation(s)
- Gretchen E White
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Alfons Pomp
- Weill Cornell Medical College, New York, New York
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | | | - Walter Pories
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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White GE, Courcoulas AP, King WC. Drug- and alcohol-related mortality risk after bariatric surgery: evidence from a 7-year prospective multicenter cohort study. Surg Obes Relat Dis 2019; 15:1160-1169. [PMID: 31182414 DOI: 10.1016/j.soard.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/28/2019] [Accepted: 04/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is unclear whether bariatric surgery affects the risk of drug- and alcohol-related mortality. OBJECTIVES To compare the observed drug- and alcohol-related mortality rate with age, sex, race, and year-adjusted rates from the general U.S. POPULATION SETTING The Longitudinal Assessment of Bariatric Surgery-2, a prospective cohort study of 2458 adults who underwent bariatric surgery at 10 U.S. hospitals between April 2006 and April 2009. METHODS Participants attended presurgery and annual postsurgery assessments for up to 7 years. Drug- and alcohol-related standardized mortality ratios (SMR) comparing the observed post-bariatric surgery mortality rate with the age, sex, race, and year-adjusted expected mortality rate from the general U.S. population, among the entire cohort, and among those who underwent Roux-en-Y gastric bypass (RYGB). RESULTS Ten deaths related to drug or alcohol use (6 accidental overdose, 1 intentional overdose, 1 intent unknown overdose, and 2 alcoholic liver disease) occurred across 15,616 person-years of follow-up, all among participants who underwent RYGB (n = 1770). The observed mortality rate was significantly higher than expected for all drug- and alcohol-related causes overall (SMR = 2.10, 95% confidence interval = 1.01-3.86, P = .03) and among participants who underwent RYGB (SMR = 2.90, 95% confidence interval = 1.39-5.33, P = .003). The RYGB SMRs were significant for all overdoses (P = .002) and accidental overdoses (P = .01) and in the same direction but nonsignificant for intentional overdoses, intent unknown overdoses, and alcoholic liver disease (P for all ≥. 05). CONCLUSIONS Drug- and alcohol-related mortality is significantly higher than expected in the 7 years after bariatric surgery, specifically after RYGB.
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Affiliation(s)
- Gretchen E White
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Patient Behaviors and Characteristics Related to Weight Regain After Roux-en-Y Gastric Bypass. Ann Surg 2019; 272:1044-1052. [DOI: 10.1097/sla.0000000000003281] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kalarchian MA, King WC, Devlin MJ, Hinerman A, Marcus MD, Yanovski SZ, Mitchell JE. Mental disorders and weight change in a prospective study of bariatric surgery patients: 7 years of follow-up. Surg Obes Relat Dis 2019; 15:739-748. [PMID: 30826244 DOI: 10.1016/j.soard.2019.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/02/2019] [Accepted: 01/11/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Long-term, longitudinal data are limited on mental disorders after bariatric surgery. OBJECTIVE To report mental disorders through 7 years postsurgery and examine their relationship with changes in weight and health-related quality of life. SETTING Three U.S. academic medical centers. METHOD As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 199 adults completed the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition prior to Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric band. Participants who completed ≥1 follow-up through 7 years postsurgery are included (n = 173; 86.9%). Mixed models were used to examine mental disorders over time, and among the RYGB subgroup (n = 104), their relationship with long-term (≥4 yr) pre- to postsurgery changes in weight and health-related quality of life, measured with the Short Form-36 Health Survey, and with weight regain from nadir. RESULTS Compared with presurgery (34.7%), the prevalence of having any mental disorder was significantly lower 4 years (21.3%; P < .01) and 5 years (19.2%; P = .01), but not 7 years (29.1%; P = .27) after RYGB. The most common disorders were not related to long-term weight loss postRYGB. However, independent of weight change, mood and anxiety disorders, both pre- and postRYGB, were significantly related to less improvement in mental (but not physical) health-related quality of life. Having a concurrent mood disorder appeared to be associated with greater weight regain (6.4% of maximum weight lost, 95% confidence interval, -.3 to 13.1), but this was not statistically significant (P = .06). CONCLUSIONS Bariatric surgery does not result in consistent long-term reductions in mental disorders. Mood disorders may impact long-term outcomes of bariatric surgery.
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Affiliation(s)
| | - Wendy C King
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, New York
| | - Amanda Hinerman
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Field AE, Inge TH, Belle SH, Johnson GS, Wahed AS, Pories W, Spaniolas K, Mitchell JE, Pomp A, Dakin GF, Wolfe B, Courcoulas AP. Association of Obesity Subtypes in the Longitudinal Assessment of Bariatric Surgery Study and 3-Year Postoperative Weight Change. Obesity (Silver Spring) 2018; 26:1931-1937. [PMID: 30421853 PMCID: PMC6249053 DOI: 10.1002/oby.22287] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/11/2018] [Accepted: 07/29/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The study objective was to empirically identify subgroups of patients with obesity and investigate their association with postoperative weight change. METHODS A longitudinal analysis of 2,458 adults in the Longitudinal Assessment of Bariatric Surgery (LABS) study was used. Baseline data were used to identify subgroups. The outcome was 3-year weight change after bariatric surgery. RESULTS We identified four classes (subtypes) of obesity, which could be characterized as diabetes with low rates of high-density lipoprotein (Class 1), disordered eating (Class 2), mixed (Class 3), and extreme obesity with early onset (Class 4). Approximately 98% of participants in Class 1 had diabetes compared with < 40% in the other classes. There were high rates of binge eating in Class 2, and more than 92% of those in this class reported eating when not hungry. Class 4 was characterized by a higher BMI at baseline. Adults in Class 4 lost an average of 25.0% (males) and 30.3% (females) of their baseline weight over 3 years. In contrast with participants in Class 1, those in Classes 2 and 3 had significantly larger 3-year weight losses than their peers in Class 4. CONCLUSIONS Obesity is a heterogeneous disease. Bariatric surgery may be most beneficial for adults with disordered eating.
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Affiliation(s)
- Alison E. Field
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Thomas H. Inge
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Steven H. Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Geoffrey S Johnson
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Abdus S. Wahed
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Walter Pories
- Departments of Surgery, Biochemistry and Kinesiology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Konstantinos Spaniolas
- Departments of Surgery, Biochemistry and Kinesiology, Brody School of Medicine, East Carolina University, Greenville, NC
| | | | - Alfons Pomp
- Weill Cornell Medical Center, New York, NY, USA
| | | | - Bruce Wolfe
- Oregon Health and Science University, Portland, OR
| | - Anita P. Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Devlin MJ, King WC, Kalarchian MA, Hinerman A, Marcus MD, Yanovski SZ, Mitchell JE. Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. Int J Eat Disord 2018; 51:1322-1330. [PMID: 30520527 PMCID: PMC6876117 DOI: 10.1002/eat.22979] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study examines the course of eating pathology and its associations with change in weight and health-related quality of life following bariatric surgery. METHOD Participants (N = 184) completed the eating disorder examination-bariatric surgery version (EDE-BSV) and the medical outcomes study 36-Item short form health survey (SF-36) prior to and annually following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7 years. RESULTS The prevalence of ≥ weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post-RYGB and remained lower through 7 years (LOC: 5.4% at Year-7 vs. 16.2% pre-RYGB, p = .03; picking/nibbling: 7.0% vs. 32.4%, p < .001; and cravings: 19.4% vs. 33.6%, p = .02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre-LAGB (29.4% vs 45.8%, p = .049), while cravings (p = .13) and LOC eating (p = .95) were not. EDE-BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre-surgery (p's for all <.05). LOC eating following RYGB was associated with less long-term weight loss from surgery (p < .01) and greater weight regain from weight nadir (p < .001). Higher post-surgery EDE-BSV global score was associated with less weight loss/greater regain (both p < .001) and worsening/less improvement from surgery in the SF-36 mental component summary scores (p < .01). DISCUSSION Initial improvements in eating pathology following RYGB and LAGB were sustained across 7 years of follow-up. Individuals with eating pathology post-RYGB, reflected by LOC eating and/or higher EDE-BSV global score, may be at risk for suboptimal long-term outcomes.
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Affiliation(s)
- Michael J. Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Wendy C. King
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Amanda Hinerman
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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King WC, Hinerman AS, Belle SH, Wahed AS, Courcoulas AP. Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes. JAMA 2018; 320:1560-1569. [PMID: 30326125 PMCID: PMC6233795 DOI: 10.1001/jama.2018.14433] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Estimates of weight regain following bariatric surgery vary widely. OBJECTIVE To describe weight regain after reaching nadir weight following Roux-en-Y gastric bypass (RYGB) surgery and compare weight regain measures for association with outcomes. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 2458 adults who underwent bariatric surgery at 10 hospitals in 6 US cities between March 2006 and April 2009. Assessments were conducted within 30 days' presurgery, at 6 months' postsurgery, and then annually until January 2015. Of the 1703 participants who underwent RYGB surgery, 1406 (83%) were followed up for 5 years or longer and had 5 or more weight measurements (excluding those who died or underwent surgical reversal). EXPOSURES Weight regain assessed by 5 continuous measures (weight in kilograms, body mass index [BMI], percentage of presurgery weight, percentage of nadir weight, and percentage of maximum weight lost) and 8 dichotomous measures (per established thresholds) were compared in relation to clinical outcomes based on statistical significance, magnitude of association, and model fit. MAIN OUTCOMES AND MEASURES Progression of diabetes, hyperlipidemia, and hypertension and declines in physical and mental health-related quality of life and satisfaction with surgery. RESULTS Among the 1406 participants who underwent RYGB surgery, the median age was 47 years (25th-75th percentile, 38-55 years) and the median BMI was 46.3 (25th-75th percentile, 42.3-51.8) prior to surgery. Most participants were female (80.3%) and white (85.6%). The median follow-up was 6.6 years (25th-75th percentile, 5.9-7.0 years). The median percentage of maximum weight loss was 37.4% (25th-75th percentile, 31.6%-43.3%) of presurgery weight and occurred a median of 2.0 years after RYGB surgery (25th-75th percentile, 1.0-3.2 years). The rate of weight regain was highest during the first year after reaching nadir weight, but weight regain continued to increase throughout follow-up (range, a median of 9.5% of maximum weight lost [25th-75th percentile, 4.7%-17.2%] to 26.8% of maximum weight lost [25th-75th percentile, 16.7%-41.5%] 1 to 5 years after reaching nadir weight). The percentage of participants who regained weight depended on threshold (eg, 5 years after nadir weight, 43.6% regained ≥5 BMI points; 50.2% regained ≥15% of nadir weight; and 67.3% regained ≥20% of maximum weight lost). Compared with other continuous weight regain measures, the percentage of maximum weight lost had the strongest association and best model fit for all outcomes except hyperlipidemia, which had a slightly stronger association with BMI. Of the dichotomous measures, 20% or greater of maximum weight lost performed better or similarly with most of the outcomes, and was the second best measure for hyperlipidemia (after ≥10 kg of weight) and hypertension (after ≥10% of maximum weight lost). CONCLUSIONS AND RELEVANCE Among a large cohort of adults who underwent RYGB surgery, weight regain quantified as percentage of maximum weight lost performed better for association with most clinical outcomes than the alternatives examined. These findings may inform standardizing the measurement of weight regain in studies of bariatric surgery.
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Affiliation(s)
- Wendy C. King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amanda S. Hinerman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven H. Belle
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abdus S. Wahed
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anita P. Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bradley LE, Thomas JG, Hood MM, Corsica JA, Kelly MC, Sarwer DB. Remote assessments and behavioral interventions in post-bariatric surgery patients. Surg Obes Relat Dis 2018; 14:1632-1644. [DOI: 10.1016/j.soard.2018.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
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The long-term effect of pregnancy on weight loss after sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:1594-1599. [PMID: 30166263 DOI: 10.1016/j.soard.2018.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/26/2018] [Accepted: 07/07/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy outcomes after bariatric surgery have been addressed extensively; however, the impact of pregnancy on long-term outcomes after bariatric surgery has only been sparsely studied. OBJECTIVES We explored the effects of pregnancy on weight loss outcomes after laparoscopic sleeve gastrectomy (LSG). SETTING University hospital. METHODS A cross-sectional case-control study. Eighty women who became pregnant after LSG were matched by preoperative body mass index, age, and follow-up duration to 80 post-LSG patients who did not conceive after surgery (control group). RESULTS The median follow-up duration was 5.2 years for the study group and 5.3 years for the control group (P = .73). For the study group, the median time from surgery to conception was 508 (interquartile range 372-954) days and the median gestational weight gain was 9 (6-12) kg. Comparing the study with the control group, median percentage total weight loss was similar, 31% versus 30% (P = .77); as was percentage excess weight loss (EWL%) 72% versus 71% (P = .77). For the study group, a multivariable analysis showed EWL% at the end of follow-up to be directly correlated with the lowest EWL% achieved before pregnancy (β = .78, P < .0001), and inversely correlated with time lapsed from surgery (β = -.26, P < .0001); yet EWL% was not found to be associated with surgery-to-conception time interval, gestational weight gain, breastfeeding, co-morbidities, smoking, occupational status, physical activity, and dietary habits. CONCLUSIONS Pregnancy after LSG does not affect long-term weight results. Coupled with the positive reports of improved pregnancy outcomes after bariatric surgery, these data should reassure women who wish to conceive after surgery.
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Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2018; 28:3142-3150. [DOI: 10.1007/s11695-018-3332-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Han S, Agostini G, Brewis AA, Wutich A. Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery. BMC OBESITY 2018; 5:18. [PMID: 29988619 PMCID: PMC6027738 DOI: 10.1186/s40608-018-0195-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022]
Abstract
Background People living with severe obesity report high levels of weight-related stigma. Theoretically, this stigma undermines weight loss efforts. The objective of this study is to test one proposed mechanism to explain why weight loss is so difficult once an individual becomes obese: that weight-related stigma inhibits physical activity via demotivation to exercise. Methods The study focused on individuals who had bariatric surgery within the past 5 years (N = 298) and who report a post-surgical body mass index (BMI) ranging from 16 to 70. Exercise avoidance motivation (EAM) and physical activity (PA) were modeled as latent variables using structural equation modeling. Two measures of weight stigma, the Stigmatizing Situations Inventory (SSI) and the Weight Bias Internalization Scale (WBIS) were modified for people with a long history of extreme obesity for use as observed predictors. Results Exercise avoidance motivation (EAM) significantly mediated the association between both experienced (SSI) and internalized (WBIS) weight stigma and physical activity (PA) in this population. Conclusion Exercise avoidance motivation, influenced by weight stigma, may be a significant factor explaining the positive relationship between higher body weights with lower levels of physical activity.
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Affiliation(s)
- SeungYong Han
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Gina Agostini
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Alexandra A Brewis
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA.,2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
| | - Amber Wutich
- 2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
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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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King BM, Cespedes VM, Burden GK, Brady SK, Clement LR, Abbott EM, Baughman KS, Joyner SE, Clark MM, Pury CLS. Extreme under-reporting of body weight by young adults with obesity: relation to social desirability. Obes Sci Pract 2018; 4:129-133. [PMID: 29670750 PMCID: PMC5893466 DOI: 10.1002/osp4.153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/12/2022] Open
Abstract
Objective The objective of this study was to determine whether there is an association between under‐reporting of body weight and social desirability as is found with self‐reports of energy intake. Methods Twenty‐seven lean individuals (mean body mass index ± standard deviation = 21.6 ± 2.0 kg m−2) and 26 individuals with obesity (mean body mass index = 35.4 ± 4.8 kg m−2) were e‐mailed a questionnaire on which they had to state their body weight and conduct a home food inventory. The next day, research team members went to their homes to weigh the participants, conduct their own food inventory and administer the Marlowe–Crowne scale for social desirability. Results Among individuals with obesity, lower social desirability scores were associated with a greater degree of under‐reporting body weight (r = +0.48, p < 0.02). Among lean individuals, the correlation was negative but statistically non‐significant (p = −0.22, p > 0.10). Nine individuals with obesity were extreme under‐reporters (2.27 kg or more), and eight of these had social desirability scores in the bottom half of the Marlowe–Crowne scale (p < 0.01). Six under‐reported on the home food inventory by three or more items. Conclusions Individuals with obesity and low social desirability scores are more likely than others to be extreme under‐reporters of body weight, possibly due to a lack of awareness of their own weight.
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Affiliation(s)
- B M King
- Department of Psychology Clemson University Clemson South Carolina USA
| | - V M Cespedes
- Department of Psychology Clemson University Clemson South Carolina USA
| | - G K Burden
- Department of Psychology Clemson University Clemson South Carolina USA
| | - S K Brady
- Department of Psychology Clemson University Clemson South Carolina USA
| | - L R Clement
- Department of Psychology Clemson University Clemson South Carolina USA
| | - E M Abbott
- Department of Psychology Clemson University Clemson South Carolina USA
| | - K S Baughman
- Department of Psychology Clemson University Clemson South Carolina USA
| | - S E Joyner
- Department of Psychology Clemson University Clemson South Carolina USA
| | - M M Clark
- Department of Psychology Clemson University Clemson South Carolina USA
| | - C L S Pury
- Department of Psychology Clemson University Clemson South Carolina USA
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Long-Term Relationship Between Tobacco Use and Weight Loss after Sleeve Gastrectomy. Obes Surg 2018; 28:2644-2649. [DOI: 10.1007/s11695-018-3217-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
OBJECTIVE The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.
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Müller A, Claes L, Smits D, Schag K, de Zwaan M. Lifetime Self-Harm Behaviors Are Not More Prevalent in Bariatric Surgery Candidates than in Community Controls with Obesity. Obes Facts 2018; 11:109-115. [PMID: 29631270 PMCID: PMC5981630 DOI: 10.1159/000486484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG) compared to community controls with obesity (obese community group; OCG). METHODS The Self-Harm Inventory (SHI) was administered to the PSG (n = 139, BMI ≥ 35 kg/m2) and to the OCG (n = 122, BMI ≥ 35 kg/m2). RESULTS Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02). No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG). At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1) = 3.91, p = 0.048). The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline), and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio. CONCLUSION The results suggest that self-harm (including suicidal attempts) is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity.
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Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
- *Astrid Müller, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30265 Hanover, Germany,
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Odisee University College, Brussels, Belgium
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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Accuracy of Self-Reported Weight Among Adolescent and Young Adults Following Bariatric Surgery. Obes Surg 2017; 27:1529-1532. [PMID: 28012151 DOI: 10.1007/s11695-016-2514-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study evaluates accuracy of self-reported weight in adolescent bariatric surgery patients. MATERIALS AND METHODS During follow-up visits, participants self-reported weight and had weight measured. The differences between self-reported and measured weights were analyzed from 60 participants. RESULTS Participants were 70% (n = 42) female, 72% (n = 43) white, mean age of 20.8 years and a median body mass index of 36.6 kg/m2. At an average of 3.5 years following surgery, females underestimated weight (0.5 kg, range: -18.7 to 5.6 kg), while males overestimated (1.1 kg, range: -7.8 to 15.2 kg). Most (80%, n = 48) reported within 5 kg of measured weight. The majority of adolescents who previously underwent bariatric surgery reported reasonably accurate weights, but direction of misreporting varied by gender. CONCLUSION Self-reported weights could be utilized when measured values are unavailable without markedly biasing the interpretation of outcomes.
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Bradley LE, Forman EM, Kerrigan SG, Goldstein SP, Butryn ML, Thomas JG, Herbert JD, Sarwer DB. Project HELP: a Remotely Delivered Behavioral Intervention for Weight Regain after Bariatric Surgery. Obes Surg 2017; 27:586-598. [PMID: 27586525 DOI: 10.1007/s11695-016-2337-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight regain following bariatric surgery is common and potentially compromises the health benefits initially attained after surgery. Poor compliance to dietary and physical activity prescriptions is believed to be largely responsible for weight regain. Patients may benefit from developing specialized psychological skills necessary to engage in positive health behaviors over the long term. Unfortunately, patients often face challenges to physically returning to the bariatric surgery program for support in developing and maintaining these behaviors. Remotely delivered interventions, in contrast, can be conveniently delivered to the patient and have been found efficacious for a number of health problems, including obesity. To date, they have received little attention with bariatric surgery patients. The study aimed to evaluate a newly developed, remote acceptance-based behavioral intervention for postoperative weight regain. METHODS Patients at least 1.5 years out from surgery who experienced postoperative weight regain were recruited to receive the 10-week intervention. Participants were assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up. RESULTS Support for the intervention's feasibility and acceptability was achieved, with 70 % retention among those who started the program and a high mean rating (4.7 out of 5.0) of program satisfaction among study completers. On average, weight regain was reversed with a mean weight loss of 5.1 ± 5.5 % throughout the intervention. This weight loss was maintained at 3-month follow-up. Significant improvements in eating-related and acceptance-based variables also were observed. CONCLUSIONS This pilot study provides initial support for the feasibility, acceptability, and preliminary efficacy of a remotely delivered acceptance-based behavioral intervention for postoperative weight regain.
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Affiliation(s)
- Lauren E Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60625, USA.
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | | | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - David B Sarwer
- Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
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Pekkarinen T, Mustonen H, Sane T, Jaser N, Juuti A, Leivonen M. Long-Term Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity: Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery? Obes Surg 2017; 26:2161-2167. [PMID: 26843084 DOI: 10.1007/s11695-016-2090-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome. MATERIALS AND METHODS Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29-6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control. RESULTS Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m(2). Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years. CONCLUSION On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.
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Affiliation(s)
- Tuula Pekkarinen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland.
| | - Harri Mustonen
- University of Helsinki and Helsinki University Hospital, P.O. Box 440, FIN-00029 HUS, Helsinki, Finland
| | - Timo Sane
- Abdominal Center, Meilahti Hospital, Helsinki University Hospital, P.O. Box 340, FIN-00029 HUS, Helsinki, Finland
| | - Nabil Jaser
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Anne Juuti
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Marja Leivonen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
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Mack I, Ölschläger S, Sauer H, von Feilitzsch M, Weimer K, Junne F, Peeraully R, Enck P, Zipfel S, Teufel M. Does Laparoscopic Sleeve Gastrectomy Improve Depression, Stress and Eating Behaviour? A 4-Year Follow-up Study. Obes Surg 2017; 26:2967-2973. [PMID: 27178406 DOI: 10.1007/s11695-016-2219-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment. METHODS Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire. RESULTS Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5-14] vs. 6 [IQR 2-10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU. CONCLUSIONS Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Sabrina Ölschläger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Riyad Peeraully
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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50
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Goldenshluger M, Goldenshluger A, Keinan-Boker L, Cohen MJ, Ben-Porat T, Gerasi H, Amun M, Abu-Gazala M, Khalaileh A, Mintz Y, Elazary R. Postoperative Outcomes, Weight Loss Predictors, and Late Gastrointestinal Symptoms Following Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg 2017; 21:2009-2015. [PMID: 28971291 DOI: 10.1007/s11605-017-3585-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the outcomes, weight loss predictors, and gastrointestinal symptoms of patients after laparoscopic sleeve gastrectomy (LSG). METHODS The postoperative medical status of the patients was obtained retrospectively using a questionnaire and was compared to existing medical data before the surgery. RESULTS We included 201 candidates, 178 patients completed mean of 3 years of follow-up. Mean excess body weight loss (%EWL) was 65.14% ± 15.74 at 6 months, 78.53% ± 20.28 at 12 months, and 74.32% ± 23.92 at 3 years after LSG. Older age (P = 0.018), higher baseline BMI (P = 0.003), and higher number of medications (P < 0.001) were negative predictors for EWL%. Total weekly hours of physical activity was found to be a positive predictor for EWL% (P = 0.008). Remission rates of co-morbidities were 83.5% for dyslipidemia (P < 0.001), 65.8% for hypertension (P < 0.001), 62.1% for type 2 diabetes mellitus (T2DM) (P < 0.001), and 60.7% for gastroesophageal reflux (GERD) (P < 0.001). Late gastrointestinal symptoms were as follows: emesis in 25.9%, constipation in 24.7%, diarrhea in 4.5%, food intolerance in 22.5% and alopecia in 42.7% of the patients. CONCLUSION Our study shows LSG as a potential tool in achieving almost 75% of EWL% with significant remission of co-morbidities, along with various late gastrointestinal symptoms.
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Affiliation(s)
- Michael Goldenshluger
- General and Oncological Department C, Chaim Sheba Medical Center-Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 5265601, Tel Hashomer, Israel.
| | - Ariela Goldenshluger
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lital Keinan-Boker
- Israel Ministry of Health, Center for Disease Control, Ramat Gan, Israel
| | | | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Heba Gerasi
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Majd Amun
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Mahmud Abu-Gazala
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Yoav Mintz
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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