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Mackenzie RM, Ali A, Bruce D, Bruce J, Ford I, Greenlaw N, Grieve E, Lean M, Lindsay RS, O'Donnell J, Sattar N, Stewart S, Logue J. Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study. Health Technol Assess 2024; 28:1-115. [PMID: 38343107 PMCID: PMC11017628 DOI: 10.3310/unaw6331] [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] [Indexed: 02/15/2024] Open
Abstract
Background Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. Objective To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Design Prospective observational cohort study. Setting National Health Service secondary care and private practice in Scotland, United Kingdom. Participants Adults (age >16 years) undergoing their first bariatric surgery procedure. Main outcome measures Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Data sources Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Results Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was -19.0% (±14.1) from the operation and -24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was -5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression. Limitations Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. Conclusions Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed. Future work Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness. Study registration This study is registered as ISRCTN47072588. Funding details This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ruth M Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Abdulmajid Ali
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | | | - Julie Bruce
- Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Lean
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Joanne O'Donnell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sally Stewart
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Nandrino JL, Grynberg D, Gandolphe MC, Willem C, Benaisa K, Van de Maele J, Taccoen A, Verkindt H, Pattou F. Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding. Appetite 2020; 149:104620. [PMID: 32070712 DOI: 10.1016/j.appet.2020.104620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023]
Abstract
While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.
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Affiliation(s)
- Jean-Louis Nandrino
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France; Fondation Santé des étudiants de France, Clinique des 4 Cantons, Villeneuve d'Ascq, France.
| | - Delphine Grynberg
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Marie-Charlotte Gandolphe
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Clémence Willem
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Karima Benaisa
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Justine Van de Maele
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Aurore Taccoen
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Hélène Verkindt
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - François Pattou
- UMR INSERM 1190, Recherche Translationnelle sur le Diabète, Université de Lille, France; Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
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Adil MT, Jain V, Rashid F, Al-Taan O, Al-Rashedy M, Jambulingam P, Whitelaw D. Meta-analysis of the effect of bariatric surgery on physical activity. Surg Obes Relat Dis 2019; 15:1620-1631. [PMID: 31358394 DOI: 10.1016/j.soard.2019.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/20/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity leads to impairment of physical activity as measured by an inability to perform activities of daily living. Literature on the effect of bariatric surgery on physical activity is conflicting. OBJECTIVE The aim of this study was to perform a meta-analysis of the effect of bariatric surgery on physical activity from studies employing objective measurement and self-reporting of physical activity before and after bariatric surgery. METHODS Bibliographic databases were searched systematically for relevant literature until December 31, 2018. Studies employing objective and self-reported measurement of physical activity were included. Study quality was assessed using Risk of Bias in Nonrandomized Studies - of Interventions tool. Meta-analysis was performed using random effects model and presented as standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS Twenty studies identified 5886 patients suitable for the analysis. Physical activity showed significant improvement at 0-6 months (SMD: .50; 95% CI: .25-.76; P = .0001), >6-12 months (SMD: .58; 95% CI: .26-.91; P = .0004), and >12-36 months (SMD: .82; 95% CI: .27-1.36; P = .004) after bariatric surgery. Self-reported assessment after bariatric surgery showed significant improvement at 0-6 months (SMD: .65; 95% CI: .29-1.01; P = .0004), >6 to 12 months (SMD: .53; 95% CI: .18-.88; P = .003), and >12-36 months (SMD: .51; 95% CI: .46-.55; P < .00001). Objective assessment after bariatric surgery did not show improvement at 0-6 months (SMD: .31; 95%CI:-.05-.66; P = .09), but showed significant improvement at >6-12 months (SMD: .85; 95% CI:-.07-1.62; P = .03), and >12-36 months (SMD: 1.99; 95% CI: 1.13-2.86; P < .00001) after bariatric surgery. CONCLUSIONS Bariatric surgery improves physical activity significantly in a population with obesity up to 3 years after surgery. Objective measurement of physical activity does not show significant improvement within 6 months of bariatric surgery but begins to improve at >6 months. Self-reported measurement of physical activity begins to show improvement within 6 months of a bariatric procedure.
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Affiliation(s)
- Md Tanveer Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Farhan Rashid
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Omer Al-Taan
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Mohammad Al-Rashedy
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Periyathambi Jambulingam
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Douglas Whitelaw
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
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Abstract
BACKGROUND In the multidisciplinary treatment of obesity, the role of a plastic surgeon is to remove the excess of skin after weight loss to obtain cosmetic, functional, and psychological benefits. Obesity modifies body geometry, increases the mass of different segments, and imposes functional limitations in life activities that may predispose the obese to injury. The authors evaluated the postural conditions of obese patients, before and 12 months after surgery. METHODS The study included 15 obese patients of both genders affected by class II obesity. Postural function was evaluated preoperatively and 12 months postoperatively. Patients underwent conventional abdominoplasty surgical procedure. In all patients, plantar pressure distribution and balance (stabilometric test) were evaluated before and 3 months after surgery. RESULTS The static pedobarographic revealed a significant reduction in forefoot peak pressure; total plantar force; rearfoot plantar force percentage; midfoot plantar force percentage; and forefoot, midfoot, and rearfoot plantar contact areas percentage 3 months after surgery; the dynamic's one showed a reduction in the first metatarsal peak pressure and plantar contact. The stabilometric values showed a reduction in the range of center of foot pressure (CP) displacement along y axis, the average displacement of the CP speed from the mean (RMS y velocity), and CP mean peak in the condition of vision. CONCLUSIONS Our study demonstrates the beneficial effect of dermolipectomies and the consequential weight loss on postural stability of obese men. Such findings may support the hypothesis that dermolipectomy may improve postural stability with and without vision. The data demonstrate that the benefits are related to the magnitude of the resected tissue.
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Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 63:344-369. [PMID: 29214946 DOI: 10.13109/zptm.2017.63.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUBJECT In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up. METHODS Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery. RESULTS Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases.With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk. CONCLUSIONS In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients.Yet identifying these patients before surgery has so far been insufficient.
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Borisenko O, Lukyanov V, Debergh I, Dillemans B. Cost-effectiveness analysis of bariatric surgery for morbid obesity in Belgium. J Med Econ 2018; 21:365-373. [PMID: 29271279 DOI: 10.1080/13696998.2017.1419958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS This study presents the cost-effectiveness analysis of bariatric surgery in Belgium from a third-party payer perspective for a lifetime and 10-year horizon. MATERIALS AND METHODS A decision analytic model incorporating Markov process was developed to compare the cost-effectiveness of gastric bypass, sleeve gastrectomy, and adjustable gastric banding against conventional medical management (CMM). In the model, patients could undergo surgery, or experience post-surgery complications, type 2 diabetes, cardiovascular diseases, or die. Transition probabilities, costs, and utilities were derived from the literature. The impact of different surgical methods on body mass index (BMI) level in the base-case analysis was informed by the Scandinavian Obesity Surgery Registry and the Swedish Obese Subject (SOS) study. Healthcare resource use and costs were obtained from Belgian sources. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Belgium. RESULTS In the base-case analysis over a 10-year time horizon, the increment in quality-adjusted life-years (QALYs) gained from bariatric surgery vs CMM was 1.4 per patient, whereas the incremental cost was €3,788, leading to an incremental cost-effectiveness ratio (ICER) of €2,809 per QALY. Over a lifetime, bariatric surgery produced savings of €9,332, an additional 1.1 life years and 5.0 QALYs. Bariatric surgery was cost-effective at 10 years post-surgery and dominant over conventional management over a lifetime horizon. LIMITATIONS The model did not include the whole scope of obesity-related complications, and also did not account for variation in surgery outcomes for different populations of diabetic patients. Also, the data about management of patients after surgery was based on assumptions and the opinion of a clinical expert. CONCLUSIONS It was demonstrated that a current mix of bariatric surgery methods was cost-effective at 10 years post-surgery and cost-saving over the lifetime of the Belgian patient cohort considered in this analysis.
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Affiliation(s)
- Oleg Borisenko
- a Health Economics and Market Access , Synergus AB , Danderyd ( Stockholm ), Sweden
| | - Vasily Lukyanov
- b Health Economics , Synergus AB , Danderyd (Stockholm) , Sweden
| | - Isabelle Debergh
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
| | - Bruno Dillemans
- c Dienst Algemene, Vaat- en Kinderheelkunde, AZ Sint-Jan Brugge-Oostende AV, campus Sint-Jan , Ruddershove 10 , 8000 Brugge , Belgium
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Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes 2017; 7:273-289. [PMID: 28695722 PMCID: PMC5600094 DOI: 10.1111/cob.12203] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 12/19/2022]
Abstract
This is the first systematic review of reviews to assess the effect of obesity and weight loss on health-related quality of life (HRQoL). We identified 12 meta-analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre-intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non-surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight-loss interventions. We recommend longer-term studies, using both generic and obesity-specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.
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Affiliation(s)
- R. L. Kolotkin
- Quality of Life Consulting, PLLCDurhamNCUSA
- Department of Community and Family MedicineDuke University School of MedicineDurhamNCUSA
- Faculty of Health StudiesWestern Norway University of Applied SciencesFørdeNorway
- Førde Hospital TrustFørdeNorway
- Morbid Obesity CentreVestfold Hospital TrustTønsbergNorway
| | - J. R. Andersen
- Faculty of Health StudiesWestern Norway University of Applied SciencesFørdeNorway
- Førde Hospital TrustFørdeNorway
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Borisenko O, Mann O, Duprée A. Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling. BMC Surg 2017; 17:87. [PMID: 28774333 PMCID: PMC5543597 DOI: 10.1186/s12893-017-0284-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. Methods State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€). Results Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs. Conclusions Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
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Affiliation(s)
| | - Oliver Mann
- University Medical Center Hamburg, Hamburg, Germany
| | - Anna Duprée
- University Medical Center Hamburg, Hamburg, Germany
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an introduction to quality of life (QOL) outcomes after bariatric surgery and a summary of the current evidence. RECENT FINDINGS QOL has been emphasized in bariatric surgery since the NIH Consensus Conference statement in 1991. Initial studies were limited to 1- and 2-year follow-up. More recent findings have expanded the follow-up period up to 12 years, providing a better description of the impact on long-term QOL. Overall, there is little to no consensus regarding the definition of QOL or the ideal survey. Bariatric surgery has the greatest impact on physical QOL, and the impact on mental health remains unclear. There are some specific and less frequently reported threats to quality of life after bariatric surgery that are also discussed. Obesity has a definite impact on quality of life, even without other comorbidities, and surgery for obesity results in significant and lasting improvements in patient-reported quality of life outcomes. This conclusion is limited by a wide variety of survey instruments and absence of consensus on the definition of QOL after bariatric surgery.
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Affiliation(s)
- Laura M Mazer
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA
| | - Dan E Azagury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3680A, Stanford, CA, 94305-5655, USA
| | - John M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3680A, Stanford, CA, 94305-5655, USA.
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Hindle A, de la Piedad Garcia X, Brennan L. Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 2017; 18:317-334. [PMID: 28170168 DOI: 10.1111/obr.12496] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
This is the first systematic review to synthesize the evidence concerning early post-operative variables predictive of later weight and psychosocial outcomes in bariatric surgery. Eight electronic databases for empirical studies were searched (1954 to 2016). Most of the 39 included studies reported solely on weight outcomes; eating and psychosocial outcomes were less common. A better early weight loss trajectory was the most consistent predictor of more successful medium-term weight outcome (≤24 months); however, its relationship to longer term weight loss maintenance is less certain. Early eating adaptation may be associated with later weight loss, but further research is needed. Evidence is lacking for associations between early adherence or early psychosocial variables and later outcome. In particular, the relationship between early post-operative depression and later weight remains unclear. Little research has considered early prediction of later eating or psychosocial outcomes. Consideration of mediating or moderating relationships is lacking. The body of evidence is limited, and synthesis is hampered by heterogeneity in the type and time at which predictors and outcomes are measured and quality of statistical reporting. Further research on prospective prediction of bariatric surgery outcome is needed to guide early post-operative intervention for those at greatest risk of poor outcomes.
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Affiliation(s)
- A Hindle
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - X de la Piedad Garcia
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - L Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
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Lucchese M, Borisenko O, Mantovani LG, Cortesi PA, Cesana G, Adam D, Burdukova E, Lukyanov V, Di Lorenzo N. Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling. Obes Facts 2017; 10:261-272. [PMID: 28601866 PMCID: PMC5644931 DOI: 10.1159/000475842] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/13/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. METHODS A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. RESULTS In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. CONCLUSION In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis.
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Affiliation(s)
- Marcello Lucchese
- Bariatric, General Surgery and Metabolic Department, Santa Maria Nuova Hospital, Florence, Italy
| | - Oleg Borisenko
- Synergus AB, Danderyd, Sweden
- *Oleg Borisenko, MD, PhD, Health Economy, Synergus AB, Kevinge strand 20, Danderyd, 18257, Sweden,
| | | | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Nicola Di Lorenzo
- Applied Experimental Medicine and Surgery Department, University of Tor Vergata, Rome, Italy
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Bužgová R, Bužga M, Holéczy P, Zonča P. Evaluation of Quality of Life, Clinical Parameters, and Psychological Distress after Bariatric Surgery: Comparison of the Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2016.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Radka Bužgová
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Marek Bužga
- Department of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavol Holéczy
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Zonča
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms. Eur J Clin Nutr 2016; 71:441-449. [PMID: 27804961 DOI: 10.1038/ejcn.2016.198] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/28/2022]
Abstract
Currently the effects of bariatric surgery are generally expressed in excess weight loss or comorbidity reduction. Therefore the aim of this review was to provide insight in the available prospective evidence regarding the short and long-term effects of bariatric surgery on Quality of Life (QoL) and a comparison with community norms. A systematic multi-database search was conducted for 'QoL' and 'Bariatric surgery'. Only prospective studies with QoL before and after bariatric surgery were included. The 'Quality Assessment Tool for Before-After Studies with No Control Group' was used to assess the methodological quality. Thirty-six studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. Ten different questionnaires were used to measure QoL. Follow-up ranged from 6 months to 10 years, sample sizes from 26 to 1276 and follow-up rates from 45 to 100%. A significant increase in QoL after bariatric surgery was found in all studies (P⩽0.05), however, mostly these outcomes stay below community norms. Only outcomes of the IWQoL, SF-36 and OWQoL show QoL outcomes that exceed community norms. The QoL is increased after bariatric surgery on both the short and long term. However, due to the heterogeneity of the studies and the generality of the questionnaires is it hard to make a distinction between different surgeries and difficult to see a relation with medical profit. Therefore, tailoring QoL measurements to the bariatric population is recommended as the focus of future studies.
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Froylich D, Corcelles R, Daigle CR, Aminian A, Isakov R, Schauer PR, Brethauer SA. Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery. Surg Obes Relat Dis 2016; 12:1731-1736. [DOI: 10.1016/j.soard.2015.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/30/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
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Vallis M. Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract 2016; 70:196-205. [PMID: 26842304 PMCID: PMC5067635 DOI: 10.1111/ijcp.12765] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity is increasing in prevalence and placing an ever-greater burden on individuals and healthcare resources alike. Obesity management is complex and, for many, elusive. AIMS AND METHODS This paper reviews the major factors that influence psychological well-being in individuals with obesity and describes the means by which their impact on distress and other aspects of quality of life (QoL) can be quantified. The goal is to enable healthcare providers to set reasonable, achievable, maintainable weight loss targets that will improve the psychological well-being and QoL of individuals living with obesity. PubMed and Web of Science searches were conducted to identify literature that addresses the key question: How can distress over obesity be measured and taken into account when tailoring weight loss interventions for a particular patient? DISCUSSION AND CONCLUSIONS 'Distress over obesity' is a key parameter that illustrates the psychological consequences of excess weight. Healthcare providers can draw on a range of obesity-specific and non-specific assessment tools to quantify distress as well as the other contributions of obesity to QoL and mental/emotional health. When physicians consider the psychological/QoL aspects of obesity and how these change with successful weight loss, it becomes possible to set achievable, realistic weight loss goals and develop a manageable plan to achieve them. Any future developments that make it easier to achieve these goals should be made widely available to all patients in need, in order to help them turn a vicious cycle of failure into a virtuous cycle of success.
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Affiliation(s)
- M Vallis
- Nova Scotia Health Authority-Central Zone Behaviour Change Institute, Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
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17
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Herring LY, Stevinson C, Davies MJ, Biddle SJ, Sutton C, Bowrey D, Carter P. Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta-analysis. Obes Rev 2016; 17:250-61. [PMID: 26783103 DOI: 10.1111/obr.12361] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
Abstract
Although physical activity performed after bariatric surgery is associated with enhanced weight loss outcomes, there is limited information on patients' physical activity behaviour in this context. This systematic review and meta-analysis assessed pre-operative to post-operative changes in physical activity and physical function outcomes among obese adults undergoing bariatric surgery. A total of 50 studies met inclusion criteria with 26 papers reporting data for meta-analysis. Increases in both objectively recorded and self-reported physical activity at 12 months were demonstrated. Studies indicated that there was a shift towards a greater amount of active time, but of a lower intensity within the first 6 months of bariatric surgery, suggested by a reduction in moderate to vigorous physical activity but an increase in step count. A standardized mean difference (SMD) of 1.53 (95% CI: 1.02-2.04) based on nine studies indicated improved walking performance at 12 months. Similarly, analysis of five studies demonstrated increased musculoskeletal function at 3-6 months (SMD: 1.51; 95% CI: 0.60-2.42). No relationship was identified between changes in weight and walking performance post-surgery. More studies assessing physical activity, physical function and weight loss would help understand the role of physical activity in optimizing post-operative weight and functional outcomes.
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Affiliation(s)
- L Y Herring
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
| | - C Stevinson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
| | - M J Davies
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Jh Biddle
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - C Sutton
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Bowrey
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - P Carter
- NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester, UK
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Borisenko O, Adam D, Funch-Jensen P, Ahmed AR, Zhang R, Colpan Z, Hedenbro J. Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model. Obes Surg 2015; 25:1559-68. [PMID: 25639648 PMCID: PMC4522026 DOI: 10.1007/s11695-014-1567-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective. METHODS A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources. RESULTS Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of euro 8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of euro 66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime. CONCLUSION Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.
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Affiliation(s)
| | - Daniel Adam
- Synergus AB, Svardvagen 19, 182 33 Danderyd, Sweden
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19
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Luger M, Kruschitz R, Marculescu R, Haslacher H, Hoppichler F, Kallay E, Kienbacher C, Klammer C, Kral M, Langer F, Luger E, Prager G, Trauner M, Traussnigg S, Würger T, Schindler K, Ludvik B. The link between obesity and vitamin D in bariatric patients with omega-loop gastric bypass surgery - a vitamin D supplementation trial to compare the efficacy of postoperative cholecalciferol loading (LOAD): study protocol for a randomized controlled trial. Trials 2015; 16:328. [PMID: 26242295 PMCID: PMC4524369 DOI: 10.1186/s13063-015-0877-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/17/2015] [Indexed: 01/07/2023] Open
Abstract
Background Beyond its classical role in calcium homoeostasis and bone metabolism, vitamin D deficiency has been found to be associated with several diseases, including diabetes, non-alcoholic fatty liver disease, and even obesity itself. Importantly, there are limited data on therapeutic strategies for vitamin D deficiency in bariatric patients, and the procedure-specific guidelines may not be sufficient. To improve long-term outcomes, nutritional screening and appropriate supplementation to prevent nutrient deficiencies are urgently needed. Therefore, the aim of this study is to examine effects and safety of a forced dosing regimen of vitamin D versus conventional dose supplementation on vitamin D levels and other parameters in bariatric patients. Methods/Design The study includes loading plus repeat dosing compared with repeated administration of vitamin D without a loading dose, according to guidelines, in a prospective, double-blind, randomized controlled trial. Up to a triple oral loading dose is given on day 1, then 2 and 4 weeks after surgery (100,000 IU dose each time), followed by an oral maintenance dose (3420 IU/day). The control group (n = 25) will receive placebo, followed by administration of a standard dose (3420 IU/day). We hypothesize that a significant increase in vitamin D levels will occur in patients in the treatment group (n = 25) by 24 weeks after surgery. Further measurements are aimed at evaluating changes in inflammation, bone turnover, insulin resistance, blood pressure, liver, mental health, and gut microbiota of patients undergoing omega-loop gastric bypass surgery. Furthermore, possible associations between concentrations of vitamin D, the involved enzymes, or vitamin D receptor in adipose and/or liver tissues will be determined. Discussion To our knowledge, this trial is the first of its kind with this type of vitamin D supplementation in bariatric patients. Its major strength is the design and implementation of evaluation of influencing factors such as liver function, bone health, inflammation, insulin resistance, blood pressure, symptoms of depression, or microbiota. This alternative vitamin D dosing regimen has the potential to be a safe, fast, evidence-based treatment of vitamin D deficiency in bariatric patients. Owing to the increasing number of bariatric patients, it is also of interest to elucidate the link between obesity and vitamin D. Trial registration ClinicalTrials.gov identifier: NCT02092376. Registered on 17 March 2014.
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Affiliation(s)
- Maria Luger
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Guggenbichlerstraße 8/15, 5026, Salzburg, Austria.
| | - Renate Kruschitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Rodrig Marculescu
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Helmuth Haslacher
- Clinical Institute for Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition - SIPCAN, Guggenbichlerstraße 8/15, 5026, Salzburg, Austria.
| | - Enikö Kallay
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Christian Kienbacher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Carmen Klammer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Melanie Kral
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Felix Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Eva Luger
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Gerhard Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Stefan Traussnigg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Tanja Würger
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Karin Schindler
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Bernhard Ludvik
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Lindekilde N, Gladstone BP, Lübeck M, Nielsen J, Clausen L, Vach W, Jones A. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Rev 2015; 16:639-51. [PMID: 26094664 DOI: 10.1111/obr.12294] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 12/13/2022]
Abstract
This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between-study variation by examining the standardized mean magnitude of effect in change in the levels of quality of life. The following databases EMBASE, PubMed, PsycINFO, CINAHL, the Cochrane Library and Web of Science were systematically searched for studies examining change in quality of life in adults receiving bariatric surgery for obesity. Seventy-two studies were included with a total of 9,433 participants treated for obesity with bariatric surgery. The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 (95% CI: 0.80-0.96), indicating that bariatric surgery has a significant positive influence on quality of life in general. The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life. Bariatric surgery is effective in improving quality of life, especially when looking at physical well-being. Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people.
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Affiliation(s)
- N Lindekilde
- Institute of Psychology, University of Southern Denmark, Odense, Denmark
| | - B P Gladstone
- Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - M Lübeck
- Institute of Psychology, University of Southern Denmark, Odense, Denmark
| | - J Nielsen
- Institute of Psychology, University of Southern Denmark, Odense, Denmark
| | - L Clausen
- Centre of Child- and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - W Vach
- Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - A Jones
- Institute of Psychology, University of Southern Denmark, Odense, Denmark
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Subjective and objective physical activity patterns after Roux-en Y gastric bypass surgery compared with non-operated obese and non-obese control women. Obes Res Clin Pract 2015; 10:49-55. [PMID: 25773510 DOI: 10.1016/j.orcp.2015.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/30/2014] [Accepted: 02/20/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Previous studies on physical activity after bariatric surgery provided inconsistent results. The aim of our study was to comprehensively assess physical activity by subjective (questionnaires) and objective (accelerometry) measures in women who had undergone Roux-en Y gastric bypass (RYGB) surgery and to compare results with those of women displaying grade II or higher obesity and of non-obese control women. METHODS Our cross-sectional case-control study included 12 women in each group (RYGB, obese, non-obese). Wrist accelerometry was performed over 5 days. Two questionnaires were used to assess women's self-reported leisure- and work-time and sport-related physical activity. RESULTS Accelerometry indicated a lower physical activity in RYGB women than in non-obese women in particular during the weekend (p=0.010), while there was no difference between RYGB and obese women (p=0.57). Questionnaires revealed that RYGB women self-report a greater leisure- and work-time physical activity than obese women and also greater work-related physical activity than non-obese women (all p≤0.032). In contrast, sport-related activities were reduced in RYGB as compared with non-obese women (p=0.011), while there was no difference between RYGB and obese women (p=0.51). Comparison of the obese and non-obese group revealed less leisure-time and sport-related activities in the obese women (both p≤0.002). DISCUSSION Despite the preliminary character of our rather small study, data suggest a differential physical activity pattern in women who have previously undergone RYGB surgery that is characterized by rare sport activities, an increased subjective work-related physical activity and objectively reduced physical activity during the weekend as compared with non-obese control women.
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Andersen JR, Aasprang A, Karlsen TI, Karin Natvig G, Våge V, Kolotkin RL. Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies. Surg Obes Relat Dis 2015; 11:466-73. [DOI: 10.1016/j.soard.2014.10.027] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/20/2014] [Accepted: 10/30/2014] [Indexed: 11/26/2022]
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Mozafari M, Khajavikhan J, Jaafarpour M, Khani A, Direkvand-Moghadam A, Najafi F. Association of body weight and female sexual dysfunction: a case control study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e24685. [PMID: 25763278 PMCID: PMC4341402 DOI: 10.5812/ircmj.24685] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/07/2014] [Accepted: 12/13/2014] [Indexed: 11/16/2022]
Abstract
Background: Obesity is rapidly increasing worldwide with negative effects on women’s health, psychosocial factors and quality of life. Female sexual dysfunction (FSD) is a major public health problem that is worrying for many women physically, emotionally and socially. Objectives: The purpose of this study was to investigate the association of body weight with FSD and sexual satisfaction, in Ilam, western Iran, in 2010 to 2011. Patients and Methods: This was a case-control study on 120 women aged 18–50 years [64 with FSD (case), 64 without FSD (control)] married, from Ilam-IR, who were interviewed as per the Iranian version of Female Sexual Function Index (FSFI). Body mass index (BMI) and waist-to-hip ratio (WHR) were recorded by researchers. The subjects were randomly selected from primary health centers. Results: FSFI score was significantly lower in overweight women (P < 0.05). FSFI strongly correlated with body mass index (BMI) (r = -0.68, P < 0.001) and waist-to-hip ratio (r = -0.29, P < 0.05) in women with FSD. Of sexual function parameters, there was a strong and inverse correlation between BMI and arousal (r = -0.71, P < 0.001), lubrication (r = -0.61, P < 0.001), orgasm (r = -0.52, P < 0.001) and satisfaction (r = -0.54, P < 0.001), while pain (r = -0.12, P > 0.05) and desire (r = -0.17, P > 0.05) did not correlate with BMI. There was an association between BMI and extreme satisfaction (r = -0.28, P < 0.05). Extreme physical pleasure (r = -0.19, P > 0.05) and extreme emotional satisfaction (r = -0.16, P > 0.05) were not correlated with BMI. Conclusions: Overweight and obesity negative affect sexuality in women with sexual dysfunction. A systematic evaluation of sexual function to disclose a cause and effect relationship between obesity and FSD is suggested.
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Affiliation(s)
- Mosayeb Mozafari
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
| | | | - Molouk Jaafarpour
- Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding Author: Molouk Jaafarpour, Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-8412227116, Fax: +98-8412227116, E-mail:
| | - Ali Khani
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
| | | | - Fatemeh Najafi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, IR Iran
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Rezaei E, Behboodi Moghadam Z, Hagani H. The effect of sleep health behavioral education on the depression of pregnant women with sleep disorders: a randomized control trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e11420. [PMID: 25763271 PMCID: PMC4341540 DOI: 10.5812/ircmj.11420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 11/29/2013] [Accepted: 11/27/2014] [Indexed: 11/24/2022]
Abstract
Background: About 79% of the pregnant women experience sleep disorders and 70% of pregnant women experience some symptoms of the depression. Physiologic, hormonal, and physical changes of pregnancy can predispose mothers to depression these disorders before, during, and after childbirth and might be aggravated by neglecting health behavior. Health behavior education might be useful for the management of depression in pregnant women. Objectives: This study aimed to evaluate the effect of sleep health behavioral education on the improvement of depression in pregnant women with sleep disorders. Patients and Methods: This study was a randomized clinical trial, performed on 96 pregnant women with sleep disorder diagnosed according to the Pittsburgh Sleep Quality Index. Tools for data collection included demographic questionnaire and Beck's Depression Inventory (BDI). Easy and accessible sampling was done. Participants were randomly (simple) allocated to intervention and control groups. In intervention group, sleep health behavior education was presented during a four-hour session held in weeks 22, 23, 24, and 25; then the patients were followed up to fill out the BDIQ in follow-up session at weeks 29 and 33 of pregnancy. The control group received no intervention and only received routine prenatal care. The results were assessed by Chi-square tests, independent-samples t-test, and Fischer’s exact-test by SPSS 16. Results: A statistically significant change was reported in the severity of depression in pregnant women with sleep disorders in the intervention group in comparison to the control group at weeks 29 (P < 0.000) and 33 (P < 0.00). Conclusions: Sleep health behavioral education improves depression in pregnant women who are experiencing insomnia. Findings from this study add support to the reported effectiveness of sleep health behavioral education in the prenatal care and clinical management of insomnia in pregnancy.
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Affiliation(s)
- Elham Rezaei
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, IR Iran
| | - Zahra Behboodi Moghadam
- Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Zahra Behboodi Moghadam, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122494201, E-mail:
| | - Hamid Hagani
- Department of Management and Medical Information Science, Iran University of Medical Sciences, Tehran, IR Iran
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Development of Excess Skin and Request for Body-Contouring Surgery in Postbariatric Adolescents. Plast Reconstr Surg 2014; 134:627-636. [DOI: 10.1097/prs.0000000000000515] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Puzziferri N, Roshek TB, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014; 312:934-42. [PMID: 25182102 PMCID: PMC4409000 DOI: 10.1001/jama.2014.10706] [Citation(s) in RCA: 559] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size-weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size-weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass ( n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.
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Affiliation(s)
- Nancy Puzziferri
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas
| | - Thomas B Roshek
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Helen G Mayo
- University of Texas Southwestern Medical Center Library, Dallas
| | - Ryan Gallagher
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Steven H Belle
- Departments of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward H Livingston
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas5Department of Biomedical Engineering, University of Texas-Arlington, Arlington6Deputy Edito
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Andersen JR. Quality of life following laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2014; 11:76-8. [PMID: 25107478 DOI: 10.1016/j.soard.2014.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- John Roger Andersen
- Department of Surgery, Førde Central Hospital, Norway; Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway.
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Robert M, Denis A, Badol-Van Straaten P, Jaisson-Hot I, Gouillat C. Prospective longitudinal assessment of change in health-related quality of life after adjustable gastric banding. Obes Surg 2014; 23:1564-70. [PMID: 23515974 DOI: 10.1007/s11695-013-0914-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gastric banding remains a common procedure worldwide. Improving health-related quality of life (HRQOL) has become a major goal in the treatment of patients with chronic diseases, yet there are few comprehensive data regarding the effect of gastric banding on HRQOL. The aim of this study was to evaluate the impact of laparoscopic gastric banding on HRQOL with particular regard to change over time. METHODS The 262 consecutive patients included between May 2005 and September 2006 in a French multicenter prospective study designed to assess the safety and efficacy of a gastric band were asked to complete the SF36 questionnaire preoperatively and each 6 months during 3 years. The HRQOL scores were compared with community norms, and their longitudinal change was assessed using cross-sectional analysis and mixed-effects linear modeling (individual growth model). RESULTS One hundred sixty-four patients (63%) provided a preoperative and at least one postoperative SF-36 questionnaire from 12 to 36 months and form the basis of the present study. In all dimensions, the scores of HRQOL were significantly impaired preoperatively and were significantly improved at 3 years. The increase in HRQOL scores was most marked during the first postoperative months; it continued more slowly after 6 months and stabilized after 1 year. The improvement in HRQOL was associated with the decrease in BMI, in all dimensions. CONCLUSION Gastric banding results in a significant improvement in HRQOL. A return to normal can be expected at 1 year and persists at 3 years. The postoperative improvement in HRQOL is strongly related to weight loss.
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Affiliation(s)
- Maud Robert
- Centre de chirurgie de l'obésité, Hospices Civils de Lyon, Université de Lyon, Lyon, France
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29
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Coleman KJ, Huang YC, Hendee F, Watson HL, Casillas RA, Brookey J. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis 2014; 10:396-403. [PMID: 24951065 DOI: 10.1016/j.soard.2014.02.044] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND A registry was created for patients having procedures for weight loss from 2004 to the present time at a large integrated healthcare system. The objective of this study was to compare findings to the literature and national quality monitoring databases and present 3-year weight loss outcomes. METHODS Patients are passively enrolled in the registry with the following characteristics: a bariatric procedure for weight loss after January 1, 2004 and actively enrolled in the health plan at the time of surgery. RESULTS Compared to national surgical quality databases, the registry (n = 20,296) has a similar proportion of Roux-en-Y gastric bypass (RYGB; 58%), more vertical sleeve gastrectomy (SG; 40%), fewer banding (2%) procedures, more Hispanic patients (35%), and higher rates of 1 year follow-up (78%). RYGB patients lost more weight at every time point up to 3 years after surgery compared with SG patients (P<.001). Non-Hispanic white RYGB patients had a higher percent excess weight loss than non-Hispanic black (P<.001) and Hispanic (P<.001) RYGB patients. There were no differences between SG racial/ethnic groups in percent excess weight loss throughout the 3-year follow-up period. CONCLUSION We are one of the first groups to publish comparison weight outcomes for RYGB and SG in a diverse patient population, showing that the responses to RYGB and not SG vary by race/ethnicity.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California.
| | - Yii-Chieh Huang
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Fadi Hendee
- South Bay Medical Center, Department of Endocrinology, Southern California Permanente Medical Group, Harbor City, California
| | - Heather L Watson
- Population Care Management, Southern California Permanente Medical Group, Pasadena, California
| | - Robert A Casillas
- West Los Angeles Medical Center, Department of Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - John Brookey
- Quality Improvement, Southern California Permanente Medical Group, Pasadena, California
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Kiewiet RM, Durian MF, Cuijpers LPLH, Hesp FLEM, van Vliet ACM. Quality of life after gastric banding in morbidly obese Dutch patients: Long-term follow-up. Obes Res Clin Pract 2013; 2:I-II. [PMID: 24351772 DOI: 10.1016/j.orcp.2008.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 03/07/2008] [Accepted: 03/25/2008] [Indexed: 11/18/2022]
Abstract
SUMMARY OBJECTIVE Long-term effects of adjustable gastric banding (AGB) on quality of life (QoL) in a morbidly obese population were investigated in a cross-sectional study. Additionally, determinants of QoL after AGB were assessed. METHODS All patients treated by AGB for morbid obesity in a Dutch hospital were invited to complete the RAND 36-Item Health Survey. Of 121 participating patients 59 met the criteria for long-term follow-up (>5 years): 4 male and 55 female, mean age 42.4 ± 9.7 years, mean body mass index (BMI) before surgery 44.9 ± 5.9 kg/m(2). Time since surgery was 74.7 months (range 60-107.6). The control group consisted of 28 presurgical patients. General and obesity-related parameters were assessed for correlation with QoL. RESULTS Significant differences between the preoperative group and Dutch community norm (CN) values were found on five out of eight QoL subscales, in favor of CN. AGB induced significant weight loss in the postoperative group: 56.1% excess weight loss (%EWL). This group scored significantly better than the preoperative group on one out of eight subscales: physical functioning (P = 0.019). Additionally, scores on four out of eight subscales were still significantly impaired compared to CN. Postoperative BMI and %EWL influenced QoL after long-term follow-up, whereas weight regain had no negative impact. CONCLUSIONS This study shows that after long-term follow-up subjects treated by gastric banding to induce weight loss have a slightly better QoL than those who did not undergo surgery yet. QoL remains impaired in comparison to the general population. After long-term follow-up BMI and weight loss do influence QoL whereas weight regain does not have any negative impact.
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Affiliation(s)
- Rosalie M Kiewiet
- Department of Internal Medicine, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands.
| | - Marc F Durian
- Department of Internal Medicine, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
| | - Luc P L H Cuijpers
- Department of Internal Medicine, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
| | - Fried L E M Hesp
- Department of Internal Medicine, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
| | - Adrie C M van Vliet
- Department of Internal Medicine, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
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Santos J, Salgado P, Santos C, Mendes P, Saavedra J, Baldaque P, Monteiro L, Costa E. Effect of bariatric surgery on weight loss, inflammation, iron metabolism, and lipid profile. Scand J Surg 2013; 103:21-5. [PMID: 24177986 DOI: 10.1177/1457496913490467] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Accumulating evidence indicates that a state of chronic inflammation has a crucial role in the pathogenesis of obesity-related metabolic dysfunction. This study aims to evaluate changes in inflammatory process, iron metabolism, erythropoiesis, and lipid profile associated with weight loss after gastric banding surgery. MATERIAL AND METHODS A total of 46 patients were evaluated before and 3 months after gastric banding surgery. A survey was conducted to record demographic data, body mass index, and presence of comorbidities. Moreover, complete blood cell counts and serum levels of iron, ferritin, transferrin, high-sensitivity C-reactive protein, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides were performed. RESULTS At a follow-up 3 months after surgery, our patients presented a significant decrease in weight and body mass index, associated with a decreased inflammatory process (decreased high-sensitivity C-reactive protein, neutrophil counts, and neutrophil:lymphocyte ratio), increased iron availability (increased transferrin saturation and a trend to higher iron serum levels), and significant decreased triglycerides and triglycerides:high-density lipoprotein-cholesterol ratio. CONCLUSIONS Our results showed a significant decrease in the inflammation process 3 months after gastric banding surgery, associated with adipose tissue loss. This decrease in the inflammatory process is associated with more efficient iron absorption and increased iron availability for erythropoiesis. Moreover, we also found decreased triglyceride serum levels. These changes suggest benefits of weight loss, including decreased risk of cardiovascular disease.
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Affiliation(s)
- J Santos
- Hospital da Prelada-Dr. Domingos Braga da Cruz, Porto, Portugal
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The Pregnancy in Polycystic Ovary Syndrome II study: baseline characteristics and effects of obesity from a multicenter randomized clinical trial. Fertil Steril 2013; 101:258-269.e8. [PMID: 24156957 DOI: 10.1016/j.fertnstert.2013.08.056] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/16/2013] [Accepted: 08/30/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To summarize baseline characteristics from a large multicenter infertility clinical trial. DESIGN Cross-sectional baseline data from a double-blind randomized trial of two treatment regimens (letrozole vs. clomiphene). SETTING Academic Health Centers throughout the United States. PATIENT(S) Seven hundred fifty women with polycystic ovary syndrome (PCOS) and their male partners took part in the study. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Historic, biometric, biochemical, and questionnaire parameters. RESULT(S) Females averaged 30 years and were obese (body mass index [BMI] 35) with ∼20% from a racial/ethnic minority. Most (87%) were hirsute and nulligravid (63%). Most of the women had an elevated antral follicle count and enlarged ovarian volume on ultrasound. Women had elevated mean circulating androgens, LH-to-FSH ratio (∼2), and antimüllerian hormone levels (8.0 ng/mL). In addition, women had evidence for metabolic dysfunction with elevated mean fasting insulin and dyslipidemia. Increasing obesity was associated with decreased LH-to-FSH levels, antimüllerian hormone levels, and antral follicle counts but increasing cardiovascular risk factors, including prevalence of the metabolic syndrome. Men were obese (BMI 30) and had normal mean semen parameters. CONCLUSION(S) The treatment groups were well matched at baseline. Obesity exacerbates select female reproductive and most metabolic parameters. We have also established a database and sample repository that will eventually be accessible to investigators. CLINICAL TRIAL REGISTRATION NUMBER NCT00719186.
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Coulman KD, Abdelrahman T, Owen-Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev 2013; 14:707-20. [PMID: 23639053 DOI: 10.1111/obr.12041] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 04/01/2013] [Indexed: 12/01/2022]
Abstract
Bariatric surgery is increasingly being used to treat severe obesity, but little is known about its impact on patient-reported outcomes (PROs). For PRO data to influence practice, well-designed and reported studies are required. A systematic review identified prospective bariatric surgery studies that used validated PRO measures. Risk of bias in randomized controlled trials (RCTs) was assessed, and papers were examined for reporting of (i) who completed PRO measures; (ii) missing PRO data and (iii) clinical interpretation of PRO data. Studies meeting all criteria were classified as robust. Eighty-six studies were identified. Of the eight RCTs, risk of bias was high in one and unclear in seven. Sixty-eight different PRO measures were identified, with the Short Form (SF)-36 questionnaire most commonly used. Forty-one (48%) studies explicitly stated measures were completed by patients, 63 (73%) documented missing PRO data and 50 (58%) interpreted PRO data clinically. Twenty-six (30%) met all criteria. Although many bariatric surgery studies assess PROs, study design and reporting is often poor, limiting data interpretation and synthesis. Well-designed studies that include agreed PRO measures are needed with reporting to include integration with clinical outcomes to inform practice.
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Affiliation(s)
- K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK; Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
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Staalesen T, Fagevik Olsén M, Elander A. Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients. Obes Surg 2013; 23:1632-44. [DOI: 10.1007/s11695-013-0978-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Zijlstra H, Larsen JK, Wouters EJ, van Ramshorst B, Geenen R. The Long-Term Course of Quality of Life and the Prediction of Weight Outcome After Laparoscopic Adjustable Gastric Banding: A Prospective Study. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hanna Zijlstra
- Department of Nutrition and Dietetics, School of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Eveline J.M. Wouters
- Department of Allied Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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Quality of life long-term after body contouring surgery following bariatric surgery: sustained improvement after 7 years. Plast Reconstr Surg 2013; 130:1133-1139. [PMID: 22777040 DOI: 10.1097/prs.0b013e318267d51d] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bariatric surgery for morbid obesity results in massive weight loss and improvement of health and quality of life. A downside of the major weight loss is the excess of overstretched skin, which may influence the patient's quality of life by causing functional and aesthetic problems. The purpose of the current study was to evaluate the patient's quality of life long-term after body contouring following bariatric surgery. METHODS Quality of life was measured with the Obesity Psychosocial State Questionnaire in 33 post-bariatric surgery patients 7.2 years (range, 3.2 to 13.3 years) after body contouring surgery. Data were compared with previous assessments 4.1 years (range, 0.7 to 9.2 years) after body contouring surgery of the quality of life at that time and before body contouring surgery. RESULTS Compared with appraisals of quality of life before body contouring surgery, a significant, mostly moderate to large, sustained improvement of quality of life was observed in post-bariatric surgery patients 7.2 years after body contouring surgery in six of the seven psychosocial domains. A small deterioration occurred between 4.1- and 7.2-year follow-up on two of the seven domains except for the domain efficacy toward eating, which showed a significant improvement. At 7-year follow-up, 18 patients (55 percent) were satisfied with the result of body contouring surgery. CONCLUSIONS This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery. This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Aldaqal SM, Samargandi OA, El-Deek BS, Awan BA, Ashy AA, Kensarah AA. Prevalence and desire for body contouring surgery in postbariatric patients in saudi arabia. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:94-8. [PMID: 22408756 PMCID: PMC3296327 DOI: 10.4103/1947-2714.93386] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Morbid obesity has become a common problem worldwide and as a result the demand for bariatric surgery has increased as well. Most patients develop skin redundancy and sagging at many body parts after major weight loss procedures which increased the demand for body contouring procedures. Aims: The study was to address the prevalence and patient's desire for body contouring procedures. Materials and Methods: A cross-sectional study targeting the postbariatric patients from April 2011 to October 2011 was conducted at our hospital. Questionnaire was administered in order to measure frequency and patients desire to undergo body contouring surgery after massive weight loss. Results: The total number of patients was 128 patients. The mean age of our patients was 37-year old (range 18-56 year). The percentage of the desire for body contouring surgery after bariatric surgery was 78.1%. There was very pronounced desire to body contouring surgery after those who underwent gastric bypass surgery with P-value 0.001. Only 18 patients (14%) have underwent body contouring surgery, with a total of 29 procedures, in which abdominoplasty considered the most commonly procedure performed (57%). Conclusion: With the increasing number of weight loss surgery, there is higher number of patients that desire a body contouring surgery, which create huge disparity between demand and accessibility.
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Affiliation(s)
- Saleh M Aldaqal
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
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Chakravarty PD, McLaughlin E, Whittaker D, Byrne E, Cowan E, Xu K, Bruce DM, Ford JA. Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the randomised controlled trials. Surgeon 2012; 10:172-82. [PMID: 22405735 DOI: 10.1016/j.surge.2012.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures. METHOD Systematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay. RESULTS Five RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications. CONCLUSION Co-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.
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Affiliation(s)
- P D Chakravarty
- University of Aberdeen, Section of Population Health, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Schouten R, Wiryasaputra DCMS, van Dielen FMH, van Gemert WG, Greve JWM. Influence of reoperations on long-term quality of life after restrictive procedures: a prospective study. Obes Surg 2012; 21:871-9. [PMID: 21221834 PMCID: PMC3119802 DOI: 10.1007/s11695-010-0350-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quality of life improves after bariatric surgery. However, long-term results and the influence of reoperations are not well known. A prospective quality of life assessment before, 1 and 7 years after laparoscopic adjustable gastric banding (LAGB) and vertical banded gastroplasty (VBG) was performed in order to determine the influence of reoperations during follow-up. One hundred patients were included in the study. Fifty patients underwent VBG and 50 LAGB. Patients completed the quality of life questionnaires prior to surgery and two times during follow-up. Health-related quality of life (HRQoL) questionnaires included the Nottingham Health Profile I and II and the Sickness Impact Profile 68. Follow-up was 84% with a mean duration of 84 months (7 years). During follow-up, 65% of VBG patients underwent conversion to Roux-en-Y gastric bypass while 44% of LAGB patients underwent a reoperation or conversion. One year after the procedure, nearly all quality-of-life parameters significantly improved. After 7 years, the Nottingham Health Profile (NHP)-I domain “physical ability”, the NHP-II and the SIP-68 domains “mobility control”, “social behavior”, and “mobility range” were still significantly improved in both groups. The domains “emotional reaction”, “social isolation” (NHP-I), and “emotional stability” (SIP-68) remained significantly improved in the VBG group while this was true for the domain “energy level” (NHP-I) in the LAGB group. Both the type of procedure and reoperations during follow-up were not of significant influence on the HRQoL results. Weight loss and decrease in comorbidities were the only significant factors influencing quality of life. Restrictive bariatric surgery improves quality of life. Although results are most impressive 1 year after surgery, the improvement remains significant after long-term follow-up. Postoperative quality of life is mainly dependent on weight loss and decrease in comorbidities and not on the type of procedure or surgical complications.
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Affiliation(s)
- Ruben Schouten
- Department of Surgery, Atrium Medical Centre Parkstad, P.O. Box 4446, 6401, CX, Heerlen, The Netherlands.
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Tayyem R, Ali A, Atkinson J, Martin CR. Analysis of Health-Related Quality-of-Life Instruments Measuring the Impact of Bariatric Surgery. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2011; 4:73-87. [DOI: 10.2165/11584660-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Physical activity is a cornerstone in the medical management of obesity and could be important for weight loss following bariatric surgery. This review aims to describe the evolution of physical activity following massive weight loss induced by bariatric surgery, and to identify the relationship between physical activity and amount of weight loss. A literature search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self-assessment of physical activity was used in all the studies. Objective measures (pedometry) were used in two studies. The time frame for physical activity assessment varied: before surgery in two publications, after surgery in nine, and longitudinal pre- to post-operative evolution in nine. The latter nine publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss. In conclusion, observational evidence of self-reported physical activity suggests that physical activity increases after bariatric surgery and that physical activity is associated with surgically induced weight loss. However, these findings warrant further evaluation using objective measures of physical activity and testing in controlled trials.
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Affiliation(s)
- D Jacobi
- CHRU de Tours, Service de Médecine Interne et Nutrition, Tours, France
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43
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Fezzi M, Kolotkin RL, Nedelcu M, Jaussent A, Schaub R, Chauvet MA, Cassafieres C, Lefebvre P, Renard E, Bringer J, Fabre JM, Nocca D. Improvement in Quality of Life After Laparoscopic Sleeve Gastrectomy. Obes Surg 2011; 21:1161-7. [DOI: 10.1007/s11695-011-0361-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Assimakopoulos K, Karaivazoglou K, Panayiotopoulos S, Hyphantis T, Iconomou G, Kalfarentzos F. Bariatric Surgery is Associated with Reduced Depressive Symptoms and Better Sexual Function in Obese Female Patients: A One-Year Follow-Up Study. Obes Surg 2010; 21:362-6. [DOI: 10.1007/s11695-010-0303-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Impact of walking on eating behaviors and quality of life of premenopausal and early postmenopausal obese women. Menopause 2010; 17:529-38. [DOI: 10.1097/gme.0b013e3181d12361] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The impact of reconstructive procedures following bariatric surgery on patient well-being and quality of life. Obes Surg 2009; 20:36-41. [PMID: 19688408 DOI: 10.1007/s11695-009-9909-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Massive weight loss following bariatric surgery may lead to an excess of lax, overstretched skin, causing physical discomfort which may affect the patient's quality of life. Whereas the functional and aesthetic deformity is an expected result of massive weight loss, the role of the plastic surgeon in the multidisciplinary approach of the morbidly obese is still unclear. The purpose of the current study is to evaluate the results of reconstructive surgery following weight loss surgery, focusing on the impact on the physical and psycho-social well-being and quality of life of the patients. METHODS Out of a group of 465 patients, 61 patients underwent reconstructive surgery following weight loss surgery. In 43 respondents, the quality of life after reconstructive surgery was measured by the Obesity Psychological State Questionnaire. Patient satisfaction was evaluated. RESULTS Reconstructive surgery resulted in a significant improvement in quality of life in patients at a mean interval of 42 months between weight loss and reconstructive surgery. The most frequent procedures were abdominoplasty and breast reconstruction. The relative high complication rate of 27.9% was of no influence on quality of life and the majority of the patients (67%) were satisfied with reconstructive surgery. CONCLUSIONS This study shows that reconstructive surgery following weight loss after bariatric surgery results in a significant improvement in overall quality of life. Reconstructive surgery should be incorporated in the multidisciplinary care programme following weight loss surgery in the morbidly obese patient.
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Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM, Maher JW, Wing RR. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity (Silver Spring) 2009; 17:78-83. [PMID: 18997679 DOI: 10.1038/oby.2008.501] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to determine whether pre- to postoperative increases in physical activity (PA) are associated with weight loss and health-related quality of life (HRQoL) following bariatric surgery. Participants were 199 Roux-en-Y gastric bypass (RYGB) surgery patients. The International Physical Activity Questionnaire (IPAQ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level: (i) Inactive/Active (<200-min/week/>or=200-min/week), (ii) Active/Active (>or=200-min/week/>or=200-min/week) and (iii) Inactive/Inactive (<200-min/week/<200-min/week). The Medical Outcomes Study Short Form-36 (SF-36) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes. Inactive/Active participants, compared with Inactive/Inactive individuals, had greater reductions in weight (52.5 +/- 15.4 vs. 46.4 +/- 12.8 kg) and BMI (18.9 +/- 4.6 vs. 16.9 +/- 4.2 kg/m(2)). Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other. Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary (MCS) score and the general health, vitality and mental health domains (P < 0.01). Although the direction of causation is not clear, these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active. Future randomized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes.
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Affiliation(s)
- Dale S Bond
- Department of Psychiatry and Behavioral Medicine, Brown Alpert Medical School/The Miriam Hospital, Providence, Rhode Island, USA.
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Riesco E, Roussel M, Lemoine S, Garnier S, Sanguignol F, Mauriège P. What is the influence of menopausal status on metabolic profile, eating behaviors, and perceived health of obese women after weight reduction? Appl Physiol Nutr Metab 2008; 33:957-65. [PMID: 18923571 DOI: 10.1139/h08-063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The duration of the numerous weight-loss studies that combine physical activity and diet varies from 3 to 14 months, and these studies have often considered pre- and postmenopausal women separately. The purpose of this study was to compare the effects of a 3-week weight-reducing program that combines caloric restriction and exercise on the metabolic profile, eating behaviors, and perceived health of sedentary obese pre- and postmenopausal women, after adjustment for age. In 10 pre- and 22 postmenopausal women, before and after weight loss, body composition, fasting lipid-lipoprotein profile, glucose and insulin levels, eating behaviors, and perceived health state were assessed. Body mass index, fat mass, and waist girth decreased after weight reduction in both groups (p < 0.0001). Reductions in fasting serum cholesterol and low-density lipoprotein-cholesterol levels were greater in pre- than in postmenopausal women (p < 0.0001), whereas triacylglycerol, glucose, and high-density lipoprotein-cholesterol levels decreased similarly in both groups (p < 0.05). Neither fasting insulin nor free fatty-acid concentrations were modified after weight loss in either group. Disinhibition (p < 0.005) and hunger scores on the three-factor eating questionnaire (TFEQ) (p < 0.05) and the state-anxiety score on the state-trait anxiety inventory (STAI) questionnaire (p < 0.0005) decreased in both groups, but restriction (TFEQ) increased (p < 0.01) and trait anxiety (STAI) decreased (p < 0.001) after weight reduction only in premenopausal women. Improvements in selected lipid-lipoprotein indices, eating behaviors, and perceived health-state components were better in pre- than in postmenopausal women, suggesting that menopausal status has an influence on some metabolic and behavioral responses to weight loss.
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Affiliation(s)
- Eléonor Riesco
- UFR STAPS, Universite Paul Sabatier, 118, Route de Narbonne, Toulouse 31062, France
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Rutten SJE, de Goederen-van der Meij S, Pierik RGJM, Mathus-Vliegen EMH. Changes in Quality of Life After Balloon Treatment Followed by Gastric Banding in Severely Obese Patients—The Use of Two Different Quality of Life Questionnaires. Obes Surg 2008; 19:1124-31. [DOI: 10.1007/s11695-008-9732-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
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José González-González J, Sanz-Álvarez L, García Bernardo C. La obesidad en la historia de la cirugía. Cir Esp 2008; 84:188-95. [DOI: 10.1016/s0009-739x(08)72618-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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