Therapeutic outcome of adjustable gastric banding in morbid obese patients

Predicting satisfaction with outcome and follow‐up care five years after bariatric surgery: a prospective evaluation

Objective

Patient satisfaction is viewed as essential for a successful outcome of bariatric surgery. Few studies have explored long‐term satisfaction prospectively. This study aimed to examine pre‐ and post‐surgery predictors for satisfaction with follow‐up care, and change in outcome satisfaction from one to 5 years after bariatric surgery.

Methods

A sample of 210 participants was recruited from a single treatment center. Self‐reported and medical record data regarding mental and somatic health, body image, follow‐up attendance, and weight loss were obtained before, 1 year, and 5 years after surgery.

Results

Over 90% of the participants were satisfied with the results and treatment 1 year after surgery, while 69% had their outcome expectations fulfilled and 62% were satisfied with the follow‐up 5 years after surgery. A shift from initial satisfaction to unfulfillment of expectations was predicted by baseline body dissatisfaction, greater percentage of weight regain after initial weight loss, and more discomfort from somatic symptoms 5 years after surgery. In addition to symptom discomfort, worry about surgery predicted satisfaction with follow‐up care.

Conclusion

At 5 years, one‐fifth of those initially satisfied reported that bariatric surgery had failed to meet their expectations. This suggests that outcome expectations related to weight loss, somatic symptoms, and body image need to be addressed both before and after bariatric surgery.

A Brief Assessment of Body Image Perception: Norm Values and Factorial Structure of the Short Version of the FKB-20

The Body Image Questionnaire-20 (FKB-20) is one of the most applied self-report measures in the context of body image assessment in German-speaking regions. A version of the FKB-20 capturing an ideal concept of body image is also available. A special property of the scale is its high sensitivity for individuals suffering from anorexia nervosa. The present research provided a short version of this scale (for both variants) and examined its validity in a representative sample (N = 2,347) of the German population. We utilized factor analysis methods to identify the optimal short scale of the measure, finding excellent model fit and reliability for a two-factor model (FKB-6) for both real and ideal body image. Both versions of the FKB-6 can be considered invariant across sex and age groups. Good reliability indices were shown for both versions of the FKB-6. The reliability indices were similar to those mentioned in previous studies. Our study also revealed, that large discrepancies between the real and an ideal body image are correlated with somatic and body dysmorphic symptoms. Finally, we provided norm values for comparisons of individual scores with the general population. The FKB-6 is a valid and a reliable measure that economizes assessments by clinicians and researchers.

Body Image and Body Avoidance Nine Years After Bariatric Surgery and Conventional Weight Loss Treatment

Recently, there has been an increasing focus on body image dissatisfaction (BID), both as a motivational factor for seeking bariatric surgery and as a factor influencing weight loss outcome after surgery. Although associations have been reported between BID, emotional distress and successful weight loss, conclusions are limited due to methodological issues such as non-weight-specific assessment tools for body image and neglect of behavioral components (e.g. body avoidance, BA). The present study seeks to report on BID and BA 9 years after bariatric surgery using a cross-sectional data set from the 9-year follow-up assessment of the Essen-Bochum Obesity Treatment Study (EBOTS). In total, N = 291 participants of the original EBOTS sample were included in the present analyses (N = 78 bariatric surgery patients, SURG; N = 124 patients of a conventional treatment program, CONV; and N = 83 individuals with obesity not seeking treatment, OC). Current body image facets (BID and BA) were captured at the 9-year follow-up assessment via silhouette scales adapted for use in samples with obesity. Moreover, BID was assessed retrospectively to obtain baseline attitudes. Possible influences of eating disorder symptoms and depression/anxiety were controlled for and assessed via standardized self-report measures. The results imply an improvement in BID in the SURG group, but not in the CONV and OC groups. The level of BA in relation to clothing was significantly higher in the CONV group compared to both the SURG and OC group. Current BID as well as BA were positively associated with current body weight as well as depression, anxiety, and levels of disinhibited eating. A positive change from baseline to current levels of BID was associated with successful weight loss, independently of treatment. The findings emphasize the role of the different components of body image after surgery for mental health features, and suggest a robust relationship between BID and weight loss (success). Thus, it might be helpful to address BID in treatment. However, further research, particularly in the form of prospective studies, is necessary to determine the direction of influence.

Short-term changes in affective, behavioral, and cognitive components of body image after bariatric surgery

BACKGROUND

Many bariatric surgery candidates report body image concerns before surgery. Research has reported post-surgical improvements in body satisfaction, which may be associated with weight loss. However, research has failed to comprehensively examine changes in affective, behavioral, and cognitive body image.

OBJECTIVES

This research examined (1) short-term changes in affective, behavioral, and cognitive components of body image from pre-surgery to 1- and 6-months after bariatric surgery, and (2) the association between percent weight loss and these changes.

SETTING

Participants were recruited from a private hospital in the midwestern United States.

METHODS

Eighty-eight females (original N = 123; lost to follow-up: n = 15 at 1-month and n = 20 at 6-months post-surgery) completed a questionnaire battery, including the Body Attitudes Questionnaire, Body Checking Questionnaire, Body Image Avoidance Questionnaire, and Body Shape Questionnaire, and weights were obtained from patients' medical records before and at 1- and 6-months post-surgery.

RESULTS

Results indicated significant decreases in body dissatisfaction, feelings of fatness, and body image avoidance at 1- and 6-months after bariatric surgery, with the greatest magnitude of change occurring for body image avoidance. Change in feelings of fatness was significantly correlated with percent weight loss at 6-months, but not 1-month, post-surgery.

CONCLUSIONS

These findings highlight the importance of examining short-term changes in body image from a multidimensional perspective in the effort to improve postsurgical outcomes. Unique contributions include the findings regarding the behavioral component of body image, as body image avoidance emerges as a particularly salient concern that changes over time among bariatric surgery candidates.

Body image concerns amongst massive weight loss patients

AIMS AND OBJECTIVES

To explore body image matters amongst patients following massive weight loss.

BACKGROUND

In contemporary health care, a growing number of morbidly obese patients are seeking surgical solutions such as bariatric surgery or in other cases engaging with radical lifestyle changes. Massive weight loss can leave patients with a huge excess of lax overstretched skin that in some cases can trigger major body image dissatisfaction or depression. There is a scarcity of research about the needs of this group of patients and this is important for nursing practice.

DESIGN

A qualitative design using in-depth interviews was employed.

METHODS

Twenty white adults (18 women and two men) were recruited retrospectively amongst patients who had massive weight loss by undergoing bariatric surgery or radical lifestyle changes, aged 29-63 years. All of the participants gave signed informed consent. Face-to-face in-depth interviews were conducted and transcribed verbatim. The data were analysed using thematic analysis.

RESULTS

One core theme focusing on body image ugliness and three associated subthemes were identified: the subthemes included feeling socially marginalised, feeling depressed and sexual and intimacy difficulties.

CONCLUSION

Body image matters are hugely significant and appear to have a lasting effect on emotional well-being and function, contributing to psychological distress and social isolation. Greater sensitivity is required in enabling patients to work through emotional isolation and shame that has been a part of their childhood. Furthermore more, treatments need to be accessible to this growing patient population such as reconstructive surgery.

RELEVANCE TO CLINICAL PRACTICE

Nurses who care for massive weight loss patients need to be mindful of their psychodynamic needs and be non-judgemental and accepting. Moreover, nurses need to be aware of treatment options and be able to assess body image matters and implement quality care for this particular patient group including body image acceptance programmes and support groups.

Identity transformation and a changed lifestyle following dramatic weight loss and body-contouring surgery: An exploratory study

This article reports on two major quality-of-life perception changes for patients who had undergone plastic surgery following dramatic weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital. In-depth interviews were conducted, and a thematic analysis of the data was undertaken. The results provide unique glimpses of surgical consumption empowering and facilitating ‘identity transformation’, embracing improved physical function and enhanced self-esteem, confidence and quality of life, and a ‘changed lifestyle’. For a minority, identity transformation was sometimes interrupted by ‘identity lag’, posing the need for additional health-care support throughout the adjustment process. The study provides additional insight into existing quantitative studies, adding to the body of knowledge in this area.

Body image after sleeve gastrectomy: reduced dissatisfaction and increased dynamics

BACKGROUND

Individuals with severe obesity commonly report poor body image. Improvement in body image has been found after conservative weight reduction programs as well as after bariatric surgery (gastric bypass, biliopancreatic diversion, or gastric banding). However, no studies investigating body image after laparoscopic sleeve gastrectomy (LSG) are available.

METHODS

Of 70 consecutive patients who planned to undergo LSG at a comprehensive obesity center, 62 patients were included in the study and evaluated before surgery. Their mean body mass index (BMI) was 51.3 kg/m(2) and the patients' mean age before surgery was 43.8 years. One-year follow-up data were obtained for 51 patients (82.3 %). Body image was assessed using the body image questionnaire (BIQ-20), and depression was assessed using the Patient Health Questionnaire (PHQ-9).

RESULTS

Patients reported poor body image before surgery. One year after LSG, negative evaluations of the body and perceptions of body dynamics and vitality had markedly improved, without reaching healthy levels. No correlations between body image and weight-related parameters (BMI, percentage of excess weight loss) or mood after 1 year were found.

CONCLUSIONS

Body image improves after LSG. This improvement might reflect changes to patients' attitudes, beliefs, and thoughts rather than real weight lost. Further studies should investigate the factors that mediate improvement of body image after bariatric surgery.

Shame and self-acceptance in continued flux: Qualitative study of the embodied experience of significant weight loss and removal of resultant excess skin by plastic surgery

This study explored the embodied experience of body change using a qualitative design. Eight previous plastic surgery patients of a London hospital took part in in-depth, semi-structured interviews 1 year post a plastic surgery procedure to remove excess skin around their abdomen, resulting from weight loss. Participant interviews were analysed using Interpretative Phenomenological Analysis. Two sub-themes titled ‘Shame of the hidden body’ and ‘Lack of acceptance; the future focused body’ are presented in this article. Findings are considered in relation to theories of ‘Body Shame’ and in the current cultural context.

Long-term outcome after laparoscopic adjustable gastric banding for morbid obesity

This study was performed to determine the long-term consequences of laparoscopic gastric banding on weight loss, body image, and life quality in morbidly obese patients. After a minimum follow-up of 9 years (mean follow-up 10 years; range 9-12 years) several questionnaires concerning weight loss, body image, and life quality were mailed to 180 morbidly obese patients following laparoscopic adjustable gastric banding. One hundred and twelve (62%) patients (92 females, 20 males) completed and returned the questionnaires. Of the entire sample, 73 (64.9%) patients still had the first band, 17 (15.3%) a second band, and in 22 (19.8%) probands the band had been removed for various reasons. Average weight loss, calculated as change in body mass index, was 13.9 kg/m². Average excess weight loss (EWL) was 30.6%. A total of 10% patients accounted for >50% of EWL. Half of the probands were completely satisfied with their weight loss and about half had reached their planned weight. Lowest post-operative weight was reached at different times, in nearly half of the probands after 2 years, in one-fourth after 4-5 years, and in about 20% at a later time. More than 90% of the probands experienced longer interruptions in weight loss; about half knew why. The findings indicate that overall quality of life was rated good to excellent by two-thirds of the probands, and fair to poor by one-third. A close correlation was seen between extent of weight loss and quality of life and body image. Despite some limitations, laparoscopic adjustable gastric banding is an effective and safe long-term surgical treatment for a majority of morbidly obese individuals, resulting in long-term weight loss and health-related quality of life. However, there is also a minority of morbidly obese subjects who do not benefit enough from this kind of bariatric surgery. Future research should investigate what kind of bariatric surgery is best for the particular obese individual in order to minimize unsatisfying post-operative results.

Patients' explanations for unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB)

OBJECTIVE

Not all morbidly obese patients attain sufficient weight loss after laparoscopic adjustable gastric banding (LAGB). We examined patients' explanations for unsuccessful weight loss and self-awareness regarding food intake.

METHODS

Interviews with 11 patients (10 female/1 male; mean age 46 years) with unsuccessful weight loss were transcribed and analyzed with the MAXqda2 program.

RESULTS

Interviewees were disappointed with the postoperative outcome. Some showed no awareness of their own role, while others were inefficacious to continue the actions needed to maintain weight loss, especially during times of stress. Typical statements that distinguished interviewees were: 'It didn't work out', 'I don't care anymore', 'I know I have to do it', 'I know I can do it'.

CONCLUSION

Some patients with unsuccessful weight loss after LAGB are insufficiently aware that their own effort is needed to maintain weight loss. Others have self-awareness, but find it difficult to turn awareness into action.

PRACTICE IMPLICATIONS

This group could perhaps be helped by tailoring postoperative guidance to the stage of change of an individual patient. Counseling could include increasing awareness of the need to self-control eating and offering assistance to turn intentions into action and to deal with stress, emotions and physical problems.

Change in mental symptoms in extreme obesity patients after gastric banding, Part II: Six-year follow up

OBJECTIVE

Apart from increased somatic morbidity, extreme obesity causes grave psychosocial and psychopathological problems. We examined a sample of 50 extremely adipose women (BMI < 40 kg/m2) from 2000 to 2003 to find out whether surgical reduction of stomach volume leads to lasting change in Body Mass Index (BMI), psychosocial symptoms, and health related quality of life. We found that positive changes in BMI reduction, psychosocial symptoms, and health related quality of life could be expected three years after gastric banding (Int. J Psychiatry Med 2005; 35:109-122). During the following three years, we continued to observe these patients to determine long-term effects.

METHOD

Fifty adipose women who had taken part in the first study from 2004 to 2006 were surveyed. Annual primary outcome measures were BMI, self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), Hospital Anxiety and Depression Scale (HADS-D), and Health Survey (SF-36).

RESULTS

At the 6-year mark, significant changes in BMI (p < 0.01), significantly increased employment (0.012) and the existence of a partnership (p < 0.01), plus significant changes on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression: p < 0.011), and all scales of the SF-36 Health Survey (all p < 0.01) were observed.

CONCLUSIONS

The positive changes in BMI reduction, i.e., increased employment and subjects living in a partnership, improvement in eating behavior, reduction in anxiety and depressive symptoms, and improvement in health related quality of life were also confirmed as remaining stable over a 3-year observation period, i.e., for a total of six years.

Patients with extreme obesity: change in mental symptoms three years after gastric banding

OBJECTIVE

Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life.

METHOD

We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36).

RESULTS

In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery.

CONCLUSIONS

Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).