4-Year Changes in Sex Hormones, Sexual Functioning, and Psychosocial Status in Women Who Underwent Bariatric Surgery

Impact of Chronic Medical Disease on Sexual Function and Other Conditions

Chronic diseases are prevalent and impact sexual health and function. Screening for and managing sexual dysfunction in women with chronic diseases is important to optimize well-being and quality of life. Clinicians should consider the biopsychosocial impact of chronic diseases on sexual health, screen for direct and indirect factors, and identify medications that may cause dysfunction. The authors recommend a multidisciplinary approach to treat sexual dysfunction in women with chronic diseases, including sexual medicine specialists, sex therapists, and pelvic floor physical therapists when indicated. This review provides a practical approach to assessing and managing sexual dysfunction in women with chronic diseases.

Weight Gain in Midlife Women

PURPOSE OF REVIEW

To summarize the evidence and clinical implications of weight and body composition changes during midlife in women and provide an overview of weight gain prevention and management in this population.

RECENT FINDINGS

Aging-related changes such as decreased energy expenditure and physical activity are important culprits for weight gain in midlife women. The hormonal changes of menopause also influence body adiposity distribution and increase central adiposity. These body changes can have health consequences including the development of cardiometabolic diseases, osteoarthritis, cancer, worsening in cognition, mental health, and menopause symptoms. Midlife women experience changes related to aging, menopause, and lifestyle which favor weight gain. Clinical practice should focus on early counseling and anticipatory guidance on the importance of dietary changes and physical activity to attenuate this phenomenon. Future research should focus on the longitudinal relationship between weight trends in midlife and health consequences and mortality.

Association between obesity and female sexual dysfunction: a review

INTRODUCTION

Obesity is a global health crisis that has been growing over the past few decades. The economic burden associated with obesity is substantial as it is associated with multiple disabling chronic diseases, such as cardiovascular disease, certain cancers, osteoarthritis, chronic pain, and mental illness. Obesity is known to be a risk factor for sexual dysfunction in men, but this association is less well understood in women.

AIMS

To provide a narrative review of the available literature on the relationship between overweight/obesity and female sexual dysfunction, elaborate on the possible mechanisms explaining this association, and discuss the effects of weight loss on sexual function in those with obesity.

METHODS

A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on obesity and sexual function in women.

RESULTS

The relationship between obesity and female sexual function is not consistent across studies. While women with obesity are more likely to have worse sexual function and avoid sexual activity, many studies have failed to identify these associations. Lifestyle changes resulting in weight loss lead to better sexual function, and bariatric surgery has been shown to improve sexual function in the first couple of years following the procedure; yet, the long-term effects of weight loss and bariatric surgery are still uncertain.

CONCLUSIONS

The evidence on the relationship between obesity and female sexual function is mixed. Nevertheless, weight loss has been shown to improve sexual function in women with obesity. The impact of weight loss medications and the long-term effect of bariatric surgery on female sexual function require further study.

Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study

BACKGROUND

Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS.

AIM

To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy.

METHODS

Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600 IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6 months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D.

OUTCOMES

The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone.

RESULTS

A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use.

CLINICAL IMPLICATIONS

Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary.

STRENGTHS AND LIMITATIONS

This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability.

CONCLUSION

Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.

Sexual Function and Satisfaction in the Context of Obesity

PURPOSE OF REVIEW

Sexual dysfunction is commonly associated with overweight/obesity, but the underlying physiological and psychosocial mechanisms are not fully understood. This review contextualizes the obesity-sexual (dys)function relationship, describes recent insights from the medical and social science literature, and suggests opportunities for continued research.

RECENT FINDINGS

Although sexual dysfunction has been historically evaluated as a consequence/outcome of obesity, it is increasingly considered as a harbinger of future metabolic comorbidities, including type 2 diabetes and cardiovascular disease. Body image dissatisfaction is a consistent predictor for lower sexual satisfaction across BMI categories, likely mediated by cognitive distraction during partnered sex. To fully capture the relationship between obesity and sexual dysfunction, multidisciplinary research approaches are warranted. While clinically significant weight loss tends to improve sexual functioning for women and men, higher body image satisfaction may independently promote sexual function and satisfaction without concomitant weight loss.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study

OBJECTIVES

The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels.

DESIGN

A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics.

SETTING

Regional hospital and outpatient bariatric clinic in central Sweden.

PARTICIPANTS

Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed.

RESULTS

The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'.

CONCLUSION

Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

Assessment of motivating and demotivating factors to undergo bariatric surgery in high-risk populations with correlation to generalized anxiety disorder and influence of others: a cross-sectional study

Very few research have looked at the causes and influences that push individuals into bariatric surgery. Although bariatric surgery is effective in boosting self-esteem, little is known about the precise physical characteristics people want to alter.

Methods

This study was a descriptive, correlational cross-sectional study to achieve the objectives of the study. All overweight and obese population in Jeddah, Saudi Arabia. Study instrument was designed based on the data present in the latest literature. Study tool consisted of: (1) sociodemographic data, (2) motives of bariatric surgery, (3) concerns about bariatric surgery, (4) people affecting the decision of seeking bariatric surgery, and (5) general anxiety disorder scale.

Results

The study included 567 participants. More than half of the study participants were females (n=335, 59.1%). The mean age among study participants was 27.88 years. Most of the participants selected themselves as the main person (n=329). In the second place comes "person who had the surgery" (n=72). A family member was prevalent among 59 participants and a friend among 57 participants. The partner has the least frequency. The most common reason was self-esteem among 26% followed by body image among 20%. The most frequent factor was "I am satisfied with my current weight loss method) among 220 participants followed by "I am afraid of any surgery and will avoid it unless absolutely needed" among 51 participants.

Conclusion

Bariatric surgery patients want to improve their health and live longer. Several people are dissatisfied with their bodies and seek cosmetic surgery. Patients desire bariatric surgery for their own and their loved ones', physicians', and peers' reasons. This study supports emphasizing the reasons why Jeddah, Saudi Arabia residents choose bariatric surgery and the demotivating issues.

Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass: a propensity score matched nationwide analysis

BACKGROUND

Literature remains scarce on patients experiencing weight recurrence after initial adequate weight loss following primary bariatric surgery. Therefore, this study compared the extent of weight recurrence between patients who received a Sleeve Gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) after adequate weight loss at 1-year follow-up.

METHODS

All patients undergoing primary RYGB or SG between 2015 and 2018 were selected from the Dutch Audit for Treatment of Obesity. Inclusion criteria were achieving ≥ 20% total weight loss (TWL) at 1-year and having at least one subsequent follow-up visit. The primary outcome was ≥ 10% weight recurrence (WR) at the last recorded follow-up between 2 and 5 years, after ≥ 20% TWL at 1-year follow-up. Secondary outcomes included remission of comorbidities at last recorded follow-up. A propensity score matched logistic regression analysis was used to estimate the difference between RYGB and SG.

RESULTS

A total of 19.762 patients were included, 14.982 RYGB and 4.780 SG patients. After matching 4.693 patients from each group, patients undergoing SG had a higher likelihood on WR up to 5-year follow-up compared with RYGB [OR 2.07, 95% CI (1.89-2.27), p < 0.01] and less often remission of type 2 diabetes [OR 0.69, 95% CI (0.56-0.86), p < 0.01], hypertension (HTN) [OR 0.75, 95% CI (0.65-0.87), p < 0.01], dyslipidemia [OR 0.44, 95% CI (0.36-0.54), p < 0.01], gastroesophageal reflux [OR 0.25 95% CI (0.18-0.34), p < 0.01], and obstructive sleep apnea syndrome (OSAS) [OR 0.66, 95% CI (0.54-0.8), p < 0.01]. In subgroup analyses, patients who experienced WR after SG but maintained ≥ 20%TWL from starting weight, more often achieved HTN (44.7% vs 29.4%), dyslipidemia (38.3% vs 19.3%), and OSAS (54% vs 20.3%) remission compared with patients not maintaining ≥ 20%TWL. No such differences in comorbidity remission were found within RYGB patients.

CONCLUSION

Patients undergoing SG are more likely to experience weight recurrence, and less likely to achieve comorbidity remission than patients undergoing RYGB.

The predictive value of preoperative luteinizing hormone to follicle stimulating hormone ratio for ovulation abnormalities recovery after laparoscopic sleeve gastrectomy: A prospective cohort study

Introduction

Obesity-related ovulation abnormalities (OA) affect fertility. LSG is the most frequent bariatric operation. However, no research has identified a reliable indicator for predicting OA recovery after LSG. The purpose of this research was to examine the prognostic usefulness of preoperative the luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio (LFR).

Methods

Our department conducted a prospective study from 2016 to 2021. Venous blood was typically tested 3 days before surgery to get the preoperative LFR. Descriptive data, preoperative and postoperative variables were also collected. Binary logistic regression related preoperative LFR with OA recovery. The receiver operating characteristic (ROC) curve evulated preoperative LFR's predictive capability.

Results

A total of 157 women with a complete follow-up of one year were included. LFR was the only factor linked with OA (P < 0.001). AUC (area under the ROC curve) = 0.915, cutoff = 1.782, sensitivity = 0.93, and specificity = 0.82.

Discussion

Overall, LSG has a favorable surgical result, with a %TWL of 66.082 ± 12.012 at 12 months postoperatively. Preoperative sexual hormone levels, as expressed by LFR, has the potential to predict the fate of OA following LSG at one year post-operatively.

Long-term changes in body image after bariatric surgery: An observational cohort study

BACKGROUND

While body image improves in the first few months after surgery, data on long-term changes in body image after bariatric surgery are scarce and contradictory.

METHODS

We assessed body image through the Stunkard Figure Rating Scale and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale, which measures appearance evaluation and orientation, overweight preoccupation, and self-classified weight. Surveys were conducted before surgery and at regular intervals until 5 years after bariatric surgery.

RESULTS

61 patients were included in the study. No patients were lost to follow-up until 18 months after bariatric surgery. At 5 years, there were 21 patients (34%) lost to follow-up. We detected an overall improvement in body image until 12-18 months post-surgery. Scores declined after 5 years post-surgery but were still higher than preoperative evaluations. Overweight preoccupation did not change throughout the follow-up period. There was a positive correlation between body weight lost and appearance evaluation. There was also a positive correlation between weight loss and the Body Areas Satisfaction Scale. There was a negative correlation between weight loss and overweight preoccupation. Appearance orientation and self-classified weight were not correlated with weight loss.

CONCLUSIONS

Body image improved after bariatric surgery but was not maintained for all 5 years after surgery.

Female sexual dysfunction after bariatric surgery in women with obesity: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Obesity is prevalent and has a negative impact on women's health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery.

METHODS

We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes.

RESULTS

The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (β = 0.395, p = 0.1, 95% CI = 0.884, 0.095).

CONCLUSIONS

Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.

Effects of bariatric surgery on the menstruation- and reproductive-related hormones of women with obesity without polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of women with obesity who do not have polycystic ovary syndrome (PCOS).

OBJECTIVES

To evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of women of childbearing age with who do not have PCOS.

SETTING

A systematic review and meta-analysis at a university hospital.

METHODS

Online databases were searched for all studies reporting the efficacy of bariatric surgery for women with obesity until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive-related hormone levels were the primary outcomes.

RESULTS

Fifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: .40, 95% confidence interval [CI]: .20-.79, P = .008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = -13.12 mIU/L, 95% CI: -15.03 to -11.22, P < .00001), glucose (MD = -.91 mmol/L, 95% CI: -1.26 to -.56, P < .00001), triglyceride (MD = -.61 g/L, 95% CI: -.76 to -.46, P < .00001), total testosterone (MD = -.22 ng/mL, 95% CI: -.24 to -.20, P < .00001), dehydroepiandrosterone (DHEA) (MD = -25.34 μg/dL, 95% CI: -31.19 to -19.49, P < .00001), estradiol (MD = -25.13 pg/mL, 95% CI: -34.13 to -16.13, P < .00001), and anti-Mullerian hormone (AMH) (MD = -.40 ng/mL, 95% CI: -.67 to -.13, P = .003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99-52.99, P < .00001).

CONCLUSION

Bariatric surgery can lower fasting insulin, glucose, and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for women with obesity of childbearing age who do not have PCOS. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for women with severe obesity.

Comparison of Medical Management versus Bariatric Surgery for Obesity Management: Effects on Sexual Function

Both bariatric surgery and medical modification approaches to weight loss for individuals with obesity have been evaluated for their impacts on sexual health, however, a comparison between these interventions has not been undertaken. A convenience sample of 52 females were recruited from community medical and surgical weight loss clinics to participate; 25 received medical management that consisted of dietary guidance and exercise training, and 27 received bariatric surgery. Participants completed self-report questionnaires before and after treatment that examined sexual functioning, sexual satisfaction, relationship satisfaction, depression, anxiety, and body esteem. Sexual functioning decreased in both groups regardless of weight loss approach, p = .037. Sexual satisfaction increased for both groups, p = .005, with significantly greater improvements seen in the medical management group, p = .038. Measures of sexual desire, arousal, and pain did not change after treatment, and there were no group or time effects on relationship satisfaction, depressive symptoms, or body esteem. Lubrication and orgasm function decreased over time for both groups. These results highlight that sexual satisfaction can improve with either weight loss approach, even when sexual function decreases.

Influence of Gastric Bypass on Obese Women Sexual Function-a Prospective Study

INTRODUCTION

Obesity may lead to hyperandrogenia and affect female sexual function. The study aims to evaluate female sexual function and androgenic profile in obese women after laparoscopic Roux-en-Y gastric bypass (LRYGB).

METHODS

Forty obese women with a mean age of 34 years were prospectively studied. Diabetes and psychiatric and pelvic disorders were the exclusion criteria. All patients underwent LRYGB. Total (TT) and free (FT) testosterone, androstenedione (AD), dehydroepiandrosterone (DHEA) and the Sexual Quotient - Female Version were evaluated, preoperatively, 6 and 12 months after the operation.

RESULTS

Preoperative incidence of sexual dysfunction was 10% and hyperandrogenia was 40%. At 6 months, sexual function was not different; and FT (0.49-0.33 ng/dl) and AD (2.0-1.3 ng/dl) decreased significantly. At 12 months, there was an improvement in female sexual function (77-84 points), related to desire and interest (22-25 points) and comfort (15.9-17.3 points) without case of sexual dysfunction at 12 months. Hyperandrogenia (40-8%), FT levels (0.5-0.3 ng/dl), and AD (2.0-1.4 ng/dl) decreased, while DHEA levels (3.4-4.2 ng/dl) increased. The percentage of weight loss was 22% and 31% at 6 and 12 months, respectively. Sexual function did not correlate with BMI, weight, or androgen levels in any period.

CONCLUSION

Female sexual function in obese women with no diabetes and psychiatric and pelvic disorders improved in patients undergoing LRYGB, especially in desire, interest, and sexual comfort, and this occured after 6 months of the operation and unrelated to BMI, percentage of weight loss, or androgen levels.

KEY POINTS

• In obese women with no diabetes and psychiatric and pelvic disorders the FSD improvement after LRYGB. • FSD no correlation with weight loss and BMI. • FSD no correlation with androgens levels.

Effect of bariatric surgery on endogenous sex hormones and sex hormone-binding globulin levels: a systematic review and meta-analysis

BACKGROUND

Most studies have shown beneficial effect of bariatric surgery (BS) on serum levels of sex hormones.

OBJECTIVE

A systematic review and meta-analysis was conducted to examine the magnitude of possible changes in levels of sex hormones following BS.

SETTINGS

Electronic databases were searched, including PubMed, Scopus, Web of Science, and Embase, for relevant studies.

METHODS

The heterogeneity of the studies was examined by χ² tests and the degree of heterogeneity was estimated using I² statistic.

RESULTS

The results of pooled analyses revealed that BS caused a significant increase in luteinizing hormone (LH), follicular stimulating hormone (FSH), total testosterone (TT), and sex hormone binding globulin (SHBG) levels and conversely, decreased dehydroepiandrosterone (DHEA) and estradiol (E2) levels in males. For females, BS significantly increased LH, FSH, and SHBG levels and conversely, decreased androstenedione (AE), E2 and TT levels. Additionally, the level of progesterone (P), prolactin (PRL), free testosterone (FT) and dehydroepiandrosterone sulfate (DHEA-S) showed no significant changes in patients who had undergone BS.

CONCLUSION

BS changed most sex hormones levels including LH, FSH, TT, SHBG, AE, DHEA, and E2. It seems that BS is able to exert substantial impacts on sex hormones levels and as well as sexual function, however, larger, and more precise trials are required to specifically focus on these claims.

A Qualitative Exploration of Patients' Experiences with Lifestyle Changes After Sleeve Gastrectomy in China

PURPOSE

Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals' experiences related to lifestyle changes after SG in China.

MATERIALS AND METHODS

Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes.

RESULTS

Interviews (N = 15) revealed three major themes of participants' experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations.

CONCLUSION

The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.

A review of the psychosocial aspects of clinically severe obesity and bariatric surgery

For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychological Outcomes and Predictors of Weight Loss in Adolescents With Severe Obesity Following a Reversible Endoscopic Bariatric Procedure

Introduction: Adolescent and children obesity is a growing concern worldwide. Bariatric surgery is used as an effective treatment for adolescents with obesity and provides physical and mental health benefits. Application of alternative, minimally invasive, safe, and reversible endoscopic procedures, such as the Duodenojejunal bypass liner (DJBL), has been recently suggested as an effective treatment for adolescents with obesity. We explored specific psychological outcomes of adolescents with obesity during a year of follow-up after undergoing a reversible endoscopic bariatric procedure, and a year after removal. We were also interested in identifying psychological factors that could predict successful weight loss after the procedure. Methods: Nineteen adolescent with severe obesity undergoing DJBL procedure were psychologically assessed in an open-label, prospective clinical trial (NTC0218393), at the implantation of device and at the removal of device after 12 months. Control group of 26 adolescents with severe obesity were recruited from the same outpatient clinic undergoing only conservative treatment. In addition, adolescents from the intervention group were followed for 12 months after the removal of the device. The Youth Self Report (YSR) was used to assess adolescents' emotional and behavioural problems; The Multidimensional Body-Self Relations Questionnaire (MBSRQ) to assess body image and The Eating Disorder Examination Questionnaire (EDE-Q) to assess attitudes and behaviours related to eating disorder. Results: Significant improvements in somatic complain (F = 12.478, p = 0.001), emotional and behavioural problems (F = 7.169, p = 0.011) and food restraining (F = 9.605, p = 0.004) were found in the intervention group at device removal compared to the control group. Moreover, at the time of device removal compared to baseline, improvements in several psychological outcomes were found (F = 32.178 p = 0.000 for emotional and behavioural problems). Adolescents also became more satisfied with their appearance (F = 6.789, p = 0.019). Majority of observed changes remained stable at the next follow up a year after the device removal. Significant predictors of successful weight loss at device removal were fewer overeating episodes (B = 0.147, p = 0.022) and lower body satisfaction (B = 0.932, p = 0.013). Discussion: Following a reversible bariatric procedure, improvements of psychological (emotional and behavioural) factors were found in adolescents with severe obesity. Psychological predictors of successful weight loss were identified, showing the greatest importance of eating behaviour and body satisfaction in successful weight loss.

The role of body appreciation, weight bias internalization, and disordered eating behaviors among presurgical bariatric patients

BACKGROUND

Body appreciation and internalized weight bias have consistently been associated with eating behaviors. However, research has yet to examine the role of these variables among presurgical bariatric patients.

OBJECTIVES

The present study sought to assess the relationships between body appreciation and weight bias internalization, binge eating, disinhibited eating, and symptoms of depression and anxiety among a sample of presurgical bariatric patients. The study also sought to examine the extent to which body appreciation and weight bias internalization account for unique variance in disordered eating even when controlling for depression and anxiety.

SETTING

Academic medical center in the United States.

METHODS

Data were collected on body appreciation, weight bias internalization, eating behaviors, depression, and anxiety as part of a standard presurgical psychological evaluation for bariatric surgery (n = 319). Pearson correlations were used to assess relationships between all study variables. Multiple regressions were conducted to assess the roles of body appreciation and weight bias internalization on disordered eating.

RESULTS

Significant associations were found between low levels of body appreciation and high levels of weight bias internalization, disordered eating, and symptoms of depression and anxiety. Results indicated that body appreciation and weight bias internalization each significantly accounted for unique variance in symptoms of binge eating and disinhibited eating. Depressive symptoms were also statistically significant in all analyses.

CONCLUSION

Findings indicate the importance of conducting future positive body image research, as well as continuing to examine weight-related constructs, such as internalized weight bias, among bariatric surgery patients.

Does sexual functioning improve with migraine improvements and/or weight loss?-A post hoc analysis in the Women's Health and Migraine (WHAM) trial

BACKGROUND

Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migraine, obesity and female sexual dysfunction (FSD).

OBJECTIVE

To evaluate sexual function changes and predictors of improvement after behavioural weight loss (BWL) intervention for migraine or migraine education (ME).

METHODS

Women with migraine and overweight/obesity were randomized to 16 weeks of BWL (n = 54) or ME (n = 56). Participants completed a 4-week smartphone headache diary and the Female Sexual Function Index (FSFI) at pre- and post-treatment. A validated FSFI total cut-off score defined FSD. We compared changes in FSFI scores and FSD rates between conditions and evaluated migraine improvements and weight loss as predictors of sexual functioning in the full sample.

RESULTS

Among treatment completers (n = 85), 56 (65.9%) participants who reported sexual activity at pre- and post-treatment were analysed. Migraine improvements were similar between conditions, whereas BWL had greater weight losses compared with ME. FSD rates did not change overall (48.2% to 44.6%, p = .66) or by condition (BWL: 56.0% to 40.0% vs. ME: 41.9% to 48.4%, p = .17). Similar patterns were observed for changes in FSFI total and subscale scores. Across conditions, larger weight losses predicted greater improvements in FSFI total and arousal subscale scores, whereas larger migraine headache frequency reductions predicted greater improvements in FSFI satisfaction subscale scores.

CONCLUSION

Sexual functioning did not improve with either BWL or ME despite migraine headache improvements in both conditions and weight loss after BWL. However, weight loss related to improvements in physiological components of the sexual response (i.e., arousal) and overall sexual functioning, whereas reduced headache frequency related to improved sexual satisfaction. Additional research with larger samples is needed.

The Influence of Weight-Related Self-Esteem and Symptoms of Depression on Shape and Weight Concerns and Weight-Loss 12 Months After Bariatric Surgery

INTRODUCTION

While body image can improve following bariatric surgery, a portion of patients continue to experience concerns about weight and shape regardless of weight lost. Research is needed to identify risk factors for post-surgical weight and shape concerns given that body dissatisfaction may contribute to poor outcomes.

AIMS

To evaluate whether (1) change in weight-related self-esteem and symptoms of depression from pre- to 12-month post-surgery were associated with change in weight and shape concerns independent of weight-loss; (2) improvement in weight and shape concerns, symptoms of depression, and/or weight-related self-esteem predict greater weight-loss 12 months after bariatric surgery; and (3) improvements in weight-related self-esteem, symptoms of depression, weight concerns, or shape concerns predict weight loss.

METHODS

Fifty adults approved to receive bariatric surgery self-reported body mass index and completed validated measures of weight-related self-esteem, symptoms of depression, and weight and shape concerns pre- and 12-month post-surgery.

RESULTS

Improvements were observed for weight-related self-esteem, concerns over shape and weight, symptoms of depression, and body mass index from pre- to 12-month post-surgery. Improvement in weight-related self-esteem was associated with concomitant improvements in concerns over shape and weight, independent of weight loss. Improvement in symptoms of depression was associated with improvement in concerns over weight, but not shape. Finally, exploratory analyses indicated that improvements in weight-related self-esteem, and concerns over shape and weight, but not symptoms of depression were associated with improvement in weight-loss.

CONCLUSIONS

Weight-related self-esteem may represent an overlooked and important target throughout the bariatric surgery process that could enhance surgical outcomes.

Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome

OBJECTIVE

To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function.

DESIGN

Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS.

SETTING

Two academic medical centers.

PATIENTS

Women with PCOS (N = 114) defined by the Rotterdam criteria.

INTERVENTIONS

Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks.

MAIN OUTCOME MEASURES

Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks.

RESULTS

There was no change in total FSFI or FSDS-R score in any treatment group; however, an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period. Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle and Combined treatments. There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores.

CONCLUSION(S)

Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments for PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00704912.

Effects of bariatric surgery in Chinese with obesity and type 2 diabetes mellitus: A 3-year follow-up

The incidence of obesity and type 2 diabetes mellitus is growing, and bariatric surgery was applied as a new therapy in the past few decades. However, bariatric surgery started rather late in China, and the number of surgeries and the follow-up data is limited.We assessed body weight, glucose, lipid levels, and blood pressure at baseline and 6-month, 1-year, 3-year in patients who underwent bariatric surgery. Vitamins and trace elements were investigated at 3-year after surgery. The quality of life was assessed at 3-year and compared with the control group.In total 20 patients were recruited in the study, and all the 20 patients underwent surgery and completed all follow-ups. Results showed that the body weight, body mass index, glycated hemoglobin (HbA1C), glucose, and insulin level were decreased, and islet function improved significantly in 6-month and 1-year (P < .001), and the changes were more obvious in the first 6 months. However, all the indexes rebound significantly at the 3-year (P < .05), but still better than baseline (P < .05). Weight regain was 50% after 3 years, and the mean weight regain rate was 31.45%. Besides, blood pressure and lipid levels decreased significantly compared with baseline (P < .001). At the 3-year follow-up, we found that 100% of the patients showed vitamin D deficiency, 50% calcium deficiency, 20% vitamin B12 deficiency, 20% iron deficiency, and 15% suffered from anemia. Compared with the control group, the quality of life was better in patients who underwent surgery, especially in the physical health (P < .05).The current study showed that the body weight, glucose and islet function improved significantly after bariatric surgery, and the indexes changed mainly in the first 6 months, but there seemed to be a rebound after 3 years. Furthermore, the surgery may improve the blood pressure, lipid profile, and the quality of life. However, some patients may suffer anemia, calcium deficiency, iron deficiency, vitamin D, and vitamin B12 deficiency after 3 years.

Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality

BACKGROUND

Obesity and female sexual dysfunction (FSD) are prevalent conditions, and both are associated with significant adverse effects on health and well-being.

AIM

To investigate the association between body mass index and FSD, as well as potential moderators.

METHODS

This cross-sectional study was performed by analyzing medical records of 6,688 women seeking consultation for menopause-related or sexual health-related concerns at women's health clinics at Mayo Clinic Rochester, MN, and Scottsdale, AZ, between May 1, 2015, and September 15, 2019.

OUTCOMES

Female sexual function was assessed by the Female Sexual Function Index, and sexual distress was assessed by the Female Sexual Distress Scale-Revised.

RESULTS

Being overweight or obese was associated with a lack of sexual activity. Among sexually active women, those who were overweight or obese had lower Female Sexual Function Index total scores and sexual function domain scores (indicating worse sexual function), including sexual arousal, lubrication, satisfaction, orgasm, and pain, and higher levels of sexual distress than those with normal weight. However, on multivariable analysis, these associations were found to be mediated by other factors, including age, level of education, reproductive stage, medication use, and mood disturbances, which are known to impact body weight and sexual function in women.

CLINICAL IMPLICATIONS

Overweight and obesity were associated with sexual inactivity and greater odds of having FSD, which should prompt proactive assessment of sexual function.

STRENGTHS AND LIMITATIONS

The strengths of this study include the large cohort size and assessment of sexual problems in addition to sexual distress, a key component of the definition of sexual dysfunction. This study also took into account multiple potential moderating factors. Limitations include the cross-sectional design, which precludes determination of causality as well as lack of diversity in the cohort, potentially limiting generalizability of results. In addition, sexual function was not assessed in women reporting no recent sexual activity, which may confound results.

CONCLUSION

Overweight/obesity and FSD are highly prevalent conditions, which appear to be indirectly associated. These results highlight the need to identify and address FSD in all overweight and obese women, with particular attention to potential contributing factors. Faubion SS, Fairbanks F, Kuhle CL, et al. Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality. J Sex Med 2020;17:1971-1980.

Impact of Bariatric Surgery on Female Sexual Function in Obese Patients: a Meta-Analysis

We aimed to make a meta-analysis regarding the effect of bariatric surgery on female sexual function. PubMed, EMBASE, and CENTRAL were searched from database inception through August 2019. Articles were eligible for inclusion if they examined the effect of bariatric surgery on obese women's sexual function assessed by the Female Sexual Functioning Index (FSFI) or/and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Twenty articles were included into meta-analysis. Bariatric surgery was associated with significant increase in the total FSFI score. When parameters included in the FSFI scoring system were separately evaluated, significant improvements were observed in sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and sexual pain. However, the PISQ-12 and FSFI scores in women with pelvic floor disorders (PFDs) were not significantly changed postoperatively. Bariatric surgery improves female sexual function in obese patients, but not in women with PFD.

The effect of bariatric surgery on female sexual function: a cross-sectional study

The generally negative impact of obesity on female sexuality is well-established. The possible association between bariatric surgery, weight loss, and female sexuality is much less described. The aim of the study was to analyse the possible association between bariatric surgery and female sexual function. It was a cross-sectional study of 623 patients who underwent bariatric surgery between 1999 and 2017. Patients were recruited on the basis of medical records from the Military Institute of Medicine in Warsaw. Patients were invited to complete a questionnaire which consisted of self-designed demographic questions and Female Sexual Function Index (FSFI). The total FSFI score, as well as each subdomain, improved significantly after surgery. The prevalence of low score (< 26.55) was significantly lower after the surgery in comparison to the status prior to the procedure (36.3% vs. 57.5%; p < .001). There were no differences regarding the number of sexually active patients before and after the surgery (75.3% vs. 76.1%; p < .63). There were observed statistically significant, positive correlations between BMI decrease and each subdomain of the FSFI score as well as the total score. Weight loss surgery seems to decrease the risk of sexual dysfunction presence and the advantages are associated with the total BMI loss.

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

This systematic literature review aims to point out sex-specific special features that are important in the bariatric treatment of women suffering from severe obesity. A systematic literature search was carried out according to Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. After the literature selection, the following categories were determined: sexuality and sexual function; contraception; fertility; sex hormones and polycystic ovary syndrome; menopause and osteoporosis; pregnancy and breastfeeding; pelvic floor disorders and urinary incontinence; female-specific cancer; and metabolism, outcome, and quality of life. For each category, the current status of research is illuminated and implications for bariatric treatment are determined. A summary that includes key messages is given for each subsection. An overall result of this paper is an understanding that sex-specific risks that follow or result from bariatric surgery should be considered more in aftercare. In order to increase the evidence, further research focusing on sex-specific differences in the outcome of bariatric surgery and promising treatment approaches to female-specific diseases is needed. Nevertheless, bariatric surgery shows good potential in the treatment of sex-specific aspects for severely obese women that goes far beyond mere weight loss and reduction of metabolic risks.

I Am As Normal As Everyone Now. . . : Examination of Experiences of Patients Undergoing Bariatric Surgery According to Roy's Adaptation Model: A Qualitative Study

The aim of this study is to examine experiences of patients undergoing bariatric surgery according to Roy's adaptation model (RAM). This is a qualitative study with a phenomenological design. The sample included patients undergoing bariatric surgery (N: 32). Of all the patients 84.37% were female and 59.38% were married. According to results of the content analysis, adaptive patient behavior was described by the themes "My life has changed", Everything is beautiful" "I can cope" and "Luckily, I have them" and their nonadaptive behavior was described by the themes "What if I cannot succeed", "Bad news" and "So many people, so many views". Patients having bariatric surgery experience various difficulties in adapting to their life and bodies, but the surgery leads to improvements in their body image, social life, personal relationships, and maintenance of roles. However, some patients can be afraid of postoperative complications and experience anxiety about regaining weight.

One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial

BACKGROUND

Health-related quality of life (HRQoL) peaks around 1 year after Roux-en-Y gastric bypass (RYGB) surgery, and thereafter, in many patients, slowly deteriorates.

OBJECTIVES

The aim of the present study was to test early effects (study endpoint 2 years) of a dissonance-based group intervention on HRQoL (primary outcome) and wellbeing among women who underwent RYGB: a 1-year follow-up of the WELL-GBP trial.

SETTING

Women were recruited from 5 different hospitals in Sweden pre-RYGB surgery. Participants were randomized to intervention or a control group (regular care).

METHODS

The intervention consisted of 4 group sessions, 2 to 3 months post-surgery, comprising the following 4 different topics: (1) physical activity, (2) eating behavior, (3) social relationships, and (4) intimate relationships. Participants answered questionnaires about HRQoL (SF-36, Short-Form Health Survey), social adjustment, body esteem, eating behavior, and wore an accelerometer for 7 days at pre- and 1 year post-RYGB.

RESULTS

Two hundred fifty-nine women were recruited and 203 (78%) completed 1-year follow-up measurements. Mean body mass index pre-surgery was 40.8 (standard deviation = 4.5), mean age 44.7 (standard deviation = 10.3) years, and 61 of 120 women in the intervention group received the intervention according to protocol (≥3 group sessions). We observed no difference between the intervention and the control group at 1-year post-RYGB surgery. All scales improved in both groups from pre- to 1 year post-surgery.

CONCLUSIONS

We did not observe any 1-year early effects on HRQoL from a dissonance-based group intervention among female RYGB patients. Future studies may investigate long-term effects of the intervention.

Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery

BACKGROUND

Adolescents females with severe obesity are less likely to be sexually active, but those who are sexually active engage in risky sexual behaviors.

OBJECTIVES

To examine patterns and predictors of sexual risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did or did not undergo bariatric surgery across 4 years.

SETTING

Five academic medical centers.

METHODS

Using a prospective observational controlled design, female adolescents undergoing bariatric surgery (n = 111; M_age = 16.95 ± 1.44 yr; body mass index: M_BMI = 50.99 ± 8.42; 63.1% white) and nonsurgical comparators (n = 68; M_age = 16.18 ± 1.36 yr; M_BMI = 46.47 ± 5.83; 55.9% white) completed the Sexual Activities and Attitudes Questionnaire at presurgery/baseline and 24- and 48-month follow-up, with 83 surgical females (M_BMI = 39.27 ± 10.08) and 49 nonsurgical females (M_BMI = 48.56 ± 9.84) participating at 48 months.

RESULTS

Most experienced sexual debut during the 4-year study period, with a greater increase in behaviors conferring risk for sexually transmitted infections (STIs) for surgical females (P = .03). Half (50% surgical, 44.2% nonsurgical, P = .48) reported partner condom use at last sexual intercourse. The proportion of participants who had ever contracted an STI was similar (18.7% surgical, 14.3% nonsurgical). Surgical patients were more likely to report a pregnancy (25.3% surgical, 8.2% nonsurgical, P = .02) and live birth (16 births in 15 surgical, 1 nonsurgical), with 50% of offspring in the surgical cohort born to teen mothers (age ≤19 yr).

CONCLUSIONS

Bariatric care guidelines and practices for adolescent females must emphasize the risks and consequences of teen or unintended pregnancies, sexual decision-making, dual protection, and STI prevention strategies to optimize health and well-being for the long term.

Effect of Body Weight on Sexual Function in Men and Women

PURPOSE OF REVIEW

Obesity is a growing problem worldwide. This review aims to summarize the literature on the effects of weight on sexual function in both men and women from the past 5 years.

RECENT FINDINGS

In recent population-based studies of men and women, no relationship between weight and sexual function was identified. However, in studies of special populations such as women with gestational diabetes, polycystic ovarian syndrome (PCOS), pelvic organ prolapse or urinary incontinence, weight affected some aspects of sexual function. In women, surgical, but not non-surgical, weight loss was associated with resolution of some aspects of sexual dysfunction. In contrast, in men, both surgical and non-surgical weight loss improved sexual function.

SUMMARY

Weight plays a role in sexual dysfunction in both men and women. Bariatric surgery is linked to improved sexual function in both genders. However, more work is needed to fully understand the relationship between weight and sexual function.

Health and appearance: Factors motivating the decision to seek bariatric surgery

BACKGROUND

Few studies have examined the motivating factors and people that lead patients to seek bariatric surgery. Bariatric surgery helps to improve body image, but little is known about patients' desired changes in the appearance of specific body parts.

OBJECTIVES

To identify key factors and people motivating patients' decision to seek bariatric surgery, and to assess body dissatisfaction and desire for surgery to change the appearance of specific body parts.

SETTING

U.S. university-based hospital clinic.

METHODS

Patients seeking bariatric surgery (N = 208, 78.4% women, 52.4% black, mean age = 42.0 ± 12.3 yr, mean body mass index = 46.7 ± 8.5 kg/m²) completed the Reasons for Bariatric Surgery questionnaire before their preoperative Psychosocial-behavioral evaluation. Participants rated (1-10) the importance of 15 potential reasons and 7 potential people motivating their decision to seek bariatric surgery. Participants also rated their dissatisfaction and desire for surgery to change the appearance of 11 body parts.

RESULTS

Mean scores of motivating factors were highest for Physical Health (9.9 ± .4), followed by Longevity (9.7 ± .9). Patients reported high body dissatisfaction and desire for surgery to change the appearance of several body parts, including stomach and thighs. "Myself" was the highest-rated motivating person, followed by healthcare providers, family, and someone who had undergone bariatric surgery.

CONCLUSIONS

Health is the primary reason reported by patients for seeking bariatric surgery. Patients also report a strong desire for surgery to change the appearance of their body. Patients are self-driven to pursue surgery but are also influenced by healthcare providers, family, and people who have undergone surgery. (Surg Obes Relat Dis 2019;X:XXX-XXX.) © 2019 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Changes in Sexual Function and Positions in Women With Severe Obesity After Bariatric Surgery

Introduction

Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve a variety of obesity-related conditions, including sexual dysfunction.

Aim

To analyze changes in the sexual function of women with obesity following bariatric surgery.

Methods

A prospective study was conducted between April 2015 and April 2016 involving 62 women with obesity who underwent Roux-en-Y gastric bypass. The Female Sexual Function Index (FSFI) was used to evaluate sexual function. Sexual dysfunction was defined as an FSFI score below 26.55. Patients’ clinical and demographic data were recorded. Sexual frequency of 12 different sexual positions was also evaluated.

Main Outcome Measure

Sexual dysfunction prevalence and the frequency of sexual positions before and 6 months after surgery.

Results

The prevalence of sexual dysfunction decreased from 62% before surgery to 19% 6 months after the procedure. There was a 19.2% improvement in the mean overall FSFI score (P < .01). 6 months after surgery, the mean overall FSFI score had improved in all patients, with a statistically significant change being found in all 6 domains of the questionnaire (P < .05). There was an increase in the frequency of 3 of 12 sexual positions evaluated.

Conclusion

Sexual function in women with obesity effectively improves after bariatric surgery. Favorable changes following weight loss included a significant reduction in the prevalence of sexual dysfunction and an increase in the frequency of different sexual positions during intercourse.

Oliveira CFA, dos Santos PO, Oliveira RA, et al. Changes in sexual function and positions in women with severe obesity after bariatric surgery. Sex Med 2019;7:80–85.

Obesity and Sexual Functioning

PURPOSE OF THE REVIEW

Sexual functioning is an important, yet often overlooked, aspect of quality of life for many individuals with obesity.

RECENT FINDINGS

With the growing recognition of obesity as a significant, international public health issue, a developing body of research has investigated the relationship between obesity and sexual functioning. Several studies have found that obesity is associated with impairments in sexual functioning. The mechanisms of this relationship, whether physiological, psychosocial, or a combination of the two, are yet to be fully elucidated. Other studies have suggested that weight loss, whether induced by bariatric surgery or less intensive interventions, is associated with significant and clinically meaningful change in sexual functioning and relevant reproductive hormones. This chapter reviews the research in these areas and provides recommendations for future research on these relationships.

Body mass index and health-related quality of life

OBJECTIVE

There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains.

METHODS

This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity.

RESULTS

A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7).

CONCLUSIONS

This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.