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Neff KMH, Wood GC, Stil CD. Changes in Internalized Weight Bias and Associations with Weight Loss Outcomes After Bariatric Surgery. Obes Surg 2024:10.1007/s11695-024-07487-9. [PMID: 39240451 DOI: 10.1007/s11695-024-07487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024]
Affiliation(s)
- Kirstie M Herb Neff
- Department of Population Health Sciences, Geisinger Medical Center, 100 N Academy Ave, MC 44-00, Danville, PA, 17822, USA.
- Center for Obesity and Metabolic Research, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
| | - G Craig Wood
- Center for Obesity and Metabolic Research, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Christopher D Stil
- Center for Obesity and Metabolic Research, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
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Galvain T, Bosut MP, Jamous N, Ben Mansour N. Cost-Effectiveness of Bariatric Surgery in Tunisia. Diabetes Metab Syndr Obes 2023; 16:935-945. [PMID: 37033399 PMCID: PMC10075262 DOI: 10.2147/dmso.s385110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE Obesity is a growing global issue with evidence linking it to an increase in loss of disease-free years, reduced quality of life, increased mortality, and additional economic burden. This study sought to establish the cost-effectiveness of gastric bypass and sleeve gastrectomy, compared to conventional therapy in patients with obesity, from a Tunisian healthcare payor perspective. PATIENTS AND METHODS A Markov model compared lifetime costs and outcomes of bariatric surgery with conventional treatment among patients with body mass index (BMI) ≥ 40 kg/m2, BMI ≥ 35 kg/m2 with obesity-related co-morbidities (Group 1), or BMI ≥ 35 kg/m2 with type 2 diabetes mellitus (T2DM) (Group 2). Inputs were sourced from the Tunisian Health Examination Survey, local clinician data and literature sources. Health states were associated with different cost and utility decrements. Changes in body mass index, systolic blood pressure, lipid ratio and diabetes remission rates were modelled on a yearly basis. The incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs) and net monetary benefit (NMB) were key outcomes. Sensitivity and scenario analyses were performed to test the model's robustness. RESULTS The model showed that the benefits of bariatric surgery were favorable compared to conventional treatment, with an ICER of 1844 TND/QALY in Group 1 patients and 2413 TND/QALY in Group 2 patients. Bariatric surgery resulted in a QALY gain of 3.26 per patient in Group 1 and a gain of 1.77 per patient in Group 2. At a willingness to pay threshold of 31,379 TND/QALY, the incremental NMB was 96,251 TND and 51,123 TND for Group 1 and Group 2, respectively. CONCLUSION From the Tunisian healthcare payor perspective, bariatric surgery is cost-effective for patients with obesity and those with T2DM and obesity-related comorbidities. These findings may have impact on future decision-making on funding and reimbursement of bariatric surgery in Tunisia.
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Affiliation(s)
- Thibaut Galvain
- Health Economics and Market Access, Johnson & Johnson Medical NV, Diegem, Belgium
- Correspondence: Thibaut Galvain, Health Economics and Market Access, Johnson & Johnson Medical NV, Leonardo da Vincilaan 15, Diegem, Belgium, Tel +33648649800, Email
| | - Melek Pinar Bosut
- Health Economics and Market Access, Johnson & Johnson Medical NV, Diegem, Belgium
| | - Nadine Jamous
- Health Economics and Market Access, Johnson & Johnson Medical NV, Diegem, Belgium
| | - Nadia Ben Mansour
- National Institute of Health, Tunis, Tunisia
- Faculty of Medicine, Université de Tunis El Manar, Tunis, Tunisia
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Bidstrup H, Brennan L, Hindle A, Kaufmann L, de la Piedad Garcia X. Internalised Weight Stigma Mediates Relationships Between Perceived Weight Stigma and Psychosocial Correlates in Individuals Seeking Bariatric Surgery: a Cross-sectional Study. Obes Surg 2022; 32:3675-3686. [PMID: 36094627 PMCID: PMC9613718 DOI: 10.1007/s11695-022-06245-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Research suggests that internalised weight stigma may explain the relationship between perceived weight stigma and adverse psychological correlates (e.g. depression, disordered eating, body image disturbances). However, few studies have assessed this mechanism in individuals seeking bariatric surgery, even though depression and disordered eating are more common in this group than the general population. MATERIALS AND METHODS We used data from a cross-sectional study with individuals seeking bariatric surgery (n = 217; 73.6% female) from Melbourne, Australia. Participants (Mage = 44.1 years, SD = 11.9; MBMI = 43.1, SD = 7.9) completed a battery of self-report measures on weight stigma and biopsychosocial variables, prior to their procedures. Bias-corrected bootstrapped mediations were used to test the mediating role of internalised weight stigma. Significance thresholds were statistically corrected to reduce the risk of Type I error due to the large number of mediation tests conducted. RESULTS Controlling for BMI, internalised weight stigma mediated the relationship between perceived weight stigma and psychological quality of life, symptoms of depression and anxiety, stress, adverse coping behaviours, self-esteem, exercise avoidance, some disordered eating measures and body image subscales, but not physical quality of life or pain. CONCLUSION Although the findings are cross-sectional, they are mostly consistent with previous research in other cohorts and provide partial support for theoretical models of weight stigma. Interventions addressing internalised weight stigma may be a useful tool for clinicians to reduce the negative correlates associated with weight stigma.
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Affiliation(s)
- Hugh Bidstrup
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia
| | - Annemarie Hindle
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
- School of Psychology and Public Health, La Trobe University, Albury-Wodonga, 3690, Australia
- Centre for Eating, Weight, and Body Image, Suite 215, 100 Victoria Parade, East Melbourne, VIC, 3002, Australia
| | - Leah Kaufmann
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Xochitl de la Piedad Garcia
- School of Behavioural and Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia.
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Hatami M, Pazouki A, Kabir A. Excessive weight loss after bariatric surgery: a prediction model retrospective cohort study. Updates Surg 2022; 74:1399-1411. [PMID: 35779229 DOI: 10.1007/s13304-022-01319-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Bariatric surgery has been recognized as the most effective long-term treatment for morbid obesity. Despite the considerable positive results, adverse consequence can develop. Excessive Weight Loss (EXWL), a rare consequence of bariatric surgery, can lead to a broad adverse consequence. The aim of this study was determining of prevalence and the predicting model of EXWL in patient underwent bariatric surgery until 24 months after surgery. Data have been extracted from the National Obesity Surgery Database in obesity clinic of Iran University of Medical Sciences. The subjects of this retrospective cohort study were morbid obese individuals who underwent three various types of bariatric surgery [One Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), or Sleeve Gastrectomy (SG)] in period of 24 months ago. EXWL has been defined as reaching to less than or equal to BMI 18.5 at any time until 24 months after surgery. SPSS was used in data analysis. Among 4214 subjects of this study, most excess weight loss after surgery has taken place in 18 months after surgery. 11.4% (n = 495) of patients experienced EXWL with highest percentage among OAGB patients (15.1%) at time of 24 months after surgery. The females (20.4% vs.9.9%) and younger persons (35.45 ± 10.25 vs. 39.06 ± 10.76) were more susceptible to EXWL. Patients with EXWL had significantly lower BMI (body mass index) (41.11 ± 4.51 vs. 46.73 ± 6.26) (Kg/m2), and were less probable to had emotional eating. Visceral fat level, fat percentage, and BMI were the best predictor of EXWL (P value for all < 0.05). So that per level increase in visceral fat, decreases the probability of EXWL as 47% and 61% in SG and OAGB. Moreover, each unit lower BMI leads to 25% higher susceptibility to experience EXWL. Surgery should be adjusted in younger females with a lower BMI and healthy metabolic status who are more prone to EXWL. In such a way that minimize weight loss speed/value. It may be possible by selection of other surgery procedures, rather than OAGB, tighter follow-ups, and consultations of patients after surgery is emphasized for more EXWL vulnerable patients.
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Affiliation(s)
- Mahsa Hatami
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of International Federation for Surgery of Obesity, Hazrat E Rasool Hospital, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.
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Yokoyama H, Nozaki T, Nishihara T, Sawamoto R, Komaki G, Sudo N. Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy. Front Psychiatry 2022; 13:1025946. [PMID: 36339837 PMCID: PMC9634420 DOI: 10.3389/fpsyt.2022.1025946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss. OBJECTIVE The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss. METHODS One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m2, age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires. RESULTS Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID. CONCLUSION Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID. CLINICAL TRIAL REGISTRATION [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Nozaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Tomoe Nishihara
- Department of Psychosomatic Medicine, National Hospital Organization Fukuoka Higashi Medical Center, Koga, Japan
| | - Ryoko Sawamoto
- Department of Psychosomatic Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Gen Komaki
- Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Susmallian S, Nikiforova I, Azoulai S, Barnea R. Outcomes of bariatric surgery in patients with depression disorders. PLoS One 2019; 14:e0221576. [PMID: 31454382 PMCID: PMC6711535 DOI: 10.1371/journal.pone.0221576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/10/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the impact of sleeve gastrectomy in patients suffering from depression compared with those who are not in a depressive state. INTRODUCTION Obesity is considered a global epidemic. Often patients with obesity suffer from depressive state. Depressive disorders may be both a cause and a consequence of obesity. MATERIAL AND METHODS The study includes 300 consecutives patients that underwent laparoscopic sleeve gastrectomy. Out of the 300 patients, 253 (84.33%) of them completed the follow up for three years. RESULTS Out of the 300-patients, with the average age of 41.65±11.05 years old, the ratio of males to females was 1:2. The average baseline BMI was 42.02 kg/m2. A total of 105 (35.33%) of the patients suffer from depression, which was more common in male (43%) than in female (31.5%), with statistically significant difference (p = .05). Comparing the weight loss after surgery in both groups, the mean weight loss in the depression-group was 12.0 ΔBMI and in the non-depression group was 13.03 ΔBMI, (p< .001). After three years, 94 (88.68%) patients of the depression group responded as they were optimistic and satisfied with the results of the operation, with positive changes in their lives, 8 (7.55%) did not experience change and 4 (3.77%) expressed to have worsened their depressive state. CONCLUSION Laparoscopic sleeve gastrectomy is successful and leads to weight loss even in subjects who are affected by depression syndrome.
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Affiliation(s)
- Sergio Susmallian
- Department of General Surgery, Assuta Medical Center, Tel-Aviv, Israel
| | - Ilana Nikiforova
- Department of Nutrition, Assuta Medical Center, Tel-Aviv, Israel
| | - Shir Azoulai
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel
| | - Royi Barnea
- Assuta Health Services Research Institute, Assuta Medical Center, Tel-Aviv, Israel
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