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Heitmann BL, Køster-Rasmussen R, Meyer LB, Larsen SC, Thorsteinsdottir F, Sandholdt CT, Bojsen-Møller KN, Overbeck G, Waldorff FB, Kousgaard MB, Specht IO, Dirksen C. Debating Weight Loss vs. Weight Neutral Strategies for Improvements of Health. Curr Obes Rep 2024; 13:832-842. [PMID: 39289256 DOI: 10.1007/s13679-024-00587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE OF REVIEW Despite decades of development and testing of weight-loss interventions, the adult populations worldwide have witnessed a continuous rise in body weight. There is an ongoing debate about how to move forward. Some argue that this rise calls for more intensive and possibly life-long treatments, including the new effective GLP1 weight loss medications, while others have called for a fundamental shift away from weight and on to a broader understanding of health. The two strategies are represented as a weight-centric health strategy and a weight neutral health strategy. This paper debates the benefits and potential harms related to the use of these two strategies. RECENT FINDINGS While major weight loss may have substantial health benefits, many individuals will need intensive treatment including weight loss medication to achieve it, as generally few are able to sustain a lifestyle induced weight loss in the long term. Both the weight loss and the weight-neutral health strategies have advantages and limitations emphasizing the need for further research comparing the two strategies. Currently, not everyone is offered, can afford, will tolerate or even desire treatment with weight loss medication, and weight neutral health strategies may be a desirable alternative intervention offering a more holistic approach to health and addressing psychological and social issues including the burden of experienced and internalized weight stigma. However, this method still needs to be tested for effectiveness with regards to both physical and long-term psychological benefits.
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Affiliation(s)
- Berit L Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of the Copenhagen University Hospital, Frederiksberg, 2000, Denmark.
- The Boden Initiative, The Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark.
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Lene B Meyer
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Sofus C Larsen
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of the Copenhagen University Hospital, Frederiksberg, 2000, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Fanney Thorsteinsdottir
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of the Copenhagen University Hospital, Frederiksberg, 2000, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Catharina T Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Kirstine N Bojsen-Møller
- Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Part of the Copenhagen University Hospital, Hvidovre, 2650, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Frans B Waldorff
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Marius B Kousgaard
- The Boden Initiative, The Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Ina O Specht
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of the Copenhagen University Hospital, Frederiksberg, 2000, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, 1353, Denmark
| | - Carsten Dirksen
- Department of Respiratory Diseases and Endocrinology, Amager and Hvidovre Hospital, Part of the Copenhagen University Hospital, Hvidovre, 2650, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nicolau J, Sanchís P, Ayala L, Pascual S, Tamayo Pozo MI, Cifuentes A, Masmiquel L. Differences in the cluster of depressive symptomatology among bariatric surgery candidates, long-term bariatric surgery patients, and subjects with a major depressive disorder without obesity. NUTR HOSP 2024. [PMID: 39446122 DOI: 10.20960/nh.05196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
INTRODUCTION depression is more frequent among people with obesity (PwO) compared to the general population. Depression seems to improve after bariatric surgery (BS) at short term, but data are inconclusive at long term. Besides, it is not known whether depressive symptoms among PwO are similar to those people with a major depression without obesity. OBJECTIVES we aimed to study whether there are differences regarding depressive symptomatology among subjects seeking BS or patients after BS in the long-term compared with subjects with MDD. METHODS the Beck Depression Inventory (BDI) was administered to three groups: 52 patients seeking BS (OB), 135 patients with a BS with a minimum follow-up of 18 months (BS) and 45 subjects with a MDD (MDD). RESULTS the MDD obtained the higher score with the BDI whether compared to the OB (18.9 ± 12.7 vs 14.2 ± 6.9; p = 0.01) or the BS (18.9 ± 12.7 vs 8.1 ± 8; p < 0.0001). Also, BS presented a lower BDI than the OB (8.1 ± 8 vs 14.2 ± 6.9; p < 0.0001). The MDD scored higher in the psychological domain than patients in the OB (9.9 ± 7.5 vs 5.7 ± 5.1; p < 0.0001) as well as in the BS (9.9 ± 7.5 vs 3.1 ± 3; p < 0.0001). There was a negative correlation between a greater score in the somatic domain and %EPP (p = 0.04). CONCLUSIONS at long term, depressive symptomatology among subjects with a BS remained lower compared to PwO seeking BS.PwO presented a different cluster of depression compared to individuals with a MDD. BS reduces the somatic depressive cluster at long term, although its presence is associated to a lesser weight loss.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | - Pilar Sanchís
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | - Luisa Ayala
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | | | | | | | - Lluís Masmiquel
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
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Thomas TA, Tilk K, Klassen K, Pommnitz M, Wunder R, Mall JW, Köhler H, de Zwaan M, Meyer G, Hüttl TP, Müller A. Self-Harm Before and Six Months After Obesity Surgery. Obes Surg 2024; 34:3579-3591. [PMID: 39134834 PMCID: PMC11481644 DOI: 10.1007/s11695-024-07439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS. MATERIALS AND METHODS Pre-surgery patients (N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations. RESULTS Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation. CONCLUSION No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.
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Affiliation(s)
- Tobias A Thomas
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Katja Tilk
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Katharina Klassen
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Melanie Pommnitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Ruth Wunder
- Department of General, Visceral, and Bariatric Surgery, DRK Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hanover, Germany
| | - Julian W Mall
- Department of General, Visceral, and Bariatric Surgery, KRH Nordstadt, Haltenhoffstr. 41, 30167, Hanover, Germany
| | - Hinrich Köhler
- Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124, Brunswick, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Günther Meyer
- Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Waldstraße 7, 82166, Gräfelfing, Germany
| | - Thomas P Hüttl
- Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Denninger Str. 44, 81679, Munich, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
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Konttinen H, Sjöholm K, Carlsson LMS, Peltonen M, Svensson PA. Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment. Int J Obes (Lond) 2024; 48:1447-1456. [PMID: 38902388 PMCID: PMC11420074 DOI: 10.1038/s41366-024-01572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Evidence on the long-term (≥10 years) development of health-related quality of life (HRQoL) following bariatric surgery is still limited and mainly based on small-scale studies. This study aimed to investigate (1) 15-year changes in mental, physical, social, and obesity-related HRQoL after bariatric surgery and non-surgical obesity treatment; and (2) whether sociodemographic factors and pre-operative health status are associated with 15-year HRQoL changes in the surgery group. METHODS Participants were from the non-randomized, prospective, controlled Swedish Obese Subjects study. The surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual obesity care. Recruitment took place in 1987-2001 and measurements (including six HRQoL scales) were administered before treatment and after 0.5, 1, 2, 3, 4, 6, 8, 10 and 15 years. Multilevel mixed-effect regression models using all observations for estimation were conducted. RESULTS Surgical patients experienced greater 15-year improvements in perceived health and overall mood, and greater reductions in depression, obesity-related problems, and social interaction limitations than controls (all p < 0.001, adjusted for baseline differences). Effect size (ES) was classified as large only for obesity-related problems (ES = 0.82). At the 15-year follow-up, surgical patients reported better perceived health (p < 0.001) and less obesity-related problems (p = 0.020) than controls. In the surgery group, patients with baseline diabetes had smaller 15-year reductions in social interaction limitations (p < 0.001) and depression (p = 0.049) compared to those without baseline diabetes. Although surgical patients with a history of psychiatric disorder reported lower HRQoL than those without such history over the 15-year follow-up, there were no significant differences in the long-term improvements between the two groups (p = 0.211-0.902). CONCLUSIONS Over 15 years, surgical patients experienced more positive development of HRQoL compared to those receiving usual care. This difference was large for obesity-related problems, but otherwise the differences were small. Patients with pre-operative diabetes might be at increased risk for smaller long-term HRQoL improvements.
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Affiliation(s)
- Hanna Konttinen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Kajsa Sjöholm
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena M S Carlsson
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Per-Arne Svensson
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Strumila R, Lengvenyte A, Guillaume S, Nobile B, Olie E, Courtet P. GLP-1 agonists and risk of suicidal thoughts and behaviours: Confound by indication once again? A narrative review. Eur Neuropsychopharmacol 2024; 87:29-34. [PMID: 39068741 DOI: 10.1016/j.euroneuro.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024]
Abstract
Glucagon-like peptide-1 (GLP-1) agonists have been successfully used in clinical practice for the treatment of diabetes and obesity, offering significant clinical benefits. However, concerns regarding their potential link to psychiatric side effects, like suicidal thoughts and behaviours (STB) have emerged. This narrative review investigates the complex interplay between GLP-1 agonists and STB, focusing on the biological stress induced by rapid weight loss, psychological and social consequences, similar mechanism with addiction, and the evaluative lens of the Bradford Hill criteria on causality. While GLP-1 agonists can contribute to substantial health improvements, they also introduce biological and psychological stressors. Disruptions in homeostasis from quick weight reduction can elevate cortisol and norepinephrine levels, heightening the risk for, or exacerbation of STB. Psychological factors, including unfulfilled expectations and identity changes after significant weight loss, compound these risks. Utilizing the Bradford Hill criteria reveals insufficient evidence for a direct causal link between GLP-1 agonists and STB. Yet, the indirect effects related to the metabolic and psychological disturbances associated with rapid weight loss call for a cautious approach. Used carefully in targeted populations GLP-1 agonists may even emerge as protective agents against STB. Therefore, it is crucial to monitor patients during the treatment and screen for preexisting mental health conditions. If detected, appropriate clinical management should be applied. Future studies should aim at optimizing dosing schedules to mitigate the adverse effects of rapid weight loss and further investigate GLP-1 agonists in possible STB prevention.
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Affiliation(s)
- Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Psychiatric Clinic, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Benedicte Nobile
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Emilie Olie
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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Ueda P, Söderling J, Wintzell V, Svanström H, Pazzagli L, Eliasson B, Melbye M, Hviid A, Pasternak B. GLP-1 Receptor Agonist Use and Risk of Suicide Death. JAMA Intern Med 2024:2823083. [PMID: 39226030 PMCID: PMC11372654 DOI: 10.1001/jamainternmed.2024.4369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Importance Concerns have been raised regarding a link between use of glucagon-like peptide-1 (GLP-1) receptor agonists and increased risk of suicidality and self-harm. Objective To assess the association between use of GLP-1 receptor agonists and the risk of suicide death in routine clinical practice. Design, Setting, and Participants This active-comparator new-user cohort study used nationwide register data from Sweden and Denmark from 2013 to 2021. Adults 18 to 84 years old who initiated treatment with GLP-1 receptor agonists or the comparator sodium-glucose cotransporter-2 (SGLT2) inhibitors were included. Data were analyzed from March to June 2024. Exposure Initiation of treatment with a GLP-1 receptor agonist or SGLT2 inhibitor. Main Outcomes and Measures The primary outcome was suicide death recorded in the cause of death registers. Secondary outcomes were the composite of suicide death and nonfatal self-harm and the composite of incident depression and anxiety-related disorders. Using propensity score weighting, hazard ratios (HRs) with 95% CIs were calculated separately in the 2 countries and pooled in a meta-analysis. Results In total, 124 517 adults initiated a GLP-1 receptor agonist and 174 036 initiated an SGLT2 inhibitor; among GLP-1 receptor agonist users, the mean (SD) age was 60 (13) years, and 45% were women. During a mean (SD) follow-up of 2.5 (1.7) years, 77 suicide deaths occurred among users of GLP-1 receptor agonists and 71 suicide deaths occurred among users of SGLT2 inhibitors: weighted incidences were 0.23 vs 0.18 events per 1000 person-years (HR, 1.25; 95% CI, 0.83-1.88), with an absolute difference of 0.05 (95% CI, -0.03 to 0.16) events per 1000 person-years. The HR was 0.83 (95% CI, 0.70-0.97) for suicide death and nonfatal self-harm, and the HR was 1.01 (95% CI, 0.97-1.06) for incident depression and anxiety-related disorders. Conclusions and Relevance This cohort study, including mostly patients with type 2 diabetes, does not show an association between use of GLP-1 receptor agonists and an increased risk of suicide death, self-harm, or incident depression and anxiety-related disorders. Suicide death among GLP-1 receptor agonist users was rare, and the upper limit of the confidence interval was compatible with an absolute risk increase of no more than 0.16 events per 1000 person-years.
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Affiliation(s)
- Peter Ueda
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Wintzell
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Svanström
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Laura Pazzagli
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn Eliasson
- The Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mads Melbye
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Danish Cancer Institute, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Björn Pasternak
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Yanovski SZ, Yanovski JA. Approach to Obesity Treatment in Primary Care: A Review. JAMA Intern Med 2024; 184:818-829. [PMID: 38466272 DOI: 10.1001/jamainternmed.2023.8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Importance More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed. Observations Lifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences. Conclusions and Relevance Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.
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Affiliation(s)
- Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Sarwer DB, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, LaGrotte C, Williams N, Soans R, Tewksbury C, Wu J, Tajeu G, Allison KC. Psychopathology, disordered eating, and impulsivity as predictors of weight loss 24 months after metabolic and bariatric surgery. Surg Obes Relat Dis 2024; 20:634-642. [PMID: 38480031 PMCID: PMC11193608 DOI: 10.1016/j.soard.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/21/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The relationship between theoretically relevant psychosocial and behavioral variables and outcomes of metabolic and bariatric surgery remains unclear. Some studies have found that the presence of psychopathology, disordered eating, and impulsivity, either before surgery or during the early postoperative period, is associated with suboptimal postoperative weight loss. Other studies have not found these relationships. OBJECTIVE Examine the relationship between psychopathology, disordered eating, impulsivity, and weight loss 24 months postoperatively. SETTING Two large, urban university health systems. METHODS Participant characteristics were collected using validated interviews, patient-reported outcome measures, and computerized assessment methods. Linear mixed effect models were used to test the association of the variables of interest on percent weight loss (%WL). RESULTS Three hundred participants were enrolled at baseline; weight data at 24 months were available for 227 participants; between 181 and 53 individuals completed other outcome measures. The mean %WL was 23.3 ± 9.9% at 24 months. Patients who underwent Roux-en-Y gastric bypass lost more weight than those who underwent sleeve gastrectomy. The presence of subjective binge episodes at baseline was related to a greater %WL at 24 months; there were no other baseline predictors. The presence of eating disorder diagnoses and disordered eating symptoms after surgery were associated with smaller weight losses over 24 months. Current and lifetime psychopathology and impulsivity were unrelated to %WL at 24 months. CONCLUSION Disordered eating after bariatric surgery was associated with a smaller %WL at postoperative year 2. Additional monitoring of these symptoms in the early postoperative period is recommended. Psychotherapeutic and/or dietary interventions may promote more optimal weight loss outcomes.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, New York
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Courtney McCuen-Wurst
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin LaGrotte
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Noel Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rohit Soans
- Department of Surgery, Lewis Katz School of Medicine, Temple University
| | - Colleen Tewksbury
- Department of Surgery, Lewis Katz School of Medicine, Temple University
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Gabriel Tajeu
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Kelly C Allison
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Keyte R, Mantzios M, Hussain M, Tahrani AA, Abbott S, Strachan R, Singhal R, Egan H. 'Surgery is my only hope': A qualitative study exploring perceptions of living with obesity and the prospect of having bariatric surgery. Clin Obes 2024; 14:e12643. [PMID: 38302857 DOI: 10.1111/cob.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
The health benefits of bariatric surgery are well documented; however, the occurrence of weight-regain after surgery, along with the development of mental health difficulties poses a question of how contemporary psychology could assist to prepare people living with obesity prior to undergoing bariatric surgery. This research explored individuals' (in the immediate pre-operative and post-operative population) attitudes, beliefs and experiences towards obesity and their journey to bariatric surgery. Seventeen adult participants (males n = 4; age range: 26-64 years) were recruited and participated in a semi-structured interview. Twelve individuals participated prior to undergoing bariatric surgery. Five individuals participated in the early post-operative period (<3 months post-surgery). People living with obesity displayed high optimism for positive outcomes, with participants hoping that bariatric surgery would be different to previous attempts at weight regulation, with there being a clear shift in the locus of control for weight management from self to healthcare professionals. Whilst this is adaptive, there was the presence of seemingly unrealistic optimism, with many pre-surgery participants not relaying the realistic possibility of post-surgery weight-regain. Despite the optimism individuals feel about bariatric surgery, participants felt that the psychological factors influencing eating behaviours are not being addressed by healthcare. These findings suggest that mindfulness, mindful eating, and self-compassion approaches should be incorporated into clinical practice to support weight regulation and adaption to physiological changes after bariatric surgery.
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Affiliation(s)
- Rebecca Keyte
- Department of Psychology, School of Social Sciences, Birmingham City University, Birmingham, UK
| | - Michail Mantzios
- Department of Psychology, School of Social Sciences, Birmingham City University, Birmingham, UK
| | - Misba Hussain
- Department of Psychology, School of Social Sciences, Birmingham City University, Birmingham, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Sally Abbott
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rachel Strachan
- Black Country Healthcare NHS Foundation Trust, West Bromwich, UK
| | | | - Helen Egan
- Department of Psychology, School of Social Sciences, Birmingham City University, Birmingham, UK
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Haugh S, Cromwell P, Kirrane R, Heneghan H. Impact of antidepressant use on post-operative weight loss following bariatric surgery. Ir J Med Sci 2024; 193:903-908. [PMID: 37728725 DOI: 10.1007/s11845-023-03482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Antidepressant medication can be associated with weight gain. Consideration should be given to the specific agent prescribed to optimize bariatric surgery outcomes. AIM The aim of this study is to investigate if patients treated with antidepressants stratified by risk of weight gain are associated with less weight loss at 1 year postbariatric surgery. METHOD A single centre, retrospective analysis of all patients who underwent bariatric surgery between July 2018 and 2021 within St Vincent's University Hospital group. The exposure was antidepressant use, stratified for risk of weight gain, and the control group was patients who underwent surgery but no antidepressant use. The primary outcome was % TWL (total weight loss) at 6 weeks, 6 months and 12 months post-surgery. Multivariate linear regression analysis was used to estimate the impact of antidepressant treatment on post-surgery weight loss at 12 months using the variables of age, gender and pre-operative BMI. RESULTS Of the total cohort (n = 315), 70 patients (22.2%) were taking antidepressants. At 12 months, post-operatively patients taking medium risk for weight gain antidepressants had significantly less mean %TWL compared to those not taking antidepressants (p = 0.015). Overall, taking any antidepressant was not found to be a significant predictor of %TWL at 12 months after surgery (β = - 2.590, p = 0.0836). CONCLUSION Many patients undergoing bariatric surgery have concurrent psychiatric conditions. Given the complex relationship between bariatric surgery and mental health, psychotropic medications may be best managed by a specialist in the field such as a bariatric psychiatrist in order to optimize patient outcomes.
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Affiliation(s)
- Sinead Haugh
- Department of Psychiatry, Blanchardstown Mental Health Services, Connolly Hospital, Blanchardstown, Dublin, West, Ireland.
| | - Paul Cromwell
- Department of Surgery, National Bariatric Centre, St. Vincents University Hospital, Dublin, Ireland
| | - Richelle Kirrane
- Department of Psychiatry, Blanchardstown Mental Health Services, Connolly Hospital, Blanchardstown, Dublin, West, Ireland
| | - Helen Heneghan
- Department of Surgery, National Bariatric Centre, St. Vincents University Hospital, Dublin, Ireland
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Lau D, Gamble JM. Suicidality among users of glucagon-like peptide-1 receptor agonists: An emerging signal? Diabetes Obes Metab 2024; 26:1150-1156. [PMID: 38229461 DOI: 10.1111/dom.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Darren Lau
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John-Michael Gamble
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Ontario, Canada
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Kozela M, Stepaniak U, Koziara K, Karpińska I, Major P, Matyja M. No association between history of psychiatric treatment and postoperative weight reduction after bariatric surgery. Eat Weight Disord 2024; 29:19. [PMID: 38489068 PMCID: PMC10942884 DOI: 10.1007/s40519-024-01645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE The objective of the study was to assess whether the history of psychiatric treatment was associated with (1) body weight and BMI on admission for bariatric surgery, (2) weight loss > 5 kg prior to bariatric surgery, and (3) postoperative body weight reduction. METHODS Data from medical records of all consecutive patients admitted for surgical treatment of obesity in the 2nd Department of General Surgery Jagiellonian University Medical College were obtained. There were 1452 records of patients who underwent bariatric surgery between 2009 and 2021 included in the study. RESULTS History of psychiatric treatment was found in 177 (12%) of the sample and was inversely associated with body weight and BMI on admission for surgery in women. Men with history of psychiatric treatment were 54% less likely to lose > 5 kg before the surgery (OR = 0.46 95% CI = 0.24-0.88). Both in men and women %TWL did not differ significantly by history of psychiatric treatment (Me: 40.7 vs. 45.9; p = 0.130 and Me: 27.0 vs. 23.9; p = 0.383, respectively). After adjustment for covariates no association was found between history of psychiatric treatment and body weight reduction one year after surgery. CONCLUSION Although men with preoperative history of psychiatric treatment had lower odds of losing weight before the surgery, psychiatric treatment did not differentiate the effectiveness of bariatric treatment in 1 year of observation. Bariatric surgery appears to be an effective obesity care for people treated for mental disorders. LEVEL OF EVIDENCE III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 8 Skawinska St., 31-066, Krakow, Poland.
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 8 Skawinska St., 31-066, Krakow, Poland
| | - Karolina Koziara
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 8 Skawinska St., 31-066, Krakow, Poland
| | - Izabela Karpińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Matyja
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 8 Skawinska St., 31-066, Krakow, Poland
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Bhattacharya K, Bhattacharya N, Yagnik VD, Garg P. Suicide and Depression After Bariatric Surgery: A Critical Analysis. Indian J Surg 2024. [DOI: 10.1007/s12262-024-04020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/03/2024] [Indexed: 07/26/2024] Open
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Wang W, Volkow ND, Berger NA, Davis PB, Kaelber DC, Xu R. Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med 2024; 30:168-176. [PMID: 38182782 PMCID: PMC11034947 DOI: 10.1038/s41591-023-02672-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
Concerns over reports of suicidal ideation associated with semaglutide treatment, a glucagon-like peptide 1 receptor (GLP1R) agonist medication for type 2 diabetes (T2DM) and obesity, has led to investigations by European regulatory agencies. In this retrospective cohort study of electronic health records from the TriNetX Analytics Network, we aimed to assess the associations of semaglutide with suicidal ideation compared to non-GLP1R agonist anti-obesity or anti-diabetes medications. The hazard ratios (HRs) and 95% confidence intervals (CIs) of incident and recurrent suicidal ideation were calculated for the 6-month follow-up by comparing propensity score-matched patient groups. The study population included 240,618 patients with overweight or obesity who were prescribed semaglutide or non-GLP1R agonist anti-obesity medications, with the findings replicated in 1,589,855 patients with T2DM. In patients with overweight or obesity (mean age 50.1 years, 72.6% female), semaglutide compared with non-GLP1R agonist anti-obesity medications was associated with lower risk for incident (HR = 0.27, 95% CI = 0.200.32-0.600.36) and recurrent (HR = 0.44, 95% CI = 0.32-0.60) suicidal ideation, consistent across sex, age and ethnicity stratification. Similar findings were replicated in patients with T2DM (mean age 57.5 years, 49.2% female). Our findings do not support higher risks of suicidal ideation with semaglutide compared with non-GLP1R agonist anti-obesity or anti-diabetes medications.
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Affiliation(s)
- William Wang
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Nathan A Berger
- Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pamela B Davis
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| | - Rong Xu
- Center for Artificial Intelligence in Drug Discovery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Miller-Matero LR, Yeh HH, Ahmedani BK, Rossom RC, Harry ML, Daida YG, Coleman KJ. Suicide attempts after bariatric surgery: comparison to a nonsurgical cohort of individuals with severe obesity. Surg Obes Relat Dis 2023; 19:1458-1466. [PMID: 37758538 PMCID: PMC10843496 DOI: 10.1016/j.soard.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The rate of suicide is higher among individuals following bariatric surgery compared with the general population; however, it is not clear whether risk is associated with bariatric surgery beyond having severe obesity. OBJECTIVE To compare the risk of a suicide attempt among those who had bariatric surgery versus a nonsurgical cohort with severe obesity. SETTING Aggregate count data were collected from 5 healthcare systems. METHODS Individuals were identified in the surgical cohort if they underwent bariatric surgery between 2009 and 2017 (n = 35,522) and then were compared with a cohort of individuals with severe obesity who never had bariatric surgery (n = 691,752). Suicide attempts were identified after study enrollment date using International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnosis codes from 2009 to 2021. RESULTS The relative risk of a suicide attempt was 64% higher in the cohort with bariatric surgery than that of the nonsurgical cohort (2.2% versus 1.3%; relative risk = 1.64; 95% CI, 1.53-1.76). Within the cohort with bariatric surgery, suicide attempts were more common among the 18- to 39-year age group (P < .001), women (P = .002), Hawaiian-Pacific Islanders (P < .001), those with Medicaid insurance (P < .001), and those with a documented mental health condition at baseline (in the previous 2 years; P < .001). CONCLUSIONS The relative risk of suicide attempts was higher among those who underwent bariatric surgery compared with a nonsurgical cohort, though absolute risk remained low. Providers should be aware of this increased risk. Screening for suicide risk after bariatric surgery may be useful to identify high-risk individuals.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Brian K Ahmedani
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Karen J Coleman
- Kaiser Permanente Southern California, Irvine, California; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Komorniak N, Kaczmarczyk M, Łoniewski I, Martynova-Van Kley A, Nalian A, Wroński M, Kaseja K, Kowalewski B, Folwarski M, Stachowska E. Analysis of the Efficacy of Diet and Short-Term Probiotic Intervention on Depressive Symptoms in Patients after Bariatric Surgery: A Randomized Double-Blind Placebo Controlled Pilot Study. Nutrients 2023; 15:4905. [PMID: 38068763 PMCID: PMC10707788 DOI: 10.3390/nu15234905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
(1) Background: studies have shown that some patients experience mental deterioration after bariatric surgery. (2) Methods: We examined whether the use of probiotics and improved eating habits can improve the mental health of people who suffered from mood disorders after bariatric surgery. We also analyzed patients' mental states, eating habits and microbiota. (3) Results: Depressive symptoms were observed in 45% of 200 bariatric patients. After 5 weeks, we noted an improvement in patients' mental functioning (reduction in BDI and HRSD), but it was not related to the probiotic used. The consumption of vegetables and whole grain cereals increased (DQI-I adequacy), the consumption of simple sugars and SFA decreased (moderation DQI-I), and the consumption of monounsaturated fatty acids increased it. In the feces of patients after RYGB, there was a significantly higher abundance of two members of the Muribaculaceae family, namely Veillonella and Roseburia, while those after SG had more Christensenellaceae R-7 group, Subdoligranulum, Oscillibacter, and UCG-005. (4) Conclusions: the noted differences in the composition of the gut microbiota (RYGB vs. SG) may be one of the determinants of the proper functioning of the gut-brain microbiota axis, although there is currently a need for further research into this topic using a larger group of patients and different probiotic doses.
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Affiliation(s)
- Natalia Komorniak
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Mariusz Kaczmarczyk
- Sanprobi sp. z o.o. sp. k., Kurza Stopka 5/C, 70-535 Szczecin, Poland; (M.K.); (I.Ł.)
| | - Igor Łoniewski
- Sanprobi sp. z o.o. sp. k., Kurza Stopka 5/C, 70-535 Szczecin, Poland; (M.K.); (I.Ł.)
- Department of Biochemical Science, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | | | - Armen Nalian
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX 75962, USA; (A.M.-V.K.); (A.N.)
| | - Michał Wroński
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
| | - Krzysztof Kaseja
- Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Bartosz Kowalewski
- Independent Provincial Public Hospital Complex in Szczecin-Zdunowo, 70-891 Szczecin, Poland;
| | - Marcin Folwarski
- Division of Clinical Nutrition and Dietetics, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
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17
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Law S, Dong S, Zhou F, Zheng D, Wang C, Dong Z. Bariatric surgery and mental health outcomes: an umbrella review. Front Endocrinol (Lausanne) 2023; 14:1283621. [PMID: 38027159 PMCID: PMC10653334 DOI: 10.3389/fendo.2023.1283621] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Aims To evaluate the breadth, depth and effectiveness of the evidence quality of all existing studies on bariatric surgery and mental health outcomes. Design Umbrella review of existing Systematic review and meta-analyses. Data sources PubMed, Embase, Web of Science, and the Cochrane Liberally databases of Systematic review and meta-analyses, and hand searching the reference lists of eligible publications. Results The search identified nine studies and 20 mental health outcomes from 1251 studies. Evidence shows that bariatric surgery is associated with significant improvement in areas such as anxiety, depression and eating disorders (including binge-eating disorder), and there is a significant harmful association with suicide, self-harm and alcohol use disorder (AUD). Among them, the most studied outcome is depression (4 articles). High-quality evidence proves that the score of depressive symptoms can be significantly improved after bariatric surgery within a two-year follow-up period and is not affected by the follow-up time. Low-quality evidence shows that bariatric surgery can significantly reduce depressive symptoms regardless of age and BMI, with an odds ratio (OR) of 0.49. Regardless of the postoperative BMI, the anxiety symptoms of women over 40 still decreased significantly, with an OR of 0.58. Regardless of the type of surgery, surgery can significantly reduce the incidence of eating disorders and symptoms. However, there is no obvious change in the follow-up time of AUD in the first two years after bariatric surgery, and the risk increases obviously in the third year, with an OR of 1.825. The evidence of moderate research shows that the risk of suicide and self-harm increases after bariatric surgery. The odds ratios in the same population and the control group were 1.9 and 3.8 times, respectively. Conclusion Bariatric surgery is beneficial for improving most mental health-related outcomes. However, we should be cautious about the increased risk of adverse mental health after surgery, such as suicide, self-harm, and AUD.
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Affiliation(s)
- Saikam Law
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Medicine, Jinan University, Guangzhou, China
| | - Shiliang Dong
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuqing Zhou
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dexi Zheng
- Gernaral Surgery, Dancheng County People’s Hospital, Zhoukou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
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18
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Kruschitz R, Fahrnberger M, Felsenreich DM, Ress C, Andersen B, Aydinkoc-Tuzcu K, Ciardi C, Huber SL, Kiefer FW. [Prevention and management of postinterventional weight regain]. Wien Klin Wochenschr 2023; 135:743-750. [PMID: 37821697 PMCID: PMC10567866 DOI: 10.1007/s00508-023-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Decreasing levels of patient motivation or compliance are far from being the only causes of postinterventional weight regain after lifestyle, psychological, pharmacological and surgical interventions. Weight regain originates from a complex and individually varying set of central and peripheral mechanisms, with the overall purpose of increasing food intake by both stimulating hunger and reducing satiety (mediated by gastrointestinal hormones) and decreasing the body's energy demands (via metabolic adaption). These mechanisms counteract any attempts to reduce or maintain body weight in today's increasingly prevalent adipogenic environments. The knowledge about the biological mechanisms of body weight regulation should be taken into consideration when planning treatment programs for long-term weight reduction, including follow-up treatment for the prevention and individualized treatment of postinterventional weight regain. Therapeutic measures as well as the frequency of medical follow-ups should be based on the extent of weight regain.
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Affiliation(s)
- Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen, Klagenfurt, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Claudia Ress
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Simone Leonore Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Florian W Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Dupont L, Alves A, Bui E, Lee Bion A, Meunier H, Briant A, Parienti JJ, Menahem B. Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders. Surg Endosc 2023; 37:8362-8372. [PMID: 37700014 DOI: 10.1007/s00464-023-10343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/30/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders. MATERIAL AND METHODS From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities. RESULTS Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years. CONCLUSION Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
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Affiliation(s)
- Ludovic Dupont
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France
| | - Eric Bui
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Psychiatry, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, U1237, PhIND «Physiopathology and Imaging of Neurological Disorders», NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, Caen University Hospital and Normandie University, Cyceron, 14000, Caen, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France.
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France.
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la cote de Nacre, 14032, Caen Cedex, France.
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Liao J, Liu Y, Yao Y, Zhang J, Wang H, Zhao J, Chen W, Lu W. Clostridium butyricum Strain CCFM1299 Reduces Obesity via Increasing Energy Expenditure and Modulating Host Bile Acid Metabolism. Nutrients 2023; 15:4339. [PMID: 37892414 PMCID: PMC10609426 DOI: 10.3390/nu15204339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Clostridium butyricum is a butyrate-producing microorganism which has beneficial effects on various diseases, including obesity. In our previous study, the anti-obesity Clostridium butyricum strain CCFM1299 (C20_1_1) was selected, but its anti-obesity mechanism was not clarified. Herein, CCFM1299 was orally administrated to high-fat-diet-treated C57BL/6J mice for 12 weeks to uncover the way the strain alleviates obesity. The results indicated that CCFM1299 alleviated obesity through increasing the energy expenditure and increasing the expression of genes related to thermogenesis in brown adipose tissue (BAT). Moreover, strain CCFM1299 could also affect the expression of immune-related genes in epididymal white adipose tissue (eWAT). This immunomodulatory effect might be achieved through its influence on the complement system, as the expression of the complement factor D (CFD) gene decreased significantly. From the view of metabolites, CCFM1299 administration increased the levels of ursodeoxycholic acid (UDCA) in feces and taurohyodeoxycholic acid (THDCA) in serum. Together, the anti-obesity potential of CCFM1299 might be attributed to the increase in energy consumption, the regulation of immune-related gene expression in eWAT, and the alteration of bile acid metabolism in the host. These provided new insights into the potential application of anti-obesity microbial preparations and postbiotics.
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Affiliation(s)
- Jingyi Liao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yaoliang Liu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Ye Yao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jie Zhang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Hongchao Wang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Wei Chen
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
| | - Wenwei Lu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China; (J.L.); (Y.L.); (Y.Y.); (J.Z.); (H.W.); (J.Z.); (W.C.)
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
- (Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou 225004, China
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Johnston L, Jackson K, Hilton C, Graham Y. The forgotten patient: A psychological perspective on the implementation of bariatric surgery guidelines. Obes Sci Pract 2023; 9:538-547. [PMID: 37810523 PMCID: PMC10551119 DOI: 10.1002/osp4.670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/04/2023] [Accepted: 03/17/2023] [Indexed: 10/10/2023] Open
Abstract
There is strong evidence demonstrating the impact of bariatric surgery on weight-loss and comorbidity improvement. In the UK, there is specific guidance to facilitate the assessment of a person's suitability for bariatric surgery. This paper highlights the clinical reality of routinely implementing this guidance, supported by literature and the perspectives of practicing psychologists. The consequences of the implementation of clinical guidelines within the context of the typical biopsychosocial profile of those referred for bariatric surgery are discussed. The ramifications of a screening approach rather than a clinical formulation-based approach to assessment, impact of a possible unconscious bias in commissioning and an overemphasis on a biomedical model approach to treatment are also presented. These contextual factors are argued to contribute to a population of "forgotten patients" that is, patients who have been assessed as not suitable for bariatric surgery, and thus "stuck" in their journey toward better health. For these individuals the only option left are energy balance only approaches, which are the very same approaches to weight-loss and comorbidity improvement that have been attempted, often for many years. Not only have these approaches not resulted in weight-loss and health improvement, they also fail to address the underlying psychological causes of obesity. Consequently, this lack of support means that patients continue to suffer from poor quality of life, with no clear pathway to improved health and wellbeing. This paper illuminates the clear gaps in weight management service provision, the implementation of guidelines in practice, and offers practical suggestions to reduce the unintended consequences of clinical guidelines for bariatric surgery.
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Affiliation(s)
- Lynne Johnston
- Halley Johnston Associated LtdWhitley BayUK
- Golden Jubilee University National HospitalScotlandUK
- Helen McArdle Nursing and Care Research InstituteFaculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
| | | | - Charlotte Hilton
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
- Hilton Health ConsultancyDerbyshireUK
- University of FloridaGainesvilleFloridaUSA
- University of DerbyDerbyUK
| | - Yitka Graham
- Helen McArdle Nursing and Care Research InstituteFaculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
- Faculty of PsychologyUniversity of Anahuac MexicoMexico CityMexico
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Babarinsa IA, Bashir M, AbdelRahman Ahmed H, Ahmed B, Konje JC. Bariatric surgery and reproduction-implications for gynecology and obstetrics. Best Pract Res Clin Obstet Gynaecol 2023; 90:102382. [PMID: 37506498 DOI: 10.1016/j.bpobgyn.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.
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Affiliation(s)
- Isaac A Babarinsa
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha.
| | | | | | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Department of Health Sciences University of Leicester, UK
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Hernández LA, Guilbert L, Sepúlveda EM, Rodríguez F, Peñuñuri F, García VH, Zerrweck C. Causes of revisional surgery, reoperations, and readmissions after bariatric surgery. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:232-237. [PMID: 34972678 DOI: 10.1016/j.rgmxen.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Bariatric surgery is the most effective treatment for weight loss, with comorbidity control. With low complication rates, the reasons for reoperation are major complications or weight loss failure/weight regain. Nonsurgical problems can also present, such as anemia, dehydration, chronic pain, and malnutrition, among others. Our aim was to analyze the main causes of revisional surgery, reoperation, and hospital readmission, at a specialized bariatric center. METHODS A retrospective study was conducted on patients that underwent bariatric surgery within the time frame of 2012 and 2019. The baseline analysis included demographic, anthropometric, and perioperative data, as well as a sub-analysis of the main readmission causes and complications. RESULTS A total of 776 primary surgeries were performed (649 RYGBP, 127 SG, and 10 revisional surgeries), and 99 patients were identified for the study: 10 revisional surgeries, 44 reoperations, and 45 readmissions. The incidence of revisional surgery was 1.2%, reoperation was 5.6%, and readmission 5.8%. Fifty percent of the revisional surgeries were performed due to insufficient weight loss or weight regain; the most frequent causes of reoperation were cholecystitis (38.6%) and internal hernias (9.1%); and the most common causes of readmission were nonspecific abdominal pain (35.5%) and dehydration (24.4%). CONCLUSION The most frequent causes of postoperative readmission were nonsurgical events, followed by non-bariatric reoperations, and finally revisional surgeries. There was a low incidence of early reoperations. Knowledge of the abovementioned data is important for identifying higher-risk patients, to prevent major complications.
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Affiliation(s)
- L A Hernández
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - L Guilbert
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - E M Sepúlveda
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - F Rodríguez
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - F Peñuñuri
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - V H García
- Servicio de Medicina Interna, Hospital General Tláhuac, Mexico City, Mexico
| | - C Zerrweck
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico.
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24
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Sumithran P, Roberts L, Caterson ID, Brown RM, Spittal MJ, Brown WA. Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study. Obesity (Silver Spring) 2023; 31:1913-1923. [PMID: 37368518 PMCID: PMC10946809 DOI: 10.1002/oby.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). METHODS This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self-harm; substance-use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. RESULTS A total of 121,203 patients were included, with median follow-up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0-18.4] restrictive, 10.8 [8.4-13.9] sleeve gastrectomy, 20.4 [9.7-42.8] gastric bypass; p = 0.18). Rates of admission with self-harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance-use disorder increased after all surgery types. CONCLUSIONS Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health.
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Affiliation(s)
- Priya Sumithran
- Department of Medicine (St Vincent's)University of MelbourneFitzroyVictoriaAustralia
- Department of EndocrinologyAustin HealthHeidelbergVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Leo Roberts
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Ian D. Caterson
- Boden Initiative, Charles Perkins Centre, University of SydneyNew South WalesAustralia
| | - Robyn M. Brown
- Department of Biochemistry and PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Wendy A. Brown
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- Department of SurgeryAlfred HospitalMelbourneVictoriaAustralia
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25
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Romagna EC, Mattos DMF, Lopes KG, Kraemer-Aguiar LG. Screening Risks of Alcohol Abuse, Depressive Symptoms, and Decreased Health-Related Quality of Life in Post-Bariatric Patients and Their Relations to Weight Regain. Obes Surg 2023:10.1007/s11695-023-06605-3. [PMID: 37097429 DOI: 10.1007/s11695-023-06605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes. MATERIAL AND METHODS Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m2) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey. RESULTS Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group. CONCLUSIONS HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
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Affiliation(s)
- Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom / Postgraduate Program on Electrical and Telecommunications Engineering (PPGEET), Fluminense Federal University, Niteroi, RJ, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de setembro, 77, Vila Isabel, Rio de Janeiro, RJ, Brazil.
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26
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Barbuti M, Maiello M, Spera V, Pallucchini A, Brancati GE, Maremmani AGI, Perugi G, Maremmani I. Challenges of Treating ADHD with Comorbid Substance Use Disorder: Considerations for the Clinician. J Clin Med 2023; 12:jcm12093096. [PMID: 37176536 PMCID: PMC10179386 DOI: 10.3390/jcm12093096] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Adults with attention deficit/hyperactivity disorder (ADHD) often present psychiatric comorbidities and, in particular, substance use disorder (SUD). ADHD-SUD comorbidity is characterized by greater severity of both disorders, earlier age of onset, higher likelihood of polydrug-abuse and suicidal behaviors, more hospitalizations, and lower treatment adherence. At the present stage, research focused on the pharmacological management of ADHD with comorbid SUD in both adolescents and adults is still lacking. Furthermore, while the short-term effects of stimulants are well studied, less is known about the chronic effects of these drugs on dopamine signaling. Current available evidence is consistent in reporting that high doses of stimulant medications in ADHD-SUD subjects have a mild to moderate efficacy on ADHD symptoms. Some data suggest that pharmacological treatment with stimulants may be beneficial for both ADHD symptoms and comorbid cocaine or amphetamine use. However, in the long run, stimulant medications may have a potential risk for misuse. For the absence of potential misuse, atomoxetine is often recommended for ADHD with comorbid cocaine or amphetamine use disorder. However, its efficacy in reducing addictive behavior is not demonstrated. In subjects with other subtypes of SUD, both atomoxetine and stimulant drugs seem to have scarce impact on addictive behavior, despite the improvement in ADHD symptomatology. In this population, ADHD treatment should be combined with SUD-specific strategies.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Marco Maiello
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Vincenza Spera
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Alessandro Pallucchini
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Giulio E Brancati
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Angelo G I Maremmani
- Section of Psychiatry, Department of Psychiatry and Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Lido di Camaiore, Italy
| | - Giulio Perugi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Icro Maremmani
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
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Kennis M, Hale EW, Hemendinger E, Davis R, Ojemann SG, Strom L, Klepitskaya O. Suicide in Deep Brain Stimulation for Parkinson's Disease: A Retrospective Case-Control Study. JOURNAL OF PARKINSON'S DISEASE 2023; 13:415-419. [PMID: 36911947 DOI: 10.3233/jpd-225049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Deep brain stimulation (DBS), a treatment of Parkinson's disease (PD), has been associated with suicidality. We conducted a case-control study comparing suicide in four pairs of cohorts: PD patients with DBS or not, epilepsy patients with resection surgery or not, subjects with BMI≥30 with bariatric surgery or not, and patients with chronic kidney disease with transplantation or not. PD patients with DBS demonstrated a lower risk of suicide relative to PD patients without DBS. Findings from other elective surgeries indicate that patients receiving operative treatments do not possess predictable differences in suicide rates relative to their medically managed counterparts.
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Affiliation(s)
- Matthew Kennis
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Elijah W Hale
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Emily Hemendinger
- University of Colorado, Department of Psychiatry, Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Davis
- University of Colorado, Department of Psychiatry, Anschutz Medical Campus, Aurora, CO, USA
| | - Steven G Ojemann
- University of Colorado Hospital, Neurosciences Center - Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- University of Colorado Hospital, Neurosciences Center - Anschutz Medical Campus, Aurora, CO, USA
| | - Olga Klepitskaya
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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28
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Aguiar PV, Dionisio WÁDS, Souza EADC, Vantini D, Campanholi R, Pinto TCC, Ximenes RCC. Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery. Eat Weight Disord 2023; 28:12. [PMID: 36800040 PMCID: PMC9938051 DOI: 10.1007/s40519-023-01533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/17/2022] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The aim of the present study was to determine possible associations between binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery. METHODS A cross-sectional study was conducted with 254 obese patients recruited from the general surgery service for bariatric procedures at the hospital affiliated with the Federal University of Pernambuco, Brazil. Evaluations were performed using the Binge Eating Scale (BES), Beck Depression Inventory, Beck Scale for Suicidal Ideation (BSSI) and a questionnaire addressing sociodemographic characteristics. RESULTS Most patients were women (82%), 48% had a moderate binge eating disorder, 42% a severe binge eating disorder, 32% had symptoms suggestive of mild, moderate or severe depression and 6% had suicidal ideation. Severe binge eating was positively associated with depressive symptoms (p < 0.001) and suicidal ideation (p < 0.05). Cases of severe binge eating were more frequent in young adults, but not necessarily associated with symptoms of depression or suicidal ideation in this portion of the sample. CONCLUSIONS The present findings underscore the need for psychological and psychiatric follow-up of obese candidates for bariatric surgery using appropriate assessment scales to guide therapeutic approaches. LEVEL III Evidence obtained from cross-sectional study.
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Affiliation(s)
- Priscilla Vasconcelos Aguiar
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Weslley Álex da Silva Dionisio
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | | | - Davi Vantini
- Clinical Analysis Laboratory, Faculdade de Medicina Do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Raphael Campanholi
- Clinical Analysis Laboratory, Faculdade de Medicina Do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Tiago Coimbra Costa Pinto
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
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29
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Konrad C, Inhoffen J, Friederich HC, Hartmann M, Wild B. Prevalence of adverse childhood experiences and effect on outcomes in bariatric surgery patients: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:118-129. [PMID: 36270937 DOI: 10.1016/j.soard.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
Adverse childhood experiences (ACEs) are defined as childhood maltreatment (sexual, physical, and emotional abuse and neglect) and other childhood traumatic experiences. Published prevalence estimates for ACEs in bariatric samples vary greatly and evidence on the association between ACEs and bariatric surgery weight loss and psychosocial outcomes is inconclusive. A systematic literature search on PubMed/Medline, PsycInfo, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Open Grey for studies published until August 30, 2021, yielded 21 publications for qualitative synthesis: 20 reporting on prevalence of ACEs in bariatric surgery candidates and patients, and 10 on the association of ACEs with outcomes. In meta-analysis, overall moderate to high heterogeneity was observed for prevalence estimates and moderate heterogeneity was observed for associations. Prevalence estimate for at least 1 form of ACEs (6 studies, n = 1368 patients) was 51% (95% confidence interval [CI]: 32%-70%). Effect size (Hedge's g) for the difference between the groups of patients reporting any or a high number of ACEs versus no or a low number of ACEs was calculated from means, standard deviations and group size, or P values. Based on 7 studies (n = 946 patients), the association between ACEs and weight loss was not significant (Hedge's g = -.15 [95% CI: -.38 to .09]; I2 = 53%), regardless of short- or long-term follow-up (P = .413) and the proportion of patients in each study receiving Roux-en-Y gastric bypass (RYGB) (β = .0005, P = .868). Preliminary findings based on 3 short- and long-term studies (n = 414 patients) showed that ACEs were significantly (P = .001) associated with higher postoperative depressive symptoms (Hedge's g = .50 [95% CI: .22-.78]; I2 = 36%). Associations between ACEs and other psychosocial outcomes such as eating pathology were reported narratively. There is a need for additional long-term studies using validated assessment tools for ACEs to evaluate the effect of ACEs on weight and psychosocial outcomes after bariatric surgery.
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Affiliation(s)
- Cinara Konrad
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Johannes Inhoffen
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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30
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Brunault P, Bourbao-Tournois C, Ballon N, de Luca A. Psychiatric, psychological and addiction management in obesity surgery: Early identification for better support. J Visc Surg 2023; 160:S22-S29. [PMID: 36725454 DOI: 10.1016/j.jviscsurg.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although bariatric surgery results in a significant weight reduction and an improvement in the quality of life in most people who undergo surgery, there are inter-individual differences in terms of postoperative results. Psychological, psychiatric and addictive disorders contribute substantially to these difficulties. Between 20% and 50% of bariatric surgery candidates have a current psychiatric/addictive disorder and approximately 30-75% have a history of a psychiatric/addictive disorder within their lifetime. Surgery is accompanied in the short-term by an improvement in depressive symptoms and binge eating, but these symptoms tend to increase again beyond the 3rd postoperative year. Over the long-term, only the improvement in depression remains durable, whilepostoperative anxiety and disordered eating symptoms do not differ significantly from the preoperative levels. There is a two to four fold increased risk of post-surgical suicide and suicide attempts (from the 1st postoperative year onward), as well as an increased risk of alcohol-abuse (beyond two years after surgery). Psychological support must therefore continue long-term. Several psychotherapeutic and pharmacological treatments have demonstrated their effectiveness in improving the postoperative prognosis of patients with psychological/psychiatric disorders. The early integration of psychological/psychiatric/addiction evaluation and support into multidisciplinary management makes it easier to identify these difficulties and to optimize the postoperative prognosis, both in terms of weight and quality of life. Prior to surgery, patients should be systematically evaluated by a psychologist or psychiatrist in order to identify and to manage disorders that could negatively impact the postoperative prognosis. After surgery, this assessment and support can be carried out in a programmed and systematic way for those patients who were identified preoperatively as the most vulnerable, but support can also be offered during follow-up in the event of specific symptoms (i.e., loss of control over food intake, failure in terms of weight or quality of life, suicidal ideation, loss of control over alcohol use, significant depression or anxiety symptoms).
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Affiliation(s)
- P Brunault
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Université de Tours, QualiPsy, EE 1901, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France.
| | - C Bourbao-Tournois
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; CHRU de Tours, Service de Chirurgie Digestive et Endocrinienne, Tours, France
| | - N Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France
| | - A de Luca
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; Inserm U1069, Université de Tours, Tours, France; CHRU de Tours, Unité Mobile de Nutrition, Tours, France
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31
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Martinelli V, Singh S, Politi P, Caccialanza R, Peri A, Pietrabissa A, Chiappedi M. Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1232. [PMID: 36673981 PMCID: PMC9859476 DOI: 10.3390/ijerph20021232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Obesity is increasingly prevalent among adolescents. Clinical and research data support the use of bariatric surgery (BS) as a treatment option for severely obese adolescents, with good results in terms of weight loss, improvement or resolution of comorbidities, and compliance to follow up. Nevertheless, concerns still remain, with significant disparities among countries and ethical concerns mainly raised by performing an irreversible and invasive procedure in adolescence, with potential life-long alterations. In this context, the purpose of this narrative review was to discuss the main current ethical challenges in performing BS in adolescence and to inform appropriate clinical management in the field. The core ethical principles of autonomy, beneficence, nonmaleficence, and justice were revised in terms of patient-centered healthcare through the lens of psychosocial implications. The review concludes with a discussion regarding the potential directives for future research for effective, patient-centered, and ethical management of obesity in the adolescent population.
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Affiliation(s)
- Valentina Martinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Simran Singh
- Medway Hospital, Windmill Rd, Gillingham ME7 5NY, UK
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Peri
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Andrea Pietrabissa
- Department of Surgery, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Surgery, University of Pavia, 27100 Pavia, Italy
| | - Matteo Chiappedi
- Vigevano Child Neurology and Psychiatry Unit, ASST Pavia, 27100 Pavia, Italy
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32
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Dahlberg K, Jaensson M, Cao Y, Näslund E, Stenberg E. Incidence of self-harm after bariatric surgery: A nationwide registry-based matched cohort study. Clin Obes 2023; 13:e12576. [PMID: 36610057 DOI: 10.1111/cob.12576] [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: 10/07/2022] [Revised: 12/02/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18-70 years at time of surgery, body mass index (BMI) > 30 kg/m2 , who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36-3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78-0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11-4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.
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Affiliation(s)
- Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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O'Hara L, Alajaimi B, Alshowaikh B. "I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar. Front Public Health 2023; 11:1015181. [PMID: 36923042 PMCID: PMC10008867 DOI: 10.3389/fpubh.2023.1015181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023] Open
Abstract
Introduction Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region. Methods We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University. Results Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood. Conclusion WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.
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Affiliation(s)
- Lily O'Hara
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
| | - Bayan Alajaimi
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
| | - Bayan Alshowaikh
- Department of Public Health, QU Health, Qatar University, Doha, Qatar
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Marchese SH, Pandit AU. Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies. Gastroenterol Clin North Am 2022; 51:785-798. [PMID: 36375996 DOI: 10.1016/j.gtc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.
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Affiliation(s)
- Sara H Marchese
- Department of Psychiatry & Behavioral Sciences, Section of Bariatric & Outpatient Psychotherapy, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL 60618, USA
| | - Anjali U Pandit
- Division of Gastroenterology and Hepatology & Psychiatry, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, 14th Floor, Chicago, IL 60611, USA.
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Nielsen C, Elander A, Staalesen T, Al Nouh M, Fagevik Olsén M. Depressive symptoms before and after abdominoplasty among post-bariatric patients - a cohort study. J Plast Surg Hand Surg 2022; 56:381-386. [PMID: 35294844 DOI: 10.1080/2000656x.2022.2050251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The majority of post-bariatric patients suffer from excess skin after weight loss, impairing physical, psychosocial and mental health. The abdomen is the most common location for excess skin, and abdominoplasty is the most commonly required reconstructive procedure. Abdominoplasty removes excess abdominal skin and attenuates related symptoms, but knowledge regarding mental health-related effects is scarce. Here, we aimed to evaluate the symptoms and severity of depression before and after abdominoplasty in post-bariatric patients and to analyse the relationships between depressive symptoms, quality of life (QoL) and experience of excess skin. We enrolled 110 former obese patients undergoing abdominoplasty. Three questionnaires evaluating the symptoms of depression (Beck Depression Inventory (BDI-II)), experience of excess skin (Sahlgrenska Excess Skin Questionnaire (SESQ)) and QoL (36-item Short-Form Health Survey (SF-36)) were completed preoperatively and 1 year postoperatively. After abdominoplasty, symptoms of depression (BDI sum score) significantly decreased (5.8 vs. 3.0, p = .037). Scores on three BDI questions improved (p < .05), and the SESQ score normalised (p < .001), while the SF-36 score was unaffected. The BDI sum score was moderately correlated with the SF-36 mental composite score (preoperatively, rs = -0.69; postoperatively, rs = -0.66) and fairly correlated with the SF-36 physical composite score (rs = 0.32, rs = 0.26). The correlation between the BDI sum and SESQ scores was poor preoperatively (rs = -0.106) and fair postoperatively (rs = 0.232). The results indicate that abdominoplasty may reduce symptoms of depression in post-bariatric patients. However, the procedure did not affect SF-36 scores. Further studies are required to validate these results.
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Affiliation(s)
- Christina Nielsen
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Trude Staalesen
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Monika Fagevik Olsén
- Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neuroscience and Physiology/Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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36
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Auge M, Dejardin O, Menahem B, Lee Bion A, Savey V, Launoy G, Bouvier V, Alves A. Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center. J Clin Med 2022; 11:jcm11216310. [PMID: 36362536 PMCID: PMC9658876 DOI: 10.3390/jcm11216310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146−1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012−1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619−0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002−1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047−1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033−1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972−0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543−0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.
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Affiliation(s)
- Marie Auge
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Olivier Dejardin
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Correspondence:
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Véronique Savey
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Guy Launoy
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Véronique Bouvier
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
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Ng CH, Xiao J, Chew NWS, Chin YH, Chan KE, Quek J, Lim WH, Tan DJH, Loke RWK, Tan C, Tang ASP, Goh XL, Nah B, Syn N, Young DY, Tamaki N, Huang DQ, Siddiqui MS, Noureddin M, Sanyal A, Muthiah M. Depression in non-alcoholic fatty liver disease is associated with an increased risk of complications and mortality. Front Med (Lausanne) 2022; 9:985803. [PMID: 36275825 PMCID: PMC9582593 DOI: 10.3389/fmed.2022.985803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims The global prevalence of non-alcoholic fatty liver disease (NAFLD) is expected to rise continuously. Furthermore, emerging evidence has also shown the potential for concomitant depression in NAFLD. This study aims to examine the prevalence, risk factors, and adverse events of depression in NAFLD and evaluate whether treated depression can reverse the increased risks of adverse outcomes. Materials and methods This study analyses the 2000–2018 cycles of NHANES that examined liver steatosis with fatty liver index (FLI). The relationship between NAFLD and depression was assessed with a generalized linear mix model and a sensitivity analysis was conducted in the no depression, treated depression, and untreated depression groups. Survival analysis was conducted with cox regression and fine gray sub-distribution model. Results A total of 21,414 patients were included and 6,726 were diagnosed with NAFLD. The risk of depression in NAFLD was 12% higher compared to non-NAFLD individuals (RR: 1.12, CI: 1.00–1.26, p = 0.04). NAFLD individuals with depression were more likely to be older, females, Hispanics or Caucasians, diabetic, and have higher BMI. Individuals with depression have high risk for cardiovascular diseases (CVD) (RR: 1.40, CI: 1.25–1.58, p < 0.01), stroke (RR: 1.71, CI: 1.27–2.23, p < 0.01), all-cause mortality (HR: 1.50, CI: 1.25–1.81, p < 0.01), and cancer-related mortality (SHR: 1.43, CI: 1.14–1.80, p = 0.002) compared to NAFLD individuals without depression. The risk of CVD, stroke, all-cause mortality, and cancer-related mortality in NAFLD individuals with treated depression and depression with untreated treatment was higher compared to individuals without depression. Conclusion This study shows that concomitant depression in NAFLD patients can increase the risk of adverse outcomes. Early screening of depression in high-risk individuals should be encouraged to improve the wellbeing of NAFLD patients.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,*Correspondence: Cheng Han Ng, ; orcid.org/0000-0002-8297-1569
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas W. S. Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan Wai Keong Loke
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xin Lei Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Yock Young
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore,National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore,Mark Muthiah, ; orcid.org/0000-0002-9724-4743
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The Factor Structure and Stability of the Beck Depression Inventory-II (BDI-II) in a Population Undergoing Bariatric Surgery. Obes Surg 2022; 32:3732-3739. [PMID: 36169910 DOI: 10.1007/s11695-022-06277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Depression is a multifaceted psychiatric condition that has been associated with suboptimal weight loss following bariatric surgery. Previous variations of Beck Depression Inventory-Second Edition (BDI-II) subscales been proposed, including those identified within bariatric populations; however, it is unclear whether the BDI-II items contained within these subscales would remain consistent after the procedure considering the physical and lifestyle changes that occur following bariatric surgery. MATERIALS AND METHODS A two-step analytic approach that comprised of exploratory (EFA) and confirmatory factor analyses (CFA) that aimed to identify a stable factor structure using pre- and 6-month post-surgical BDI-II responses. Baseline BDI-II responses of 149 patients (Group 1) were used to identify an initial EFA model. Five BDI-II models underwent CFA using BDI-II responses of a comparable pre-surgical group (Group 2; n = 142), and 6-month post-surgical data from Group 1. RESULTS EFA generated a two-factor solution. Of the five CFA models performed, the three-factor model that was initially identified by Hayes (2015) among patients undergoing bariatric surgery demonstrated superior fit across time and between groups. CONCLUSIONS Although the EFA initially identified a two-factor model, CFA determined that a previously defined three-factor model reliably fit both pre- and post-surgical BDI-II responses. This study supports using the Hayes (2015) subscales when monitoring pre- and post-bariatric surgery facets of depression specific to this population. Being able to accurately and reliably monitor depressive symptoms of patients that are undergoing bariatric surgery will allow for the provision and monitoring of targeted interventions aimed at improving their mental and physical health outcomes.
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Sharma A, Albhaisi S, Sanyal AJ. Treatments for obesity in the context of nonalcoholic steatohepatitis and mental health. Clin Liver Dis (Hoboken) 2022; 20:48-51. [PMID: 36033431 PMCID: PMC9405488 DOI: 10.1002/cld.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Aadi Sharma
- University of VirginiaCharlottesvilleVirginiaUSA
| | - Somaya Albhaisi
- Department of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and NutritionDepartment of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
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40
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Braun TD, Puhl RM, Quinn DM, Gorin A, Tishler D, Papasavas P. Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery. Surg Obes Relat Dis 2022; 18:1066-1073. [PMID: 35811291 PMCID: PMC9797255 DOI: 10.1016/j.soard.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. OBJECTIVE Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. SETTING Teaching hospital and surgical weight loss center in the United States. METHODS A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). RESULTS After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR2 = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR2 = .12 and .13, respectively; overall model R2 =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms. CONCLUSIONS Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Centers of Preventive Medicine, The Miriam Hospital, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island,Correspondence: Tosca D. Braun, Ph.D., Alpert Brown Medical School, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. (T.D. Braun)
| | - Rebecca M. Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut
| | - Diane M. Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Amy Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
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Kheniser K, Aminian A, Kashyap SR. Effects of Metabolic Medicine and Metabolic Surgery on Patient-Reported Outcomes Among Patients with Type 2 Diabetes. Metab Syndr Relat Disord 2022; 20:497-508. [PMID: 35881869 DOI: 10.1089/met.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The assessment and management of patient-reported outcomes (PROs) is considered secondary to that of cardiometabolic outcomes. When assessed, health-related quality of life (HRQOL), a PRO, can yield pertinent information that cannot be obtained from cardiometabolic assessments. For instance, physical and mental distress can be quantified and treated. Moreover, treatment convenience and satisfaction can be gaged. Behavioral modification, bariatric surgery, and pharmacotherapy can improve PROs. Typically, HRQOL is responsive to changes in weight. Specifically, weight loss and weight gain are associated with positive and negative changes in quality of life, respectively. In addition, patient satisfaction can be influenced by glycemic control. Therefore, hypoglycemia and hyperglycemic episodes can negatively affect patient satisfaction. When managing type 2 diabetes (T2D), it is important to consider how therapies impact PROs. Generally, changes in clinical outcomes mirror changes in PROs. To best manage T2D, integrating the assessment of PROs with clinical outcomes is needed.
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Affiliation(s)
- Karim Kheniser
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sangeeta R Kashyap
- Department of Endocrinology and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA
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Stenberg E, Bruze G, Sundström J, Marcus C, Näslund I, Ottosson J, Neovius M. Comparison of Sleeve Gastrectomy vs Intensive Lifestyle Modification in Patients With a BMI of 30 to Less Than 35. JAMA Netw Open 2022; 5:e2223927. [PMID: 35895057 PMCID: PMC9331100 DOI: 10.1001/jamanetworkopen.2022.23927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE There is a lack of studies evaluating sleeve gastrectomy compared with intensive lifestyle treatment in patients with class 1 obesity (body mass index [BMI] 30 to <35 [calculated as weight in kilograms divided by height in meters squared]). OBJECTIVE To compare outcomes and safety of sleeve gastrectomy compared with intensive nonoperative obesity treatment in patients with class 1 obesity. DESIGN, SETTING, AND PARTICIPANTS This matched, nationwide cohort study included patients with class 1 obesity who underwent a sleeve gastrectomy or intensive lifestyle treatment between January 1, 2012, and December 31, 2017, and who were registered in the Scandinavian Obesity Surgery Registry or the Itrim health database. Participants with class 1 obesity were matched 1:2 using a propensity score including age, sex, BMI, treatment year, education level, income, cardiovascular disease, and use of antibiotic drugs, antidepressants, and anxiolytics. INTERVENTIONS Sleeve gastrectomy or intensive lifestyle treatment. MAIN OUTCOMES AND MEASURES Outcomes included weight loss after intervention, changes in metabolic comorbidities, substance use disorders, self-harm, and major cardiovascular events retrieved from the National Patient Register, Prescribed Drug Register, and Cause of Death Register as well as the Scandinavian Obesity Surgery Registry and the Itrim health database. Data were analyzed from December 1, 2021 until May 31, 2022. RESULTS The study included 1216 surgery patients and 2432 lifestyle participants with similar mean (SD) BMI (32.8 [1.4] vs 32.9 [1.4]), mean (SD) age (42.4 [9.7] vs 42.6 [12.7] years), and sex (1091 [89.7%] vs 2191 [90.1%] women). Surgery patients had greater 1-year weight loss compared with controls (22.9 kg vs 11.9 kg; mean difference, 10.7 kg; 95% CI, 10.0-11.5 kg; P < .001). Over a median follow-up of 5.1 years (IQR, 3.9-6.2 years), surgery patients had a lower risk of incident use of diabetes drugs (59.7 vs 100.4 events per 10 000 person-years; hazard ratio [HR], 0.60; 95% CI, 0.39-0.92; P = .02) and greater 2-year diabetes drug remission (48.4% vs 22.0%; risk difference 26.4%; 95% CI, 11.7%-41.0%; P < .001), but higher risk for substance use disorder (94 vs 50 events per 10 000 person-years; HR, 1.86; 95% CI, 1.30-2.67; P < .001) and self-harm (45 vs 25 events per 10 000 person-years; HR, 1.81; 95% CI, 1.09-3.01; P = .02). No between-group difference in occurrence of major cardiovascular events was observed (23.4 vs 24.8 events per 10 000 person-years; HR, 0.96; 95% CI, 0.49-1.91; P = .92). CONCLUSIONS AND RELEVANCE In this cohort study, compared with intensive nonoperative obesity treatment, sleeve gastrectomy in patients with class 1 obesity was associated with greater weight loss, diabetes prevention, and diabetes remission but a higher incidence of substance use disorder and self-harm.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Comprehensive Review and Updates on Holistic Approach Towards Non-Alcoholic Fatty Liver Disease Management with Cardiovascular Disease. Curr Atheroscler Rep 2022; 24:515-532. [PMID: 35507280 DOI: 10.1007/s11883-022-01027-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The global prevalence of non-alcoholic fatty liver disease (NAFLD) presents an unmet need in treating these, often asymptomatic, individuals. In this review, we summarised NAFLD management and described recent developments in non-alcoholic steatohepatitis (NASH) therapeutics that can shape the future of NAFLD. RECENT FINDINGS A multi-disciplinary effort in promoting sustainable lifestyle measures is paramount, with the goal of either limiting energy surplus alone or in combination with targeting downstream pathways of inflammation and fibrosis. Several antidiabetic medications like PPAR-γ agonist and glucagon-like peptide receptor agonists have beneficial effects on the metabolic profile as well as NASH histology. Vitamin E has shown promise in specific groups of patients with the haptoglobin2 allele protein. Newer drugs have demonstrated promising results in NASH resolution and fibrosis improvement such as obeticholic acid, resmetirom, aramchol, efruxifermin, aldafermin and lanifibranor. Apart from discussing the results of late stage clinical trials and the possible challenges in managing these patients with limited approved therapies, we also discussed the specific management of comorbidities (diabetes, hypertension, hyperlipidaemia, cardiovascular diseases) in NAFLD patients. Treatment strategy needs to target improvements in liver-related outcomes and cardiometabolic profile.
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Abdul Wahab R, Al-Ruwaily H, Coleman T, Heneghan H, Neff K, le Roux CW, Fallon F. The Relationship Between Percentage Weight Loss and World Health Organization-Five Wellbeing Index (WHO-5) in Patients Having Bariatric Surgery. Obes Surg 2022; 32:1667-1672. [PMID: 35305228 PMCID: PMC8986673 DOI: 10.1007/s11695-022-06010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Purpose The association between bariatric surgery outcome and depression remains controversial. Many patients with depression are not offered bariatric surgery due to concerns that they may have suboptimal outcomes. The aim of this study was to investigate the relationship between baseline World Health Organization-Five Wellbeing Index (WHO-5) and percentage total weight loss (%TWL) in patients after bariatric surgery. Materials and Methods All patients were routinely reviewed by the psychologist and screened with WHO-5. The consultation occurred 3.5 ± 1.6 months before bariatric surgery. Body weight was recorded before and 1 year after surgery. A total of 45 out of 71 (63.3%) patients with complete WHO-5 data were included in the study. Data analysis was carried out with IBM SPSS Statistics (version 27) to determine the correlation between baseline WHO-5 and %TWL in patients having bariatric surgery. Results Overall, 11 males and 34 females were involved with mean age of 47.5 ± 11.5 and BMI of 46.2 ± 5.5 kg/m2. The %TWL between pre- and 1-year post-surgery was 30.0 ± 8.3% and the WHO-5 Wellbeing Index mean score was 56.5 ± 16.8. We found no correlation between %TWL and the WHO-5 Wellbeing Index (r = 0.032, p = 0.83). Conclusion There was no correlation between the baseline WHO-5 Wellbeing Index and %TWL 1-year post-bariatric surgery. Patients with low mood or depression need to be assessed and offered appropriate treatment but should not be excluded from bariatric surgery only based on their mood. Graphical Abstract ![]()
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Affiliation(s)
- Roshaida Abdul Wahab
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Heshma Al-Ruwaily
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Therese Coleman
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Helen Heneghan
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Karl Neff
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.,Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland. .,Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland.
| | - Finian Fallon
- Obesity Complications Clinic, St Vincent's Private Hospital, Merrion Road, Dublin, D04 NE02, Ireland
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Auge M, Menahem B, Savey V, Lee Bion A, Alves A. Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why? J Visc Surg 2022; 159:298-308. [PMID: 35304081 DOI: 10.1016/j.jviscsurg.2022.02.004] [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] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.
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Affiliation(s)
- M Auge
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France.
| | - V Savey
- Service de nutrition, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Lee Bion
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France
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46
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Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy? Obes Surg 2022; 32:1531-1538. [PMID: 35146601 DOI: 10.1007/s11695-022-05951-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (β = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (β = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (β = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (β = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.
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Hegland PA, McAleavey A, Aasprang A, Moltu C, Kolotkin RL, Andersen JR. The Norse Feedback in a population of patients undergoing bariatric surgery-Psychometric properties of a digital computer-adaptive questionnaire assessing mental health. Clin Obes 2022; 12:e12491. [PMID: 34761876 DOI: 10.1111/cob.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
The Norse Feedback (NF) is a questionnaire developed for patient-reported outcome monitoring with a clinical feedback system (PRO/CFS). As mental health is a concern after bariatric surgery, the use of the NF as part of PRO/CFS may be beneficial. The aim of this study is to test the reliability and validity of the NF in patients who have been accepted for or have undergone bariatric surgery. We performed separate robust confirmatory factor analyses (CFAs) to test the unidimensionality on 19 of the NF scales. We also performed correlation analyses on 19 of the NF scales with the Obesity-related Problems scale (OP). We included 213 patients. In the CFA analyses, three out of 12 scales with four or more items showed satisfactory psychometric properties in all goodness of fit indices (Suicidality, Need for Control and Self-Criticism). Four scales showed satisfactory psychometric properties in all indices but RMSEA (Somatic Anxiety, Substance Use, Social Safety and Cognitive Problems). Several of the scales demonstrated floor effects. In the correlation analyses, 18 of the 19 scales showed small-to-moderate correlation coefficients with the OP. Our demonstration of satisfactory psychometric properties on several important scales of the NF suggests that this tool may prove valuable in the routine follow-up of mental health in this population. However, further work is needed to innovate the NF for patients undergoing bariatric surgery.
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Affiliation(s)
- Pål A Hegland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrew McAleavey
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Anny Aasprang
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Ronette L Kolotkin
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
- Quality of Life Consulting, PLLC, Durham, North Carolina, USA
| | - John Roger Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Centre of Health Research, Førde Hospital Trust, Førde, Norway
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Fink J, Seifert G, Blüher M, Fichtner-Feigl S, Marjanovic G. Obesity Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:70-80. [PMID: 34819222 PMCID: PMC9059860 DOI: 10.3238/arztebl.m2021.0359] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 03/27/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2017, the prevalence of obesity (BMI ≥= 30 kg/m2) in Germany was approximately 16%. Obesity increases an individual's risk of developing type 2 diabetes (T2DM) and arterial hypertension; it also increases overall mortality. Consequently, effective treatment is a necessity. Approximately 20 000 bariatric operations are performed in Germany each year. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane databases and on current German clinical practice guidelines. RESULTS The types of obesity surgery most commonly performed in Germany, Roux-en-Y gastric bypass and sleeve gastrectomy, lead to an excess weight loss of 27-69% ≥= 10 years after the procedure. In obese patients with T2DM, the diabetes remission rate ≥= 10 years after these procedures ranges from 25% to 62%. Adjusted regression analyses of data from large registries have shown that the incidence of malignancies is 33% lower in persons who have undergone obesity surgery compared to control subjects with obesity (unadjusted incidence 5.6 versus 9.0 cases per 1000 person-years). The operation can cause vitamin deficiency, surgical complications, gastroesophageal reflux, and dumping syndrome. Therefore, lifelong follow-up is necessary. CONCLUSION In view of an increasing number of patients undergoing bariatric surgery, it will probably not be feasible in the future for lifelong follow-up to be provided exclusively in specialized centers.
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Affiliation(s)
- Jodok Fink
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg,*Klinik für Allgemein- und Viszeralchirurgie Sektion für Adipositas und Metabolische Chirurgie Universitätsklinikum Freiburg Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
| | - Matthias Blüher
- Helmholtz-Institute for Metabolic, Obesity and Vascular Research, (HI-MAG), Helmholtz Zentrum München at the University of Leipzig and the Medical Faculty of Leipzig AöR
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
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Troisi A. Emergence of bariatric psychiatry as a new subspecialty. World J Psychiatry 2022; 12:108-116. [PMID: 35111582 PMCID: PMC8783166 DOI: 10.5498/wjp.v12.i1.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery is the branch of surgery aimed at helping a person with obesity lose weight. The implementation of surgical treatment of obesity is growing at an impressive rate. As expected, the expanding implementation of bariatric procedures has progressively revealed critical issues that were not evident when the number of obese patients treated with surgery was relatively small. One critical issue is the importance of mental health assessment and care of bariatric patients. The aim of this review is to provide readers with an up-to-date summary of the goals, methods, and clinical strategies of bariatric psychiatry. The aims can be grouped into three distinct categories. First, to ascertain that there are no psychiatric contraindications to safe bariatric surgery. Second, to diagnose and treat pre-surgery mental conditions that could predict poor weight loss. Third, to diagnose and treat post-surgery mental conditions associated with poor quality of life. Although bariatric psychiatry has gained the status of a new subspecialty within the field of mental health and psychopathology, many clinical questions remain unsolved. We need more long-term data on outcome measures such as quality of life, adherence to behavioral guidelines, risk of suicide, and post-surgery prevalence of psychological disturbances and mental disorders.
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Affiliation(s)
- Alfonso Troisi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
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50
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Becerra AZ, Khalid SI, Morgenstern AS, Rembert EA, Carroll MM, Omotosho PA, Torquati A. The Association Between Bariatric Surgery and Psychiatric Disorders: a National Cohort Study. Obes Surg 2022; 32:1110-1118. [PMID: 35044598 DOI: 10.1007/s11695-022-05896-2] [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: 09/28/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Previous studies have shown that bariatric surgery reduces the risk of cardiovascular outcomes. Less is known about the effects of bariatric surgery on psychiatric disorders. This cohort study compared the differential risk of psychiatric disorders between those who did and did not undergo bariatric surgery, from before until after the surgery. MATERIALS AND METHODS We used PearlDiver-Mariner, a national all-payor claims database. Patients were followed for 1 year before and after the index date and a difference-in-differences (DiD) study design was executed. RESULTS We included 56,661 bariatric surgery patients matched to 56,661 individuals with obesity. Among bariatric surgery patients, the risk of psychiatric was 18% 1 year before and increased to 70% 1 year after surgery. Among individuals with obesity, the risk of psychiatric disorders also increased from 1 year before to 1 year after, but by less (21% versus 46%). DiD analysis suggested that bariatric surgery was associated with a 27 percentage point differential increase in the risk of psychiatric disorders across all patients, representing a 135% relative increase. Results using 3 years as the pre- and post-periods lead to similar inferences. CONCLUSION Preexisting psychiatric disorders are similarly prevalent among bariatric surgery patients and individuals with obesity. The prevalence of psychiatric disorders increased over time for both groups, but to a larger extent among bariatric surgery patients. Adequate treatment for psychiatric disorders and appropriate implementation of behavioral health interventions may be needed to reduce the burden of psychiatric disorders following bariatric surgery.
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Affiliation(s)
- Adan Z Becerra
- Department of Surgery, Rush University Medical Center, 1750 W. Harrison St, Chicago, IL, 60612, USA.
| | - Syed I Khalid
- Department of Surgery, Rush University Medical Center, 1750 W. Harrison St, Chicago, IL, 60612, USA
| | - Ari S Morgenstern
- Department of Psychiatry, Mount Sinai Morningside and Mount Sinai West, New York City, NY, 10025, USA
| | | | | | - Philip A Omotosho
- Department of Surgery, Rush University Medical Center, 1750 W. Harrison St, Chicago, IL, 60612, USA
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, 1750 W. Harrison St, Chicago, IL, 60612, USA
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