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Saiyalam C, Shantavasinkul PC, Chirnaksorn S, Rattanakaemakorn P, Taonam N, Rodphech V, Putadechakum S, Rattanasiri S, Sirivarasai J, Ongphiphadhanakul B, Sumritpradit P. Effects of Very Low-Calorie Diet versus Roux-en-Y Gastric Bypass Surgery on Body Composition in Patients with Obesity. Nutrients 2024; 16:2407. [PMID: 39125287 PMCID: PMC11313779 DOI: 10.3390/nu16152407] [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: 05/08/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is the most effective treatment for severe obesity. A very low-calorie diet (VLCD) is another effective dietary intervention to treat obesity. This study evaluated the effect of a VLCD versus RYGB on weight reduction, changes in body composition and the resolution of comorbidities during a 12-week period. Individuals with obesity at the obesity clinic, Ramathibodi Hospital, Mahidol University, Thailand with a body mass index (BMI) ≥ 37.5 kg/m2 or ≥32.5 kg/m2 with obesity-related complications were recruited. Treatment options, either RYGB or VLCD, were assigned depending on patients' preferences and physicians' judgment. The analysis included 16 participants in the RYGB group and 15 participants in the VLCD group. Baseline characteristics were similar between groups; nevertheless, the participants in the VLCD group were significantly younger than those in the RYGB group. The number of patients with type 2 diabetes (T2D) was slightly higher in the RYGB group (43.8% vs. 33.3%, p = 0.552). Additionally, patients in the RYGB group had a longer duration of T2D and were treated with anti-diabetic agents, while VLCD patients received only lifestyle modifications. At 12 weeks, total and percentage weight loss in the RYGB and VLCD groups, respectively, were as follows: -17.6 ± 6.0 kg vs. -15.6 ± 5.1 kg (p = 0.335) and -16.2% ± 4.3% vs. -14.1% ± 3.6% (p = 0.147). Changes in biochemical data and the resolution of comorbidities were similar between the groups at 12 weeks. A 12-week VLCD resulted in similar weight loss and metabolic improvement compared with RYGB. Large-scale studies with long follow-up periods are needed to elucidate whether VLCD is a viable alternative treatment to bariatric surgery.
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Affiliation(s)
- Chanawit Saiyalam
- Doctor of Philosophy Program in Nutrition, Faculty of Medicine Ramathibodi Hospital and Institute of Nutrition, Mahidol University, Bangkok 10400, Thailand;
| | - Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Supphamat Chirnaksorn
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Ploysyne Rattanakaemakorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Naphat Taonam
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Vorachat Rodphech
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Supanee Putadechakum
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.T.); (V.R.); (S.P.)
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Jintana Sirivarasai
- Graduate Program in Nutrition, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Boonsong Ongphiphadhanakul
- Division of Endocrine and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Preeda Sumritpradit
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
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Srinivasan N, Samaan JS, Rajeev ND, Kanu MU, Yeo YH, Samakar K. Large language models and bariatric surgery patient education: a comparative readability analysis of GPT-3.5, GPT-4, Bard, and online institutional resources. Surg Endosc 2024; 38:2522-2532. [PMID: 38472531 PMCID: PMC11078810 DOI: 10.1007/s00464-024-10720-2] [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: 10/04/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The readability of online bariatric surgery patient education materials (PEMs) often surpasses the recommended 6th grade level. Large language models (LLMs), like ChatGPT and Bard, have the potential to revolutionize PEM delivery. We aimed to evaluate the readability of PEMs produced by U.S. medical institutions compared to LLMs, as well as the ability of LLMs to simplify their responses. METHODS Responses to frequently asked questions (FAQs) related to bariatric surgery were gathered from top-ranked health institutions. FAQ responses were also generated from GPT-3.5, GPT-4, and Bard. LLMs were then prompted to improve the readability of their initial responses. The readability of institutional responses, initial LLM responses, and simplified LLM responses were graded using validated readability formulas. Accuracy and comprehensiveness of initial and simplified LLM responses were also compared. RESULTS Responses to 66 FAQs were included. All institutional and initial LLM responses had poor readability, with average reading levels ranging from 9th grade to college graduate. Simplified responses from LLMs had significantly improved readability, with reading levels ranging from 6th grade to college freshman. When comparing simplified LLM responses, GPT-4 responses demonstrated the highest readability, with reading levels ranging from 6th to 9th grade. Accuracy was similar between initial and simplified responses from all LLMs. Comprehensiveness was similar between initial and simplified responses from GPT-3.5 and GPT-4. However, 34.8% of Bard's simplified responses were graded as less comprehensive compared to initial. CONCLUSION Our study highlights the efficacy of LLMs in enhancing the readability of bariatric surgery PEMs. GPT-4 outperformed other models, generating simplified PEMs from 6th to 9th grade reading levels. Unlike GPT-3.5 and GPT-4, Bard's simplified responses were graded as less comprehensive. We advocate for future studies examining the potential role of LLMs as dynamic and personalized sources of PEMs for diverse patient populations of all literacy levels.
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Affiliation(s)
- Nitin Srinivasan
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nithya D Rajeev
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Mmerobasi U Kanu
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA.
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Bettis T, Lewis M, Wang R, Gillis A, Zmijewski P, McLeod M, Fazendin J, Lindeman B, Chen H. An Evaluation of Health Literacy in Patients Undergoing Surgical Evaluation for Thyroid Disease. J Surg Res 2024; 295:81-88. [PMID: 37995419 DOI: 10.1016/j.jss.2023.10.007] [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: 03/21/2022] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Health literacy (HL) is the ability to comprehend and apply health information to make informed health-care decisions. Poor HL results in the inability to provide informed consent, medication noncompliance, inconsistent follow-up, and delayed seeking of care. Data about HL in endocrine surgery is currently lacking. In this study, we aimed to evaluate the HL of patients with thyroid disease and identify risk factors for limited HL. METHODS We evaluated a total of 172 patients with thyroid disease in a single endocrine surgery clinic. HL was determined by the Brief Health Literacy Screening Tool, a validated HL screening questionnaire in which patient scores correlate to limited, marginal, or adequate HL. Demographic data including age, sex, race, diagnosis, employment status, and median annual income were obtained. Analysis of variance, t-test, and Chi-square test were used to compare HL between and within each demographic domain. P < 0.05 was considered significant. RESULTS Of the 172 patients, 77% had adequate HL, 16% had marginal HL, and 7% had limited HL. Patients with higher education exhibited greater HL (P < 0.001). Ninety-three percent of patients with college/postgraduate degree had adequate HL, while of those with some college only 79% had adequate HL and of those with high school or less only 48.6% had adequate HL. There was minimal variation among age, sex, race, diagnosis, employment status, or income. CONCLUSIONS Most patients with thyroid diseases from the endocrine surgery clinic at our institution have adequate HL. Limited education is a risk factor for low HL.
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Affiliation(s)
- Tucker Bettis
- University of Alabama at Birmingham, Birmingham, Alabama.
| | - Marshall Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronghzi Wang
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrea Gillis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Herbert Chen
- University of Alabama at Birmingham, Birmingham, Alabama
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Lucy AT, Rakestraw SL, Stringer C, Chu D, Grams J, Stahl R, Mustian MN. Readability of patient education materials for bariatric surgery. Surg Endosc 2023:10.1007/s00464-023-10153-3. [PMID: 37277519 DOI: 10.1007/s00464-023-10153-3] [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: 04/09/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Bariatric surgery is a successful treatment for obesity, but barriers to surgery exist, including low health literacy. National organizations recommend patient education materials (PEM) not exceed a sixth-grade reading level. Difficult to comprehend PEM can exacerbate barriers to bariatric surgery, especially in the Deep South where high obesity and low literacy rates exist. This study aimed to assess and compare the readability of webpages and electronic medical record (EMR) bariatric surgery PEM from one institution. METHODS Readability of online bariatric surgery and standardized perioperative EMR PEM were analyzed and compared. Text readability was assessed by validated instruments: Flesch Reading Ease Formula (FRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog (GF), Coleman-Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations and compared using unpaired t-tests. RESULTS 32 webpages and seven EMR education documents were analyzed. Webpages were overall "difficult to read" compared to "standard/average" readability EMR materials (mean FRE 50.5 ± 18.3 vs. 67.4 ± 4.2, p = 0.023). All webpages were at or above high school reading level: mean FKGL 11.8 ± 4.4, GF 14.0 ± 3.9, CL 9.5 ± 3.2, SMOG 11.0 ± 3.2, ARI 11.7 ± 5.1, and LWF 14.9 ± 6.6. Webpages with highest reading levels were nutrition information and lowest were patient testimonials. EMR materials were sixth to ninth grade reading level: FKGL 6.2 ± 0.8, GF 9.3 ± 1.4, CL 9.7 ± 0.9, SMOG 7.1 ± 0.8, ARI 6.1 ± 1.0, and LWF 5.9 ± 0.8. CONCLUSION Surgeon curated bariatric surgery webpages have advanced reading levels above recommended thresholds compared to standardized PEM from an EMR. This readability gap may unintentionally contribute to barriers to surgery and affect postoperative outcomes. Streamlined efforts are needed to create materials that are easier to read and comply with recommendations.
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Affiliation(s)
- Adam Timothy Lucy
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA.
- UAB Department of Surgery, 1808 7th Ave South, Boshell Diabetes Building, Suite 202, Birmingham, AL, 35233, USA.
| | - Stephanie L Rakestraw
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Courtney Stringer
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Daniel Chu
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
- Surgical Services, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - Richard Stahl
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Margaux N Mustian
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
- Surgical Services, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
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Samaan JS, Yeo YH, Rajeev N, Hawley L, Abel S, Ng WH, Srinivasan N, Park J, Burch M, Watson R, Liran O, Samakar K. Assessing the Accuracy of Responses by the Language Model ChatGPT to Questions Regarding Bariatric Surgery. Obes Surg 2023; 33:1790-1796. [PMID: 37106269 PMCID: PMC10234918 DOI: 10.1007/s11695-023-06603-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE ChatGPT is a large language model trained on a large dataset covering a broad range of topics, including the medical literature. We aim to examine its accuracy and reproducibility in answering patient questions regarding bariatric surgery. MATERIALS AND METHODS Questions were gathered from nationally regarded professional societies and health institutions as well as Facebook support groups. Board-certified bariatric surgeons graded the accuracy and reproducibility of responses. The grading scale included the following: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Reproducibility was determined by asking the model each question twice and examining difference in grading category between the two responses. RESULTS In total, 151 questions related to bariatric surgery were included. The model provided "comprehensive" responses to 131/151 (86.8%) of questions. When examined by category, the model provided "comprehensive" responses to 93.8% of questions related to "efficacy, eligibility and procedure options"; 93.3% related to "preoperative preparation"; 85.3% related to "recovery, risks, and complications"; 88.2% related to "lifestyle changes"; and 66.7% related to "other". The model provided reproducible answers to 137 (90.7%) of questions. CONCLUSION The large language model ChatGPT often provided accurate and reproducible responses to common questions related to bariatric surgery. ChatGPT may serve as a helpful adjunct information resource for patients regarding bariatric surgery in addition to standard of care provided by licensed healthcare professionals. We encourage future studies to examine how to leverage this disruptive technology to improve patient outcomes and quality of life.
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Affiliation(s)
- Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Nithya Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Lauren Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Stuart Abel
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Wee Han Ng
- Bristol Medical School, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Justin Park
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Rabindra Watson
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Omer Liran
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
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Zhang Y, Zhang H, Li S, Li Y, Hu C, Li H. Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients. BMC Nutr 2022; 8:101. [PMID: 36096877 PMCID: PMC9465139 DOI: 10.1186/s40795-022-00594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background With the accelerated pace of people’s life and the changing dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today’s society. The speedily rising hypertensive patients have become one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. Currently, there is a lack of local assessment tools for low salt consumption in mainland China. Objective To develop a short-form version of the Chinese Health Literacy Scale For Low Salt Consumption instrument for use in mainland China. Methods A cross-sectional design was conducted on a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in the diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test-retest reliability. Results The CHLSalt-22 demonstrated adequate internal consistency, good test-retest reliability, satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS). Conclusion The results indicate that the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) version has good reliability and validity and can be considered a tool to assess health literacy related to salt consumption in health screenings.
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Cantay H, Binnetoglu K, Gul HF, Bingol SA. Investigation of serum and adipose tissue levels of asprosin in patients with severe obesity undergoing sleeve gastrectomy. Obesity (Silver Spring) 2022; 30:1639-1646. [PMID: 35844162 DOI: 10.1002/oby.23471] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to reveal the relationship between obesity and asprosin (fibrillin-1) in patients undergoing bariatric surgery and to investigate the role of asprosin in obesity etiopathogenesis. METHODS The study included 37 patients who underwent laparoscopic sleeve gastrectomy for severe obesity and 37 patients who underwent laparoscopic cholecystectomy for cholelithiasis in the study and control groups, respectively. Blood samples were collected from the patients in the preoperative period to measure biochemical parameters. Blood samples were collected at 6 months postoperatively from the patients in the study group to compare their pre- and postoperative serum asprosin levels. RESULTS A significant intergroup difference in terms of mean asprosin levels in adipose tissue was noted (p = 0.001). A comparison of preoperative and postoperative 6-month serum asprosin levels in the study group showed significant differences (p = 0.021). The area under the curve of asprosin tissue levels was 78.1%, and the cutoff value was 217.34 ng/g of protein, with a sensitivity and specificity of 73.0%. Tissue levels of asprosin were found to increase the risk of obesity by a factor of 1.018 (odds ratio; 95% CI: 1.008-1.027). CONCLUSIONS Serum asprosin levels decreased significantly at 6 months after bariatric surgery. Adipose tissue of patients with obesity showed high asprosin levels and immunoreactivity. In conclusion, asprosin levels in adipose tissue were considered a potential independent risk factor in obesity etiopathogenesis.
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Affiliation(s)
- Hasan Cantay
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Kenan Binnetoglu
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Huseyin Fatih Gul
- Department of Medical Biochemistry, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Seyit Ali Bingol
- Department of Histology and Embryology, Kafkas University Faculty of Medicine, Kars, Turkey
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Breuing J, Könsgen N, Doni K, Neuhaus AL, Pieper D. Information needs of patients undergoing bariatric surgery in Germany: a qualitative study. BMC Health Serv Res 2022; 22:515. [PMID: 35436895 PMCID: PMC9017015 DOI: 10.1186/s12913-022-07950-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/08/2022] [Indexed: 12/21/2022] Open
Abstract
Background Obesity is a worldwide problem with different treatment options. Bariatric surgery is an effective treatment for severe obesity; however, it leads to drastic changes (e.g., changes in everyday life and eating behavior) for patients, which may lead to information needs. Our aim was to identify the information needs of patients undergoing bariatric surgery and to explore the information provision within the healthcare process of bariatric surgery in Germany. Methods We conducted a qualitative study (n = 14 single, semi-structured telephone interviews) between April 2018 and April 2019. The interview guide was designed prior to the interviews and consisted of four main sections (demographic information, pre-/postoperative healthcare provision, information needs). The interviews were transcribed verbatim and analyzed using qualitative content analysis with MAXQDA software. Results There were unmet information needs with two factors (time: pre/postoperative and categories of information: general/specific) to be considered. Due to the patients’ description of information, we categorized information into general (different surgical procedures, general nutritional information) and specific (occurring simultaneously with a problem) information. Most patients felt well informed concerning general information. However, it was pointed out that it was not possible to provide complete information preoperatively, as the need for information only arises when there are postoperative (specific) problems. In addition, there seems to be a high demand for specific postoperative information regarding nutrition and nutrition-related problems. However, patients stated that postoperative nutritional counseling is not reimbursed by health insurance funds. The information conveyed in support groups and the exchange of experiences are highly valued by patients. However, some patients describe the information provided within the support groups as unfiltered, frightening or exaggerated. Conclusion Overall, there were unmet information needs. Reimbursement by health insurance funds could increase the use of postoperative nutritional counseling and thus serve existing information needs. Support groups enable an exchange of experiences and therefore offer low-barrier access to information. Cooperation between support groups and healthcare professionals in information provision could be an approach to improving existing information needs or to avoiding the development of information gaps. Furthermore, the development and implementation of a digital solution for (postoperative) information dissemination could be helpful. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07950-2.
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Affiliation(s)
- Jessica Breuing
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Herdecke University, WittenWitten, Germany.
| | - Nadja Könsgen
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Herdecke University, WittenWitten, Germany
| | - Katharina Doni
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Herdecke University, WittenWitten, Germany
| | - Annika Lena Neuhaus
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Herdecke University, WittenWitten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Department for Evidence Based Health Service Research, Faculty of Health, Department of Medicine, Herdecke University, WittenWitten, Germany.,Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Brandenburg, Germany.,Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Brandenburg, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg, Germany
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Adherence to Medical Appointments Among Patients Undergoing Bariatric Surgery: Do Health Literacy, Health Numeracy, and Cognitive Functioning Play a Role? Obes Surg 2022; 32:1391-1393. [PMID: 35061155 DOI: 10.1007/s11695-022-05905-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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Jaensson M, Stenberg E, Liang Y, Nilsson U, Dahlberg K. Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study. BMJ Open 2021; 11:e056592. [PMID: 34848528 PMCID: PMC8634233 DOI: 10.1136/bmjopen-2021-056592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery. DESIGN A prospective cross-sectional psychometric study. SETTING Patients from three bariatric centres in Sweden were consecutively included in this study. PARTICIPANTS A total of 704 patients undergoing bariatric surgery filled in the questionnaires preoperatively. Inclusion criteria were scheduled for primary bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) and greater than 17 years, proficiency in Swedish. PRIMARY AND SECONDARY MEASURES Psychometric outcomes of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale. RESULTS There was a higher proportion of females (74.4%, n=523) to males (25.6%, n=180). The mean age was 42 years (SD 11.5). Limited functional health literacy and limited communicative and critical health literacy (including both inadequate and problematic health literacy) was reported in 55% (n=390) and 40% (n=285), respectively. Cronbach alpha for the Swedish Functional Health Literacy scale was α=0.86 and for the Swedish Communicative and Critical Health Literacy scale, α=0.87. Construct validity showed weak to negative correlations between the Swedish Functional Health Literacy scale and income, education and SF-36/RAND36 summary scores. Confirmatory factor analysis showed a one-factor solution for the Swedish Functional Health Literacy scale and a two-factor solution for the Swedish Communicative and Critical Health Literacy scale. CONCLUSIONS The Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale are valid and reliable to use for patients undergoing bariatric surgery in a Swedish context. Measuring dimensions of health literacy can be used as a guide for the development of health literacy friendly patient information in patients undergoing bariatric surgery.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro university, Örebro, Sweden
| | - Yuli Liang
- Department of Statistics, School of Business, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Breuing J, Könsgen N, Doni K, Neuhaus AL, Pieper D. Healthcare delivery and information provision in bariatric surgery in Germany: qualitative interviews with bariatric surgeons. BMC Health Serv Res 2021; 21:659. [PMID: 34225715 PMCID: PMC8258934 DOI: 10.1186/s12913-021-06629-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background There are several healthcare professionals involved in health information provision regarding bariatric surgery, such as bariatric surgeons, nutritionists, and medical doctors in outpatient settings. Trustworthy health information supports patients in understanding their diagnosis, treatment decisions, and possible prognosis. Therefore, it is necessary to provide health information on bariatric surgery. This study has two distinct objectives. The first is to outline the delivery of healthcare regarding bariatric surgery in Germany. The second is to describe the information provision within healthcare delivery. Methods We conducted 15 semi-structured telephone interviews with bariatric surgeons between April 2018 and February 2019. The interviews were audio recorded and transcribed verbatim. The interview guide consisted of four sections (information about the clinic/surgeon and surgical procedures, preoperative procedure, postoperative procedure, information needs). The transcribed interviews were analyzed using qualitative content analysis supported by MAXQDA software. Results The pre- and postoperative processes differed substantially between clinics. Additionally, every bariatric clinic had its own information provision concept. There were several cost-related issues the surgeons claimed to be relevant for patients, such as nutritional blood tests or postoperative psychotherapy. These issues were often caused by unclearness of responsibility within the medical disciplines involved. Conclusion Healthcare delivery in bariatric surgery in Germany is heterogeneous in terms of pre- and postoperative care. Therefore, preoperative information provision between the clinics differs. The impact of this heterogeneous healthcare delivery and information provision on patients’ information needs regarding bariatric surgery should be further investigated among patients and other healthcare professionals involved. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06629-4.
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Affiliation(s)
- Jessica Breuing
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany.
| | - Nadja Könsgen
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany
| | - Katharina Doni
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany
| | - Annika Lena Neuhaus
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany
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What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review. Obes Surg 2021; 31:3833-3847. [PMID: 34002289 DOI: 10.1007/s11695-021-05394-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
Percentage total weight loss (%TWL) might be better than percentage excess weight loss to express weight loss in bariatric surgery. In this systematic review, performed according to the PRISMA statement, results of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are assessed in %TWL. A total of 13,426 studies were screened and 49 included, reporting data of 24,760 patients. The results show that, despite limiting data, LRYGB is favorable over LSG in terms of weight loss in short-term follow-up. Although recent guidelines recommend to use %TWL when reporting outcome in bariatric surgery, this study shows that there is still insufficient quality data in %TWL, especially on LSG. The use of %TWL as the primary outcome measure in bariatric surgery should be encouraged.
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Chrissini MK, Panagiotakos DB. Health literacy as a determinant of childhood and adult obesity: a systematic review. Int J Adolesc Med Health 2021; 33:9-39. [PMID: 33592684 DOI: 10.1515/ijamh-2020-0275] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess whether Health Literacy (HL) acts as a determinant of obesity in adults and children by synthesizing the results of recent scientific evidence. CONTENT This is a systematic qualitative review following the MOOSE guidelines. A systematic, computer-assisted literature search via PubMed scientific database, between January 1st, 2000, and September 30th 2020, was conducted. Only cross-sectional epidemiologic research studies that were published in the English language, investigating HL's possible role as a determinant of childhood and adult obesity, were included. SUMMARY After screening 725 citations from the PubMed database, 39 (n=39) studies in total were included in this literature review; Four (n=4) studies were conducted in the children population, seven (n=7) studies were performed in children-parent/caregiver dyads, and 28 studies (n=28) enrolled adults. There is significant evidence that HL knowledge and skills determine the consequent management of obesity and BMI rates in children and adult populations. OUTLOOK Despite policies and action plans put in place by countries globally, overweight and obesity continue to be a pressing public health issue and one of the critical drivers of non-communicable diseases, constituting a health, social and economic burden worldwide. Health Literacy as an essential health policy and promotion agenda item and a critical empowerment strategy could increase children's and adults' control over their overall health and awareness to overcome obesity issues. Initiatives to improve HL levels could be useful tools in managing the obesity epidemic, starting from integrating HL in the school curriculum and further in family and community action plans.
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Affiliation(s)
- Maria K Chrissini
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Biostatistics, Medical Research Methods & Epidemiology, Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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15
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Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery. Surg Endosc 2020; 35:5774-5786. [DOI: 10.1007/s00464-020-08066-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
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16
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Raman J, Spirou D, Jahren L, Eik-Nes TT. The Clinical Obesity Maintenance Model: A Theoretical Framework for Bariatric Psychology. Front Endocrinol (Lausanne) 2020; 11:563. [PMID: 32903696 PMCID: PMC7438835 DOI: 10.3389/fendo.2020.00563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Ranked highly in its association with serious medical comorbidities, obesity, a rapidly growing epidemic worldwide, poses a significant socio-economic burden. While bariatric procedures offer the most efficacious treatment for weight loss, a subset of patients risk weight recidivism. Due to the heterogeneity of obesity, it is likely that there are phenotypes or sub-groups of patients that require evidence-based psychological support to produce more sustainable outcomes. So far, however, characteristics of patients have not led to a personalized treatment algorithm for bariatric surgery. Maintenance of weight loss following bariatric surgery requires long-term modification of eating behaviors and physical activity. A recent Clinical Obesity Maintenance Model (COMM) proposed a conceptual framework of salient constructs, including the role of habit, behavioral clusters, emotion dysregulation, mood, health literacy, and executive function as interconnected drivers of obesity maintaining behaviors relevant to the field of bariatric psychology. The primary aim of this concise review is to bring together emerging findings from experimental and epidemiological studies relating to the COMM constructs that may inform the assessment and follow up of bariatric surgery. We also aim to explain the phenotypes that need to be understood and screened prior to bariatric surgery to enable better pre-surgery intervention and optimum post-surgery response.
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Affiliation(s)
- Jayanthi Raman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Dean Spirou
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisbeth Jahren
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU–Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway
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Perez NP, Stanford FC, Chang DC. Comment on: Socioecological factors associated with metabolic and bariatric surgery utilization: a qualitative study in an ethnically diverse sample. Surg Obes Relat Dis 2020; 16:795-797. [PMID: 32305318 DOI: 10.1016/j.soard.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Numa P Perez
- Healthcare Innovation Research Fellow, Healthcare Transformation Lab, Department of Surgery, Massachusetts General Surgery, Boston, Massachusetts
| | - Fatima Cody Stanford
- Division of Endocrinology-Neuroendocrine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Chang
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts
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