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Paul R, Andersson E, Olbers T, Frisk J, Berterö C. Impact of bariatric surgery on premenopausal women's womanliness: A qualitative systematic review and meta-synthesis. PLoS One 2024; 19:e0308059. [PMID: 39208194 PMCID: PMC11361607 DOI: 10.1371/journal.pone.0308059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Obesity is associated with several co-morbidities in women, including disturbed sex hormone regulation with menstrual disturbances, subfertility, hirsutism, and central fat dispersion, all with an impact on sexual function and quality of life. There are few investigations regarding women's experiences of obesity-related altered sex hormone regulation and resolution after bariatric surgery. OBJECTIVES This systematic review and interpretive meta-synthesis aim to identify the current qualitative knowledge base concerning women undergoing bariatric surgery and experiences of changes after weight loss, emphasising aspects of womanliness. METHODS A systematic review and qualitative meta-synthesis was conducted to gain a deeper and broader understanding of the available knowledge about premenopausal women's experienced changes after bariatric surgery. Relevant papers were identified by systematically searching PubMed, CINAHL, Embase, PsycInfo, PsycArticles, Scopus, Cochrane Library, Web of Science and Open Grey. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol was registered on PROSPERO (CRD42023394225). RESULTS A total of 10 studies were considered relevant and included in the qualitative meta-synthesis. Three fusions were identified and interpreted as: "Womanliness," "A healthy and functioning body," and "Mind and Body Connection." Women experienced a return to womanliness after undergoing bariatric surgery with restored menstruation cycles, improved fertility and changed hair and fat dispersion signalling restored sex hormones. Women value a return to a healthy and functioning body that improves their experience of life and ability to take part in it. However, women experienced difficulties in adapting mentally to the drastic physical changes that occur after undergoing surgery. CONCLUSIONS Women that have undergone bariatric surgery report several benefits to their health and well-being, although difficulties in adapting mentally to changes in outer appearance need to be managed in order to successfully move forward with a new life after surgery.
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Affiliation(s)
- Rebecca Paul
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
- Department of Surgery, Falun County Hospital, Falun, Sweden
- Centre for Clinical Research, Uppsala University, Region Dalarna, Falun, Sweden
| | - Ellen Andersson
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
- Wallenberg Centre for Molecular Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jessica Frisk
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Carina Berterö
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Facchin F, Pagani A, Perozzo FAG, Scarpa C, Bassetto F, Vindigni V. Litigation Cases After Post-Bariatric Surgery: Lesson from the Past. Aesthetic Plast Surg 2023; 47:2479-2485. [PMID: 36820862 PMCID: PMC10784373 DOI: 10.1007/s00266-023-03287-1] [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: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Due to the high demand of post-bariatric surgeries, the number of litigation cases is rapidly growing. Even if surgical mistakes still represent one of the main causes of medico-legal issues, many disputes depend on what happens in the post-operative course. In this article we analyzed the litigation cases that occurred in our Plastic Surgery Department, the current literature about medico-legal disputes and the importance of the doctor-patient relationship. PATIENTS AND METHODS The medical records of 788 post-bariatric surgeries, the post-operative complications and the related litigation cases from January 2015 to December 2019 were collected, analyzed and compared. RESULTS We performed 380 abdominoplasties, 28 torsoplasties, 65 breast reductions, 99 mastopexies, 94 brachioplasties, 52 thighplasties, 65 liposuctions and 5 facelifts between 2015 and 2019. Eight patients complained of medical issues and claimed for litigation. Despite in all cases the judges highlighted the risk of consent misinterpretation, the payout was granted only in one case. CONCLUSION Post-bariatric patients often mistake their preoperative condition and consider body contouring procedures as an aesthetic surgery treatment. Patients should be therefore clearly informed about the complexity of body contouring procedures after massive weight loss, which should never be compared to aesthetic surgery. Surgeons should always promote the communication with their patients and build a strong and trustworthy relationship. This attitude will allow to deal more easily with complications and, in the worst situations, with medico-legal litigations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Federico Facchin
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
- Plastic Surgery Unit, San Bortolo Hospital, 36100, Vicenza, Italy.
| | - Andrea Pagani
- Clinic and Polyclinic of Plastic and Hand Surgery, Technical University of Munich, 81675, Munich, Germany
| | - Filippo Andrea Giovanni Perozzo
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Carlotta Scarpa
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, Department of Neurosciences, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Carbone EA, Aloi M, Rania M, de Filippis R, Quirino D, Fiorentino TV, Segura-Garcia C. The relationship of food addiction with binge eating disorder and obesity: A network analysis study. Appetite 2023; 190:107037. [PMID: 37714336 DOI: 10.1016/j.appet.2023.107037] [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: 04/12/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
Food addiction (FA) has been associated with binge eating disorder (BED) and obesity at varying levels of severity and treatment outcomes. Despite much debate and scientific interest in FA, the mechanisms that underlie its co-occurrence with both conditions are not yet well understood. In order to understand this relationship, this study explores FA in a clinical sample of individuals with BED and obesity using network analysis (NA). A total of 303 patients (151 with BED and 152 with obesity) completed a battery of tests that investigated eating psychopathology, eating behaviours, emotional dysregulation, depression and FA. Two different NAs were conducted to investigate the interaction between these variables and FA. The BED and obesity groups were comparable in age (38 ± 14 vs. 42 ± 13 years), body mass index (38.8 ± 8.5 vs 42.4 ± 7.8), sex and demographics. According to the expected influence values, binge eating severity and depression were identified as the central nodes in both networks. In the BED group, binge eating severity was the central node and showed strong connections to both FA and grazing. In contrast, in the obesity group, depression was the central node, but its connections were weak, with only marginal associations to FA. These results suggest that FA represents an important and distinct construct of the two populations. In patients with BED, FA is intimately connected to other loss-of-control-related eating behaviours, such as binge eating and grazing. Conversely, in those with obesity, depression explains the relationship of FA with pathological eating behaviours. The presence of FA seems to be a distinguishing characteristic in the psychopathology of patients suffering from obesity with and without BED, and this could have implications for the prevention, treatment and management of these disorders.
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Affiliation(s)
- Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Matteo Aloi
- Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy; Department of Health Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Marianna Rania
- Center for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, 88100, Catanzaro, Italy
| | - Renato de Filippis
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Daria Quirino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy; Center for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, 88100, Catanzaro, Italy.
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Konings G, Drukker M, Severeijns R, Ponds R. The complexity of obesity-related health problems after bariatric surgery: The patient perspective. OBESITY PILLARS (ONLINE) 2023; 7:100082. [PMID: 37990685 PMCID: PMC10661984 DOI: 10.1016/j.obpill.2023.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 11/23/2023]
Abstract
Background Bariatric surgery aims to improve quality of life by means of weight loss. Obesity-related physical and psychological health problems should improve, but long-term data are scarce. Objectives To evaluate preoperative physical and mental health problems perceived by the patient and the association with weight loss and quality of life, 5 years after bariatric surgery. Methods 101 persons (response rate 67%) who had had bariatric surgery an average of 4.6 years before this study completed a written survey on obesity-related physical and psychological health problems and three psychological questionnaires collecting information on eating behavior and quality of life. Over half of the participants (55%) had had a laparoscopic adjustable gastric banding. Results Preoperatively reported health problems improved but were not necessarily associated with weight loss. Minimal improvement in tiredness, shame and weight instability were associated with significantly less weight loss. Preoperative type 2 diabetes mellitus (T2D) improved but participants had significantly less weight loss and more dissatisfaction regarding the bariatric trajectory than participants without T2D. Eating concerns, emotional eating and external eating improved but not restrained eating. Compared to the Dutch population reference, most quality of life scores of the participants were lower. Conclusion In this analysis, participants did report satisfaction although from a patients' perspective, improvements of weight and health did not necessarily lead to satisfaction regarding the bariatric trajectory. Participants with postoperative reported fatigue and shame as well as participants with preoperative T2D showed significant less weight loss. More long-term research is necessary to close the current knowledge gap.
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Affiliation(s)
- G Konings
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, the Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - M Drukker
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, the Netherlands
| | - R Severeijns
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, the Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - R Ponds
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience (MHeNS), Maastricht University, the Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
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Association between Fecal Microbiota, SCFA, Gut Integrity Markers and Depressive Symptoms in Patients Treated in the Past with Bariatric Surgery-The Cross-Sectional Study. Nutrients 2022; 14:nu14245372. [PMID: 36558532 PMCID: PMC9781380 DOI: 10.3390/nu14245372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Depressive symptoms often appear after surgical treatment. (2) Methods: We involved 41 adults who underwent bariatric surgery a minimum of 6 months before the study and had the Beck scale ≥12. We analysed patients' mental state, gut barrier markers, faecal short chain fatty acids, and microbiota. (3) Results: Gut microbiota composition differed significantly among patients undergoing two different types of surgery (F = 1.64, p = 0.00002). Additionally, we discovered an association between short chain fatty acids and the Beck scale (F = 1.22, p = 0.058). The rearrangement of bacterial metabolites may be due to the patients' use of increased dietary protein, with insufficient intake of products containing vegetable fiber (Diet Quality Index (DQI-I )adequacy 22.55 (±3.46) points). (4) Conclusions: Bariatric surgery affects the gut microbiota, which may play an important role in the development of depressive and gastrointestinal symptoms in patients after bariatric surgery. Low fiber consumption and increased levels of faecal isobutyric acid may lead to intestinal inflammation. There is a need for further research on this topic including a larger sample size.
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Bosc L, Mathias F, Monsaingeon M, Gronnier C, Pupier E, Gatta-Cherifi B. Long-term changes in body image after bariatric surgery: An observational cohort study. PLoS One 2022; 17:e0276167. [PMID: 36477002 PMCID: PMC9728839 DOI: 10.1371/journal.pone.0276167] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While body image improves in the first few months after surgery, data on long-term changes in body image after bariatric surgery are scarce and contradictory. METHODS We assessed body image through the Stunkard Figure Rating Scale and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale, which measures appearance evaluation and orientation, overweight preoccupation, and self-classified weight. Surveys were conducted before surgery and at regular intervals until 5 years after bariatric surgery. RESULTS 61 patients were included in the study. No patients were lost to follow-up until 18 months after bariatric surgery. At 5 years, there were 21 patients (34%) lost to follow-up. We detected an overall improvement in body image until 12-18 months post-surgery. Scores declined after 5 years post-surgery but were still higher than preoperative evaluations. Overweight preoccupation did not change throughout the follow-up period. There was a positive correlation between body weight lost and appearance evaluation. There was also a positive correlation between weight loss and the Body Areas Satisfaction Scale. There was a negative correlation between weight loss and overweight preoccupation. Appearance orientation and self-classified weight were not correlated with weight loss. CONCLUSIONS Body image improved after bariatric surgery but was not maintained for all 5 years after surgery.
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Affiliation(s)
- Laurène Bosc
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Flore Mathias
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Maud Monsaingeon
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Caroline Gronnier
- Digestive Surgery Department, Bordeaux University Hospital, Pessac, France
- University of Bordeaux, Bordeaux, France
| | - Emilie Pupier
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
| | - Blandine Gatta-Cherifi
- Endocrinology Department, Bordeaux University Hospital, Pessac, France
- University of Bordeaux, Bordeaux, France
- Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, University of Bordeaux, U1215, Bordeaux, France
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Body Image and Body Mass Index Influence on Psychophysical Well-Being in Bariatric Patients: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12101597. [PMID: 36294736 PMCID: PMC9604850 DOI: 10.3390/jpm12101597] [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: 09/05/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Psychophysical factors may have an impact on the disease of obesity, and it is important to explore which aspects may play an important role on the well-being of obese patients undergoing bariatric surgery. The purpose of this study was to assess the associations of a high body mass index (BMI) and greater dissatisfaction with body image with higher levels of psychopathological aspects, feelings of hopelessness, and psychological and physical health in patients undergoing evaluation for bariatric surgery. Methods: Fifty-nine patients undergoing bariatric surgery filled out the Symptom Checklist-90-Revised, the Body Uneasiness Test, the 12-item Short Form Survey, the Beck Inventory Scale II, and the Beck Hopelessness Scale. Correlations and hierarchical regressions between measures were performed. Results: Dissatisfaction with the perception of one’s own body image was strongly correlated with a worse psychophysiological health. On the contrary, BMI showed no significant correlation with the previous variables. Furthermore, the perception of one’s own body image significantly predicted the state of psychological health. Conclusions: The findings showed a more relevant role of body image compared to the BMI in the association with psychological outcomes, suggesting the importance of considering body image in the assessment and treatment of obese patients requiring bariatric treatment.
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Gordon EL, Terrill AL, Smith TW, Ibele AR, Martinez P, McGarrity LA. Overvaluation of Shape and Weight (Not BMI) Associated with Depressive Symptoms and Binge Eating Symptoms Pre- and Post-bariatric Surgery. Obes Surg 2022; 32:2272-2279. [DOI: 10.1007/s11695-022-06062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
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Yokoyama H, Nozaki T, Nishihara T, Sawamoto R, Komaki G, Sudo N. Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy. Front Psychiatry 2022; 13:1025946. [PMID: 36339837 PMCID: PMC9634420 DOI: 10.3389/fpsyt.2022.1025946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss. OBJECTIVE The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss. METHODS One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m2, age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires. RESULTS Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID. CONCLUSION Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID. CLINICAL TRIAL REGISTRATION [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Nozaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Tomoe Nishihara
- Department of Psychosomatic Medicine, National Hospital Organization Fukuoka Higashi Medical Center, Koga, Japan
| | - Ryoko Sawamoto
- Department of Psychosomatic Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Gen Komaki
- Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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