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Wu TCH, He W, Dharmasena I, Prior HJ, Vergis A, Hardy K. Prescription drug usage as measure of comorbidity resolution after bariatric surgery: a population-based cohort study. Surg Endosc 2023; 37:8601-8610. [PMID: 37491659 DOI: 10.1007/s00464-023-10294-5] [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: 04/06/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Obesity is a chronic and progressive disease associated with significant morbidity, mortality, and health-care costs. Bariatric surgery is the most effective intervention for sustainable weight loss and resolution of obesity-related comorbidities. Studies examining comorbidity resolution largely rely on individual self-reported outcomes and electronic record reviews. We present a population-based study looking at prescription medication utilization before and after bariatric surgery as a measure of comorbidity resolution. METHODS All patients enrolled in the Center for Metabolic and Bariatric Surgery who underwent either gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Demographic information, follow up, and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy for 5 years pre- and post-surgery. RESULTS A total of 1184 patients were included. Antidepressants and selective serotonin reuptake inhibitors were the most commonly prescribed classes, and along with thyroid medication, utilization remained stable after bariatric surgery. Proton pump inhibitors and opioid class drugs increased at 1 year after surgery then returned to baseline. Glucose and lipid-lowering medications, including statins, biguanides, sulfonylureas, and insulin, were decreased. Antihypertensives, including ACE inhibitors, calcium channel blockers, angiotensin receptors blockers, thiazides, and beta blockers, similarly decreased. CONCLUSION This is the first Canadian study employing a provincial-wide prescription database to measure long-term comorbidity resolution after bariatric surgery. The use of administrative data eliminates potential biases and inaccuracies in follow up and self-reported outcomes. Consistent with the literature, prescriptions for the treatment of metabolic syndrome all decreased and were sustained at long-term follow up. Further studies are needed to delineate the effects of altered pharmaceutical utilization on patient quality of life and health-care expenditures.
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Affiliation(s)
- Ted Chia Hao Wu
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Wenjing He
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Isuru Dharmasena
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Ashley Vergis
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Department of Surgery, Max Rady College of Medicine, Boniface General Hospital, University of Manitoba, Z3039 - 409 Tache Avenue, St., Winnipeg, MB, R2H 2A6, Canada.
| | - Krista Hardy
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Murtha JA, Alagoz E, Breuer CR, Eierman L, Jawara D, Farrar-Edwards D, Voils CI, Funk LM. Impact of COVID-19 on the Postoperative Bariatric Surgery Patient Experience. Ann Surg 2023; 277:e745-e751. [PMID: 35794783 DOI: 10.1097/sla.0000000000005446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize patient and provider perceptions of the impact of coronavirus disease 2019 (COVID-19) on weight loss following bariatric surgery. BACKGROUND COVID-19 has disrupted routines and healthcare throughout the United States, but its impact on bariatric surgery patients' postoperative experience is unknown. METHODS Semistructured interviews with bariatric surgery patients, primary care providers, and health psychologists were conducted from April to November 2020. As part of a secondary analysis, patients and providers described how the COVID-19 pandemic affected the postoperative experience within 3 domains: dietary habits, physical activity, and follow-up care. Interview guides were created from 2 conceptual models: Torain's Surgical Disparities Model and Andersen's Behavioral Model of Health Services Use. Study team members derived codes, which were grouped into themes using conventional content analysis. RESULTS Thirty-four participants were interviewed: 24 patients (12 Roux-en-Y gastric bypass and 12 sleeve gastrectomy), 6 primary care providers, and 4 health psychologists. Patients were predominately female (83%) and White (79%). Providers were predominately female (90%) and White (100%). COVID-19 affected the postoperative bariatric surgery patient experience via 3 mechanisms: (1) it disrupted dietary and physical activity routines due to facility closures and fear of COVID-19 exposure; (2) it required patients to transition their follow-up care to telemedicine delivery; and (3) it increased stress due to financial and psychosocial challenges. CONCLUSIONS COVID-19 has exacerbated patient vulnerability. The pandemic is not over, thus bariatric surgery patients need ongoing support to access mental health professionals, develop new physical activity routines, and counteract increased food insecurity.
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Affiliation(s)
- Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
| | - Lindsey Eierman
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
| | - Dawda Jawara
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
| | - Dorothy Farrar-Edwards
- Collaborative Center for Health Equity, University of Wisconsin, Madison, WI
- Department of Medicine, University of Wisconsin Madison School of Education, Madison, WI
| | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
- William S. Middleton Memorial Veterans Administration Hospital, Madison, WI
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, WI
- William S. Middleton Memorial Veterans Administration Hospital, Madison, WI
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Associations of COVID-19 Lockdowns on Eating Behaviors and Body Mass Index in Patients with a History of Bariatric Surgery: a Cross-Sectional Analysis. Obes Surg 2023; 33:1099-1107. [PMID: 36763309 PMCID: PMC9912237 DOI: 10.1007/s11695-023-06460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Few studies have explored the impact of the COVID-19 pandemic on the eating behaviors, dietary quality, and changes in weight of postoperative bariatric surgery patients. METHODS A cross-sectional survey on eating behaviors and attitudes toward food was emailed or given to patients who had bariatric surgery before March 2020. Patient charts were reviewed for weight measures. RESULTS Seventy-five (71.43%) patients experienced weight recurrence with an average increase in body mass index (BMI) of 2.83 kg/m2 (SD: 2.19). The majority of patients reported no symptoms of binge eating (n = 81, 77.14%) with 16 (15.24%) qualifying for loss of control eating (LOCE). LOCE was significantly associated with grazing behavior (p = 0.04), emotional over-eating (p = 0.001), and food responsiveness (p = 0.002). LOCE was negatively associated with dietary quality (p = 0.0009) and satiety responsiveness (p = 0.01). Grazing behavior was significantly associated with emotional over-eating (p < 0.0001) and food responsiveness (p < 0.0001) as well as negatively associated with dietary quality (p < 0.0001). Slow eating was negatively associated with grazing (p = 0.01), emotional over-eating (p = 0.003), and food responsiveness (p < 0.0001). When included in a regression model controlling for age and sex, emotional over-eating was a significant predictor of weight recurrence (β = 0.25; p = 0.04). CONCLUSION Our results suggest that maladaptive eating behaviors contributed to LOCE and poor dietary quality during the COVID-19 pandemic; however, slow eating may be protective against grazing, emotional over-eating, and food responsiveness.
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Salituro N, Landi G, Garelli S, Balsamo F, Rottoli M, Cattivelli R, Tossani E, Grandi S, Pagotto U, Bernante P, Agostini A. The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis. J Psychosom Res 2023; 165:111144. [PMID: 36608506 PMCID: PMC9805045 DOI: 10.1016/j.jpsychores.2022.111144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain. METHODS A total of 67 patients (71.6% female, Mage = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire. RESULTS Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η2 = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6). CONCLUSION Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.
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Affiliation(s)
- N. Salituro
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G. Landi
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy,Corresponding author at: Department of Psychology, University of Bologna, viale Berti Pichat 5, Bologna 40127, Italy
| | - S. Garelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F. Balsamo
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna 40138, Italy
| | - M. Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R. Cattivelli
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - E. Tossani
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - S. Grandi
- Department of Psychology “Renzo Canestrari”, University of Bologna, Italy,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - U. Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - P. Bernante
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - A. Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna 40138, Italy
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Boniecka I, Czerwonogrodzka-Senczyna A, Sekuła M, Zawodny P, Szemitko M, Sieńko M, Sieńko J. The Impact of the COVID-19 Epidemic on the Mood and Diet of Patients Undergoing Bariatric Surgery. Nutrients 2022; 14:nu14142849. [PMID: 35889806 PMCID: PMC9322372 DOI: 10.3390/nu14142849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023] Open
Abstract
Limited social contacts, lack of professional activities, economic insecurity, and a sense of threat, as well as boredom during the COVID-19 pandemic, contributed to tension and stress. All of these increase the risk of an inappropriate diet. The aim of this cross-sectional study was to assess the impact of the COVID-19 pandemic on the mood and nutrition of patients undergoing bariatric surgery. A group of 312 patients (both before and after bariatric surgery) completed a questionnaire about their diet and mood during COVID-19 lockdown. About 70% of all respondents reacted to the epidemiological situation: irritability, anxiety about their own health, and eating without being hungry. A total of 74% of all of the subjects snacked between meals (especially sweets). The respondents who believed that obesity and its complications had a negative impact on the prognosis of the coronavirus infection had a statistically significant higher prevalence of health anxiety, feeling that important life issues were out of control, irritability, need for psychological support, and need for dietary consultation. Patients after bariatric surgery had e.g., a statistically significant lower incidence of feeling hungry, eating after meals, and eating fatty foods. The COVID-19 pandemic has been shown to negatively affect the mood and diet of bariatric patients, which may affect their health status and worsen the prognosis of COVID-19.
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Affiliation(s)
- Iwona Boniecka
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka Str. 27, 01-445 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-572-09-31
| | - Aneta Czerwonogrodzka-Senczyna
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, E Ciołka Str. 27, 01-445 Warsaw, Poland;
| | - Marzena Sekuła
- Interdisciplinary Doctoral School of Social Sciences and Humanities, SWPS University of Social Sciences and Humanities, Chodakowska Str. 19/31, 03-815 Warsaw, Poland;
| | - Piotr Zawodny
- Zawodny Clinic, Ku Słońcu Str. 58, 71-047 Szczecin, Poland;
| | - Marcin Szemitko
- Department of Interventional Radiology, Pomeranian Medical University, Al. Pow. Wielkopolskich Str. 72, 70–111 Szczecin, Poland;
| | - Magdalena Sieńko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University in Szczecin, Unii Lubelskiej Str. 1, 71-252 Szczecin, Poland;
| | - Jerzy Sieńko
- Department of General Surgery and Transpalntation, Pomeranian Medical University, Al. Pow. Wielkopolskich Str. 72, 70–111 Szczecin, Poland;
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Yazıcı D, Fersahoğlu MM, Fersahoğlu T, Bulut NE, Çiğiltepe H, Çeler Ö, Sancak S, Sulu C, Durcan E, Şahin S, Polat Korkmaz Ö, Bozdoğan Polat SH, Taşkın E, İşeri C, Gürsoy E, Küçük Yetgin M, Kaya T, Özdemir F, Mestanoğlu İstanbullu N, Kıyıcı S, Öztürk S, Güngör K, Can B, Sargın M, Tabak Z, Averi S, Nazlı A, Polat Y, Akbas F, Tekin S, Topaloğlu Ö, Boz Uzaldı E, Çatalçam S, Bayraktaroğlu T, Çalıkoğlu BF, Nasifova V, Soyluk Selçukbiricik Ö, Karşıdağ K, Sezer H, Özışık S, Bulut H, Bekdemir B, Deyneli O, Dinçer C, Gogas Yavuz D, İlkova H, Yumuk VD. Status of Weight Change, Lifestyle Behaviors, Depression, Anxiety, and Diabetes Mellitus in a Cohort with Obesity during the COVID-19 Lockdown: Turk-Com Study Group. Obes Facts 2022; 15:528-539. [PMID: 35545017 PMCID: PMC9372476 DOI: 10.1159/000522658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic led to a lockdown period. Confinement periods have been related to unhealthy lifestyle behaviors. Our study aimed to determine weight change, changes in eating and exercise habits, the presence of depression and anxiety, and diabetes mellitus (DM) status in a cohort of patients with obesity. METHODS The study was undertaken in nine centers of Collaborative Obesity Management (COM) of the European Association for the Study of Obesity (EASO) in Turkey. An e-survey about weight change, eating habits, physical activity status, DM status, depression, and anxiety was completed by patients. The International Physical Activity Questionnaire (IPAQ) score was used to determine physical activity in terms of metabolic equivalents (METs). A healthy nutrition coefficient was calculated from the different categories of food consumption. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) Questionnaire were used for determining depression and anxiety, respectively. RESULTS Four hundred twenty-two patients (age 45 ± 12.7 years, W/M = 350/72) were included. The healthy nutrition coefficient before the pandemic was 38.9 ± 6.2 and decreased to 38.1 ± 6.4 during the pandemic (p < 0.001). Two hundred twenty-nine (54.8%) patients gained weight, 54 (12.9%) were weight neutral, and 135 (32.3%) lost weight. Patients in the weight loss group had higher MET scores and higher healthy nutrition coefficients compared with the weight gain and weight-neutral groups (p < 0.001). The PHQ and GAD scores were not different between the groups. Percent weight loss was related to healthy nutrition coefficient (CI: 0.884 [0.821-0.951], p = 0.001) and MET categories (CI: 0.408 [0.222-0.748], p = 0.004). One hundred seventy patients had DM. Considering glycemic control, only 12 (8.4%) had fasting blood glucose <100 mg/dL and 36 (25.2%) had postprandial BG <160 mg/dL. When patients with and without DM were compared in terms of dietary compliance, MET category, weight loss status, PHQ-9 scores, and GAD-7 scores, only MET categories were different; 29 (11.7%) of patients in the nondiabetic group were in the highly active group compared with 5 (2.9%) in the diabetic group. CONCLUSION The COVID-19 lockdown resulted in weight gain in about half of our patients, which was related to changes in physical activity and eating habits. Patients with DM who had moderate glycemic control were similar to the general population in terms of weight loss but were less active.
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Affiliation(s)
- Dilek Yazıcı
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
- *Dilek Yazıcı,
| | - Mehmet Mahir Fersahoğlu
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Tuba Fersahoğlu
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Hüseyin Çiğiltepe
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Özgen Çeler
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Seda Sancak
- Health Sciences University Fatih Sultan Mehmet Education and Research Hospital COM, Istanbul, Turkey
| | - Cem Sulu
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Emre Durcan
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Serdar Şahin
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | | | | | - Eren Taşkın
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Ceren İşeri
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | - Evren Gürsoy
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
| | | | - Tuğba Kaya
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | - Feyza Özdemir
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | | | - Sinem Kıyıcı
- Health Sciences University Bursa Yİ Education and Research Hospital COM, Bursa, Turkey
| | - Serkan Öztürk
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Kağan Güngör
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Bülent Can
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Mehmet Sargın
- Medeniyet University Göztepe Education and Research Hospital COM, Istanbul, Turkey
| | - Zeynep Tabak
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Sevda Averi
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Aysun Nazlı
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Yeliz Polat
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Feray Akbas
- Health Sciences University Istanbul Education and Research Hospital COM, Istanbul, Turkey
| | - Sakin Tekin
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | | | - Ebru Boz Uzaldı
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | - Safiye Çatalçam
- Bülent Ecevit University Medical Faculty COM, Zonguldak, Turkey
| | | | | | | | | | | | - Havva Sezer
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Seçil Özışık
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Hande Bulut
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Bahar Bekdemir
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Oğuzhan Deyneli
- Koç University Medical School COM (EASO Collaborating Centre for Obesity Management), Istanbul, Turkey
| | - Ceyda Dinçer
- Marmara University Medical Faculty COM, Istanbul, Turkey
| | | | - Hasan İlkova
- Cerrahpaşa Medical Faculty COM, Istanbul, Turkey
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