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Haddad A, Suter M, Greve JW, Shikora S, Prager G, Dayyeh BA, Galvao M, Grothe K, Herrera M, Kow L, Le Roux C, O'Kane M, Parmar C, Quadros LG, Ramos A, Vidal J, Cohen RV. Therapeutic Options for Recurrence of Weight and Obesity Related Complications After Metabolic and Bariatric Surgery: An IFSO Position Statement. Obes Surg 2024:10.1007/s11695-024-07489-7. [PMID: 39400870 DOI: 10.1007/s11695-024-07489-7] [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: 07/22/2024] [Revised: 08/16/2024] [Accepted: 08/27/2024] [Indexed: 10/15/2024]
Abstract
Obesity is a chronic disease that may require multiple interventions and escalation of therapy throughout the years. Until recently, no universal definition existed for recurrent weight gain and insufficient weight loss. Standardization of reporting is key so outcomes can be compared and data can be pooled. The recent IFSO consensus provided standard terminology and definitions that will likely resolve this in the future, and publishers will need to enforce for authors to use these definitions. This current IFSO position statement provides guidance for the management of recurrent weight gain after bariatric surgery.
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Affiliation(s)
- Ashraf Haddad
- Gastrointestinal Metabolic and Bariatric Surgery Center -GBMC- Jordan Hospital, Amman, Jordan.
| | | | | | | | | | | | - Manoel Galvao
- Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, FL, USA
| | | | - Miguel Herrera
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lilian Kow
- Flinders University, Adelaide, Australia
| | | | - Mary O'Kane
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Almino Ramos
- GastroObesoCenter - Institute for Metabolic Optimization, São Paulo, Brazil
| | - Josep Vidal
- Hospital Clínic de Barcelona, Barcelona, Spain
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Riedel O, Braitmaier M, Dankhoff M, Haug U, Klein M, Zachariassen W, Hoyer J. Alcohol use disorders after bariatric surgery: a study using linked health claims and survey data. Int J Obes (Lond) 2024:10.1038/s41366-024-01606-3. [PMID: 39242916 DOI: 10.1038/s41366-024-01606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/07/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Previous studies have repeatedly reported alcohol use disorders (AUDs) in patients after bariatric surgery (BS). This research field can benefit from studies combining health claims data with survey data. METHODS Based on a combined retrospective cohort and cross-sectional study, 2151 patients with BS identified in a large health claims database received a questionnaire, by which we assessed the presence of AUDs based on a validated instrument (AUDIT) as well as by ICD-10 codes from the health claims data. We described patients with vs. without AUDs regarding sex, time since surgery, satisfaction with weight loss and health care resource utilization (HCRU). RESULTS The majority of patients were female (80.7%) with a median time since surgery of 6 years (Interquartile range: 4-9 years). For the majority of patients, the bariatric intervention was either a RYGB-Bypass (50%) or sleeve gastrectomy (43%). Overall, 3% had at least one AUD diagnosis code in the claims data (men: 5.5%, women: 2.5%). Among men, 43.6% of diagnoses were coded after but not before the surgery (women: 52%). According to AUDIT (completed by 1496 patients), 9.4% of all patients showed at least hazardous/harmful alcohol consumption. Higher scores were associated with sex of the person, longer time since surgery, dissatisfaction with the weight loss and higher HCRU, with contradicting results regarding psychotherapeutic care. CONCLUSIONS The proportion with AUDs in the study population gives rise to concern as alcohol consumption should be restricted after BS. The results suggest the necessity for close monitoring and post-surgical care.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
| | - Malte Braitmaier
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- University of Bremen, Faculty of Human and Health Sciences, Bremen, Germany
| | | | | | - Jana Hoyer
- Adipositas-Zentrum, Städtisches Klinikum Dresden, Dresden, Germany
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3
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Kenkre JS, Gesell S, Keller A, Milani RM, Scholtz S, Barley EA. Alcohol Misuse post Metabolic and Bariatric Surgery: A Systematic Review of Longer-term Studies with Focus on new Onset Alcohol use Disorder and Differences Between Surgery Types. Curr Obes Rep 2024; 13:596-616. [PMID: 38850501 PMCID: PMC11306568 DOI: 10.1007/s13679-024-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Evidence suggests an increased risk of alcohol problems post-surgery where no problematic alcohol use was present prior to surgery which may be different across types of surgery. OBJECTIVE To characterise the risk of new onset alcohol misuse post bariatric surgery, differences between surgeries and the impact over time. METHODS All published studies on new and relapsing alcohol use were reviewed. Data were classed as 'subjective' (clinical interview, self-report questionnaires) and 'objective' (hospital admissions, substance misuse programmes) and further categorised by follow up time - 'shorter-term' (one year), 'medium-term' (one year to two years) and 'long-term' (> two years). RESULTS Twenty-three of the forty-two studies included in the review reported new onset data. Nine studies reported on differences between surgery types. In those reporting objective measures, all of which were long term, RYGB carried a higher risk than SG, followed by LAGB. All but one study using subjective measures reported a small but significant number of new onset concerning alcohol use, and comparisons between surgery types had more varied results than the objective measures. Studies of substance abuse programmes found high rates of new onset cases (17-60%). CONCLUSION This systematic review provides support for the consensus guidance suggesting patients should be informed of a small but significant risk of new onset alcohol use following bariatric surgery, with the strongest evidence in the medium- to long-term and in those who have had RYGB followed by SG.
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Affiliation(s)
- Julia S Kenkre
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK
| | - Sutapa Gesell
- Central and North West London NHS Foundation Trust, London, UK
| | - Annalise Keller
- School of Human and Social Sciences, University of West London, London, UK
| | - Raffaella M Milani
- School of Human and Social Sciences, University of West London, London, UK
| | - Samantha Scholtz
- Section of Endocrinology and Investigative Medicine, Imperial College, London, UK.
- West London NHS Trust, London, UK.
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Kikuchi JLD, Carvalhal MMDL, Inete MB, Souza YDDES, Moraes TM, Costa RLV, Gabbay RD, Paracampo CCP, Gomes DL. Emotional Eating and Uncontrolled Eating as Risk Predictors for Disordered Eating Attitudes in Candidates for Bariatric Surgery Treated at a Public Hospital in the Amazon. Nutrients 2024; 16:1600. [PMID: 38892533 PMCID: PMC11174724 DOI: 10.3390/nu16111600] [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: 04/19/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
This study analyzes the eating behavior and factors associated with the presence of disordered eating attitudes in patients undergoing bariatric surgery. It is a cross-sectional, descriptive, and analytical study conducted at a hospital in the Amazon region of Brazil. The Disordered Eating Attitude Scale reduced version (DEAS-s) was used to assess the risk of eating disorders and the Three-Factor Eating Questionnaire (TFEQ-R21) was used to characterize eating behavior. A total of 205 patients participated, with a mean age of 37.5 ± 8.6 years. The majority of participants were female (93.7%; p < 0.001), and the mean BMI was 45.3 ± 6.7 kg/m2. It was found that cognitive restraint had the highest mean (52.6 ± 19.9; p < 0.001). As for the DEAS-s, the question with the highest mean response was "spending one or more days without eating or consuming only liquids to lose weight" (2.80 ± 1.99). Female participants had a higher score for emotional eating (p = 0.016). Disordered eating attitudes showed a correlation with emotional eating and uncontrolled eating. These results suggest that candidates for bariatric surgery may have susceptibility to eating disorders. The importance of a multidisciplinary team conducting monitoring during the preoperative period is highlighted.
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Affiliation(s)
- Jeane Lorena Dias Kikuchi
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Millena Borges Inete
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Tainá Martins Moraes
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Rafaela Lorena Viana Costa
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Rafaelle Dias Gabbay
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Carla Cristina Paiva Paracampo
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Daniela Lopes Gomes
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
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5
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Cooper KM, Colletta A, Hebda N, Devuni D. Alcohol associated liver disease and bariatric surgery: Current perspectives and future directions. World J Gastrointest Surg 2024; 16:650-657. [PMID: 38577096 PMCID: PMC10989338 DOI: 10.4240/wjgs.v16.i3.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/27/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity. However, bariatric surgery has also been linked to increased alcohol use with up to 30% of these patients developing alcohol use disorder (AUD). The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic, metabolic, and neurohumoral changes associated with post-surgical anatomy. These patients are at increased risk of alcohol associated liver disease and, in some cases, require liver transplantation. In this article, we provide a scoping review of epidemiology, pathophysiology, and clinical outcomes of alcohol-related health conditions after bariatric surgery.
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Affiliation(s)
- Katherine M Cooper
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, United States
| | - Alessandro Colletta
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, United States
| | - Nicholas Hebda
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, United States
| | - Deepika Devuni
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, United States
- Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01655, United States
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6
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Zoumpou T, Fleishman A, Jones DB, Wee CC. Decision regret up to 6 years after sleeve gastrectomy. Surg Endosc 2023; 37:9381-9392. [PMID: 37653161 DOI: 10.1007/s00464-023-10364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is one of the most popular types of weight loss surgery today but is neither risk-free nor universally effective. We previously demonstrated that 5% of Roux-en-Y gastric bypass (RYGB) patients and up to 20% of gastric banding patients report overall regret 4 years after surgery. This study explores patients' attitudes toward their decision to have SG and decision regret rates up to 6 years postoperatively. METHODS We surveyed 185 patients who were at least 6 months post-SG (response rate 30%). We used a modified version of the Decision Regret Scale developed by Brehaut et al. We converted responses to a 0-100 scale so that higher scores (> 50) reflect greater regret. We characterized patients who expressed having overall decision regret (score > 50) vs. those who did not (≤ 50). Demographic and preoperative clinical information was extracted from the online medical records. RESULTS Of 185 SG patients, only 13 (7%) reported regret scores > 50 (i.e. high decision regret). Mean time from SG to survey completion was 41 months (range 6-76 months). Unadjusted comparisons between the two groups revealed that patients with high regret scores had lower mean weight loss (32.1% vs. 48.9% EBMIL), and reported less improvement in quality-of-life (QoL), such as physical health (46.2% vs. 93.5% "somewhat" or "significantly" improved). The two groups were similar in short-term complications, but those reporting overall regret were more likely to report GI complaints such as bloating (61.5% vs. 30.4%). Finally, patients with regret scores > 50 were more likely to be further out from SG (median time since surgery 61.8 vs. 41.1 months). CONCLUSION In our study, very few patients reported regret (7%) up to 6 years postoperatively, in line with prior reports after RYGB. Those with regret reported poorer QoL.
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Affiliation(s)
- Theofano Zoumpou
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Deaconess 207, 185 Pilgrim Road, Boston, MA, 02215, USA.
| | - Daniel B Jones
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christina C Wee
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- American College of Physicians, Philadelphia, PA, USA
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Nicanor-Carreón JG, Seyedsadjadi N, Rowitz B, Pepino MY. Weight Regain and Ingestive Behavior in Women after Metabolic Surgery. Nutrients 2023; 15:3670. [PMID: 37686704 PMCID: PMC10490188 DOI: 10.3390/nu15173670] [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: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated associations between maladaptive ingestive behaviors and weight regain in women who underwent metabolic surgery 2-10 years ago. Using a web-based survey, we assessed emotional, external, and restrained eating (Dutch Eating Behavior Questionnaire-DEBQ), food cravings (Food-Craving Inventory-FCI), and other behaviors (e.g., Eating Disorder Examination Questionnaire-EDE-Q; Alcohol Use Disorder Identification Test-Concise-AUDIT-C) in 36 women (42.9 ± 9.5 years old) post-surgery. We found that weight regain was specifically associated with increased frequency of cravings for sweets (r = 0.43), higher global scores in the EDE-Q (r = 0.38), and time elapsed since surgery (r = 0.35; all p's < 0.04). Multiple regression analysis revealed that the association between weight regain and sweet cravings interacted with time after surgery (p = 0.04), with the strongest association observed in women assessed closer to the surgery (i.e., 2.0-2.8 years). The combination of time after surgery and its interaction with sweet cravings accounted for 31% of the individual variations in weight regain (p = 0.005). Notably, among participants who reported alcohol consumption (31 of 36), 55% had an AUDIT-C score indicating hazardous drinking. These findings highlight the relevance of attending to patients' reports of frequent sweet cravings and screening for alcohol use to enhance strategies tailored to prevent weight regain and alcohol-related health problems post-surgery.
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Affiliation(s)
- Jessica G. Nicanor-Carreón
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
| | - Neda Seyedsadjadi
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Blair Rowitz
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
- Department of Surgery, Carle Foundation Hospital, Urbana, IL 61801, USA
| | - Marta Yanina Pepino
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
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8
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Capelo Vides M, Campello de Oliveira M, Lassi DLS, Malbergier A, Florio L, de Azevedo-Marques Périco C, Abrantes do Amaral R, Torales J, Ventriglio A, Negrão AB, Castaldelli-Maia JM. Bariatric surgery and its influence on alcohol consumption: Differences before and after surgery - A systematic review and meta-analysis. Int Rev Psychiatry 2023; 35:367-376. [PMID: 38299644 DOI: 10.1080/09540261.2023.2223317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/06/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Through new publications on the subject, the main goal of this article is to seek a change in the pattern of alcohol use before and after bariatric surgery. METHODS We searched the National Library of Medicine, CINAHL, and PsycINFO databases. We included original articles regarding alcohol consumption before and after bariatric surgery to conduct the systematic review. RESULTS Our systematic review, which included 18 articles, yielded mixed results. Meta-analysis of six articles did not reveal statistically significant differences in alcohol use behaviours before and one year after bariatric surgery. However, throughout the perspective of follow-up after bariatric surgery, nine out of the twelve articles showed improvement in the pattern of alcohol consumption when evaluated up to two years after the end of the surgical period, and four out of the five articles with monitoring beyond two years showed worsening in consumption, compared to pre-surgery alcohol use behaviours. CONCLUSIONS Conclusions about the relationship between alcohol consumption and bariatric surgery are challenging primarily because of the variety of the methods used and the alcohol consumption measures. Despite that, our research pointed to an increased risk of alcohol use disorders two years after bariatric surgery.
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Affiliation(s)
- Mariana Capelo Vides
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | | | | | - André Malbergier
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Ligia Florio
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
| | | | | | - Julio Torales
- Department of Psychological Medicine, School of Medical Sciences, National University of Asuncion, San Lorenzo, Paraguay
| | - Antonio Ventriglio
- Department of Experimental Medicine, Medical School, University of Foggia, Foggia, Italy
| | | | - João Mauricio Castaldelli-Maia
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, Brazil
- Department of Psychological Medicine, School of Medical Sciences, National University of Asuncion, San Lorenzo, Paraguay
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Lüscher A, Vionnet N, Amiguet M, Chartoumpekis D, Mantziari S, Frantz J, Favre L. Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome. Obes Surg 2023; 33:2072-2082. [PMID: 37145292 PMCID: PMC10289928 DOI: 10.1007/s11695-023-06595-2] [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: 10/26/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conflicting results have been reported regarding the predictive value of preoperative psychological assessment and weight outcome after bariatric surgery. This might be attributed to different factors affecting early weight loss and long-term weight loss. Herein, we investigated whether preoperative psychiatric profile was associated with preoperative BMI and with both early (1 year) and long-term (5 years) weight loss after Roux-en-Y gastric bypass (RYGB). METHODS Prospective observational cohort study of patients undergoing RYGB between 2013 and 2019. Symptoms related to anxiety, depression, eating disorder, and alcohol use disorders were assessed by employing validated, specific psychometric tests (STAI-S/T, BDI-II, BITE, AUDIT-C) prior to surgery. Pre-operative BMI, early weight loss (1 year), and long-term weight evolution (up to 5 years) were registered. RESULTS Two hundred thirty six patients (81% women) were included in the present study. Linear longitudinal mixed model showed a significant effect of preoperative high anxiety (STAI-S) on long-term weight outcome, after controlling for gender, age and type 2 diabetes. Patient with high preoperative anxiety score regained weight faster than those experiencing low anxiety (each year percent excess BMI loss (%EBMIL) - 4.02%, ± 1.72, p = 0.021). No other pre-operative psychiatric symptoms have been shown to have an impact on long-term weight loss. In addition, no significant association was found between any of the pre-operative psychiatric variables and pre-operative BMI, or early weight loss (%EBMIL) at 1-year post-RYGB. CONCLUSION Herein we identified high anxiety score (STAI-S) as a predictor for long-term weight regain. Thus, long-term psychiatric surveillance of these patients and the development of tailored management tools could serve as a means to prevent weight regain.
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Affiliation(s)
- Anouk Lüscher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nathalie Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Amiguet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dionysios Chartoumpekis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Styliani Mantziari
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Service of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Johanna Frantz
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucie Favre
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, CHUV, Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Rue St Martin 3, CH-1003, Lausanne, Switzerland.
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10
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Butt M, Eisler RA, Hu A, Rogers AM, Rigby A. Incidence of Substance Use Disorder Following Bariatric Surgery: A Retrospective Cohort Study. Obes Surg 2023; 33:890-896. [PMID: 36477697 DOI: 10.1007/s11695-022-06400-6] [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: 08/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND New-onset substance use disorder (SUD) following bariatric surgery is a significant concern that is likely multi-factorial, although the etiologies are unclear. Previous studies have identified variable rates of SUD along with utilizing different methods and measures. The objective of this study is to evaluate new-onset SUD diagnoses among adults following bariatric surgery and compare these rates to those in the general population as well as those diagnosed with overweight or obesity. METHODS Data was extracted from TriNetX Research Platform and used to build three cohorts of adults: those who had bariatric surgery (bariatric surgery cohort), those diagnosed with obesity or overweight, and a general population cohort. Rates of incident SUD were compared among these three groups. Initial encounters for all individuals were from January 1, 2018, to June 30, 2019. RESULTS The incidence rate of SUD in patients with a history of bariatric surgery was 6.55% (n = 2523). When compared to the general population, persons who had any type of bariatric procedure had a decreased risk of new-onset SUD with an overall odds ratio (OR) [95% confidence limits (CL)] of 0.89 [0.86, 0.93]. When compared to persons with overweight or obesity, bariatric patients were less likely to develop any form of SUD (OR: 0.65 [0.62, 0.67]). CONCLUSION While overall rates of new-onset SUD are lower among those who had bariatric surgery, they also vary by surgery and substance type. Efforts should still be made to address new-onset SUD in order to optimize the post-surgical care of patients.
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Affiliation(s)
- Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Riley A Eisler
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Antoinette Hu
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Andrea Rigby
- Department of Surgery - Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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11
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The role of preoperative toxicology screening in patients undergoing bariatric surgery. Surg Obes Relat Dis 2023; 19:187-193. [PMID: 36443215 DOI: 10.1016/j.soard.2022.10.021] [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: 06/21/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some programs and insurers may require patients to undergo toxicology screening despite lack of evidence that this practice affects postoperative outcomes. OBJECTIVES To understand the prevalence of screening positive on toxicology testing in the bariatric surgical population and to examine the association between testing positive and important surgical outcomes. METHODS We performed a retrospective review of patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from an academic health system from 2017-2020. We described the rate of preoperative toxicology positivity as determined by serum and urine testing. We examined the association between toxicology positivity and outcomes of preoperative length, 30-day complications (bleeding, venous thromboembolism, leak, wound infection, pneumonia, urinary tract infection, and myocardial infarction), readmissions, and 1-year weight loss using chi-square and t-test analysis. RESULTS Of 1057 patients, there were 134 patients (12.7%) who had positive toxicology testing. Of these, 37 (28%) were positive for opiates and 21 (16%) were positive for cotinine. Mean preoperative length was 381.8 days (standard deviation [SD], 222.5) for patients with positive testing versus 287.8 days (SD, 151.5; P = 1.00) for negative testing. Toxicology positivity was not associated with readmissions (5.2% versus 4.3%, X2 = 0.22; P = .64). The loss to follow-up at 1 year was 32.5%. There was no association with 1-year mean change in body mass index (mean of loss 12.23kg/m2 [SD, 5.61]) versus mean of loss 12.74 (SD, 6.44; P = .20)]. CONCLUSIONS Our study is the first to describe preoperative toxicology positivity rates. We found no association between toxicology positivity and preoperative length, readmissions, or weight loss. Given its lack of impact on outcomes, toxicology testing prior to bariatric surgery may be an unnecessary burden on patients and healthcare, with regard to cost and wait times.
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Grigson PS, Hobkirk AL, Grigson PS, Hobkirk AL. Addiction III: From mouse to man. Brain Res Bull 2023; 193:22-26. [PMID: 36464128 DOI: 10.1016/j.brainresbull.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, USA.
| | - Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, USA
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, USA
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Testino G, Pellicano R, Balbinot P. Disordered Eating Behavior, Alcohol Use Disorder, and Bariatric Surgery. Obes Surg 2022; 32:1777-1778. [PMID: 35192132 DOI: 10.1007/s11695-022-05967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Gianni Testino
- ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy.
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