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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; 34:3944-3962. [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] [MESH Headings] [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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Nicolau J, Sanchís P, Ayala L, Pascual S, Tamayo Pozo MI, Cifuentes A, Masmiquel L. Differences in the cluster of depressive symptomatology among bariatric surgery candidates, long-term bariatric surgery patients, and subjects with a major depressive disorder without obesity. NUTR HOSP 2024. [PMID: 39446122 DOI: 10.20960/nh.05196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
INTRODUCTION depression is more frequent among people with obesity (PwO) compared to the general population. Depression seems to improve after bariatric surgery (BS) at short term, but data are inconclusive at long term. Besides, it is not known whether depressive symptoms among PwO are similar to those people with a major depression without obesity. OBJECTIVES we aimed to study whether there are differences regarding depressive symptomatology among subjects seeking BS or patients after BS in the long-term compared with subjects with MDD. METHODS the Beck Depression Inventory (BDI) was administered to three groups: 52 patients seeking BS (OB), 135 patients with a BS with a minimum follow-up of 18 months (BS) and 45 subjects with a MDD (MDD). RESULTS the MDD obtained the higher score with the BDI whether compared to the OB (18.9 ± 12.7 vs 14.2 ± 6.9; p = 0.01) or the BS (18.9 ± 12.7 vs 8.1 ± 8; p < 0.0001). Also, BS presented a lower BDI than the OB (8.1 ± 8 vs 14.2 ± 6.9; p < 0.0001). The MDD scored higher in the psychological domain than patients in the OB (9.9 ± 7.5 vs 5.7 ± 5.1; p < 0.0001) as well as in the BS (9.9 ± 7.5 vs 3.1 ± 3; p < 0.0001). There was a negative correlation between a greater score in the somatic domain and %EPP (p = 0.04). CONCLUSIONS at long term, depressive symptomatology among subjects with a BS remained lower compared to PwO seeking BS.PwO presented a different cluster of depression compared to individuals with a MDD. BS reduces the somatic depressive cluster at long term, although its presence is associated to a lesser weight loss.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | - Pilar Sanchís
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | - Luisa Ayala
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
| | | | | | | | - Lluís Masmiquel
- Endocrinology and Nutrition Department. Hospital Universitari Son Llàtzer
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Thomas TA, Tilk K, Klassen K, Pommnitz M, Wunder R, Mall JW, Köhler H, de Zwaan M, Meyer G, Hüttl TP, Müller A. Self-Harm Before and Six Months After Obesity Surgery. Obes Surg 2024; 34:3579-3591. [PMID: 39134834 PMCID: PMC11481644 DOI: 10.1007/s11695-024-07439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS. MATERIALS AND METHODS Pre-surgery patients (N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations. RESULTS Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation. CONCLUSION No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.
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Affiliation(s)
- Tobias A Thomas
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Katja Tilk
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Katharina Klassen
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Melanie Pommnitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Ruth Wunder
- Department of General, Visceral, and Bariatric Surgery, DRK Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hanover, Germany
| | - Julian W Mall
- Department of General, Visceral, and Bariatric Surgery, KRH Nordstadt, Haltenhoffstr. 41, 30167, Hanover, Germany
| | - Hinrich Köhler
- Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124, Brunswick, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Günther Meyer
- Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Waldstraße 7, 82166, Gräfelfing, Germany
| | - Thomas P Hüttl
- Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Denninger Str. 44, 81679, Munich, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
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Marchitelli S, Mazza C, Ricci E, Faia V, Biondi S, Colasanti M, Cardinale A, Roma P, Tambelli R. Identification of Psychological Treatment Dropout Predictors Using Machine Learning Models on Italian Patients Living with Overweight and Obesity Ineligible for Bariatric Surgery. Nutrients 2024; 16:2605. [PMID: 39203742 PMCID: PMC11357013 DOI: 10.3390/nu16162605] [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: 07/04/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
According to the main international guidelines, patients with obesity and psychiatric/psychological disorders who cannot be addressed to surgery are recommended to follow a nutritional approach and a psychological treatment. A total of 94 patients (T0) completed a battery of self-report measures: Symptom Checklist-90-Revised (SCL-90-R), Barratt Impulsiveness Scale-11 (BIS-11), Binge-Eating Scale (BES), Obesity-Related Well-Being Questionnaire-97 (ORWELL-97), and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Then, twelve sessions of a brief psychodynamic psychotherapy were delivered, which was followed by the participants completing the follow-up evaluation (T1). Two groups of patients were identified: Group 1 (n = 65), who fully completed the assessment in both T0 and T1; and Group 2-dropout (n = 29), who fulfilled the assessment only at T0 and not at T1. Machine learning models were implemented to investigate which variables were most associated with treatment failure. The classification tree model identified patients who were dropping out of treatment with an accuracy of about 80% by considering two variables: the MMPI-2 Correction (K) scale and the SCL-90-R Phobic Anxiety (PHOB) scale. Given the limited number of studies on this topic, the present results highlight the importance of considering the patient's level of adaptation and the social context in which they are integrated in treatment planning. Cautionary notes, implications, and future directions are discussed.
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Affiliation(s)
- Serena Marchitelli
- UOC of Endocrinology, Metabolic Diseases, Andrology—CASCO (Center of High Specialization for the Treatment of Obesity), Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Cristina Mazza
- Department of Dynamic and Clinical Psychology, & Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy;
| | - Eleonora Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, University “G.d’Annunzio”, 66100 Chieti-Pescara, Italy;
| | - Valentina Faia
- The Free Spirit Collective Polyclinic, Dubai 252330, United Arab Emirates;
| | - Silvia Biondi
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (S.B.); (P.R.)
| | - Marco Colasanti
- Department of Psychological, Health and Territorial Sciences, University “G.d’Annunzio”, 66100 Chieti-Pescara, Italy;
| | | | - Paolo Roma
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (S.B.); (P.R.)
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, & Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy;
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DeFazio S, Mastrili N, Szoka N, Schneider KL, Cox S, Aylward L. Sexual orientation moderates the relationship between internalized weight bias and binge eating symptoms among adults pursuing bariatric surgery. Surg Obes Relat Dis 2024; 20:784-789. [PMID: 38641526 DOI: 10.1016/j.soard.2024.03.019] [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: 12/21/2023] [Revised: 02/16/2024] [Accepted: 03/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Sexual minorities have higher rates of anxiety, depression, and binge eating compared to heterosexual peers. Internalized weight bias (IWB) is also higher for sexual minorities when compared to heterosexual peers. However, research has not examined whether the relationships between IWB and anxiety, depression, and binge eating differ among heterosexual and sexual minority adults pursuing bariatric surgery. OBJECTIVES To examine whether sexual orientation (heterosexual or sexual minority) moderated the relationships between IWB and anxiety, depression, and binge eating among adults pursuing bariatric surgery. SETTING University hospital, United States METHODS: Participants included 811 adults who presented for bariatric surgery, 45 (5.5%) of which identified as a sexual minority. Self-reported data were collected as part of a standard preoperative psychological evaluation for surgical clearance. Three separate moderation models were run to test hypotheses. RESULTS Sexual orientation did not moderate the association of IWB with anxiety or depression. The IWB by sexual orientation interaction was significant for binge eating (F 1856) = 4.84, P = .03, R2 = .27 such that the association between IWB and binge eating was significantly stronger for sexual minority patients (b = .54, 95% confidence interval {CI} [.36, .70]), compared to heterosexual patients (b = .33, 95% CI [.30, .38]). CONCLUSIONS Minority stress from identifying as a sexual minority may increase vulnerability to binge eating from IWB among bariatric candidates. Future research examining the directionality of the relationship between IWB and binge eating among sexual minorities is warranted.
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Affiliation(s)
- Sarah DeFazio
- School of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Noelle Mastrili
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
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Mauro MFFP, Papelbaum M, Brasil MAA, Carneiro JRI, Luiz RR, Hiluy JC, Appolinario JC. Mental health and weight regain after bariatric surgery: associations between weight regain and psychiatric and eating-related comorbidities. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230208. [PMID: 39420888 PMCID: PMC11326743 DOI: 10.20945/2359-4292-2023-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/01/2024] [Indexed: 10/19/2024]
Abstract
Objective Weight regain is a common outcome of weight loss interventions. Mental health-related comorbidities, among other factors, can mediate weight regain regardless of the implemented treatment modality. This study explores whether postoperative psychopathological comorbidities are associated with weight regain after bariatric surgery. Subjects and methods This cross-sectional study recruited 90 outpatients who underwent Roux-en-Y gastric bypass surgery. Anthropometric measurements were collected retrospectively from medical charts. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) Axis I Disorders (SCID-I) was applied to evaluate psychiatry diagnoses. Validated self-report instruments were used to assess depression, anxiety, alcohol use, impulsivity, binge eating, and body image dissatisfaction. Weight regain was defined as a ≥20% increase from the maximum weight lost. Level of evidence: Level III, cross-sectional study based on a well-designed study. Results Overall, 55.6% of participants experienced weight regain. Notably, mental disorders such as current binge-eating disorder and lifetime diagnoses including bulimia nervosa, alcohol abuse/dependence, and obsessive-compulsive disorder were significantly associated with weight regain. However, controlled analysis found that, for mental disorders, only current binge-eating disorder (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.26-31.06, p = 0.024) remained associated with weight regain. Eating-related psychopathologies also associated with weight regain included binge eating (d = 0.55; p = 0.013), eating disinhibition (d = 0.76; p = 0.001), higher hunger levels (d = 0.39; p = 0.004), and non-planning trait impulsivity (d = 0.69; p = 0.0001). Conclusion Postoperative presence of psychopathological comorbidities, such as eating psychopathology and trait impulsivity, were associated with weight regain after bariatric surgery. These findings highlight the importance of addressing mental health in individuals experiencing postsurgical weight regain.
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Affiliation(s)
- Maria Francisca F. P. Mauro
- Grupo de Obesidade e Transtornos AlimentaresInstituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Grupo de Obesidade e Transtornos Alimentares, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marcelo Papelbaum
- Grupo de Obesidade e Transtornos AlimentaresInstituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Grupo de Obesidade e Transtornos Alimentares, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marco Antônio Alves Brasil
- Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - João Regis Ivar Carneiro
- Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde PúblicaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Instituto de Estudos de Saúde Pública, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - João C. Hiluy
- Grupo de Obesidade e Transtornos AlimentaresInstituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Grupo de Obesidade e Transtornos Alimentares, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - José Carlos Appolinario
- Grupo de Obesidade e Transtornos AlimentaresInstituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Grupo de Obesidade e Transtornos Alimentares, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Diep C, Lee S, Xue Y, Xiao M, Pivetta B, Daza JF, Jung JJ, Wijeysundera DN, Ladha KS. Preoperative depression and outcomes after metabolic and bariatric surgery: A systematic narrative review. Obes Rev 2024; 25:e13743. [PMID: 38572605 DOI: 10.1111/obr.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient-reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta-analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies (n = 3390) the associations between preoperative depression and weight loss outcomes at 6-72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient-important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations.
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Affiliation(s)
- Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maggie Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Bianca Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
| | - James J Jung
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
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Punt SE, Caicedo MR, Rhodes AC, Ilardi SS, Hamilton JL. A semi-structured interview is associated with bariatric surgery outcomes. J Behav Med 2024; 47:483-491. [PMID: 38393445 DOI: 10.1007/s10865-024-00471-9] [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: 02/26/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
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Affiliation(s)
- Stephanie E Punt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Mariana Rincon Caicedo
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Ashley C Rhodes
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Jessica L Hamilton
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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Atlantis E, Kormas N, Piya M, Sahebol-Amri M, Williams K, Huang HCC, Bishay R, Chikani V, Girolamo T, Prodan A, Fahey P. Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study. Obes Surg 2024; 34:2073-2083. [PMID: 38467898 PMCID: PMC11127827 DOI: 10.1007/s11695-024-07123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The purpose of this study is to develop a decision aid tool using "real-world" data within the Australian health system to predict weight loss after bariatric surgery and non-surgical care. MATERIALS AND METHODS We analyzed patient record data (aged 16+years) from initial review between 2015 and 2020 with 6-month (n=219) and 9-/12-month (n=153) follow-ups at eight clinical obesity services. Primary outcome was percentage total weight loss (%TWL) at 6 months and 9/12 months. Predictors were selected by statistical evidence (p<0.20), effect size (±2%), and clinical judgment. Multiple linear regression and bariatric surgery were used to create simple predictive models. Accuracy was measured using percentage of predictions within 5% of the observed value, and sensitivity and specificity for predicting target weight loss of 5% (non-surgical care) and 15% (bariatric surgery). RESULTS Observed %TWL with bariatric surgery vs. non-surgical care was 19% vs. 5% at 6 months and 22% vs. 5% at 9/12 months. Predictors at 6 months with intercept (non-surgical care) of 6% include bariatric surgery (+11%), BMI>60 (-3%), depression (-2%), anxiety (-2%), and eating disorder (-2%). Accuracy, sensitivity, and specificity were 58%, 69%, and 56%. Predictors at 9/12 months with intercept of 5% include bariatric surgery (+15%), type 2 diabetes (+5%), eating disorder (+4%), fatty liver (+2%), atrial fibrillation (-4%), osteoarthritis (-3%), sleep/mental disorders (-2-3%), and ≥10 alcohol drinks/week (-2%). Accuracy, sensitivity, and specificity were 55%, 86%, and 53%. CONCLUSION Clinicians may use DACOS to discuss potential weight loss predictors with patients after surgery or non-surgical care.
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Affiliation(s)
- Evan Atlantis
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia.
| | - Nic Kormas
- Department of Endocrinology, Concord Hospital, Concord, New South Wales, Australia
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia
| | - Milan Piya
- South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Mehdi Sahebol-Amri
- Ryde Hospital, Northern Sydney Local Health District, Ryde, New South Wales, Australia
| | - Kathryn Williams
- Department of Endocrinology, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
- Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia
| | - Hsin-Chia Carol Huang
- Respiratory & Sleep Medicine, Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia
- Canberra Obesity Management Service, Canberra Health Services, Belconnen, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia
| | - Ramy Bishay
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Metabolic & Weight Loss Clinic, University Clinics, Western Sydney University, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Viral Chikani
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Teresa Girolamo
- Re:You Health, Adelaide Weight Management and Wellness, Adelaide, South Australia, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia
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10
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Xie J, Wang Y. Multidisciplinary combined treatment based on bariatric surgery for metabolic syndrome: a review article. Int J Surg 2024; 110:3666-3679. [PMID: 38489549 PMCID: PMC11175773 DOI: 10.1097/js9.0000000000001320] [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: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
As a chronic, multifactorial disease, obesity is associated with a global social and economic burden. This condition significantly affects normal daily life and healthy social interactions, and shortens the life expectancy of patients. Compared with traditional weight-loss methods, the emergence of bariatric surgery has effectively improved the management of obesity. Furthermore, bariatric surgery can also inhibit the progression of multiple metabolic diseases. Despite its potential advantages, bariatric surgery cannot completely eliminate the possibility of weight regain and inadequate weight loss following the procedure. For super-obese patients, bariatric surgery still remains a surgical risk. In addition, the psychological problems and poor eating habits of obese patients also affect the weight loss effect and daily life. Thus, various adjuvant therapies involving multiple disciplines have attracted people's attention. Recently, it has been recognized that the combination of multiple interventions based on bariatric surgery is more advantageous than a single intervention in alleviating the complex and diverse metabolic diseases associated with obesity. The combined therapy considerably enhances the long-term efficacy of bariatric surgery and plays a positive role in the mental health and social lives of patients. In this article, the authors review this multidisciplinary combination therapy to enhance the current understanding of the treatment of obesity.
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Affiliation(s)
| | - Yong Wang
- Center of Bariatric and Metabolic Surgery, Fourth Affiliated Hospital of China Medical University, Liaoning, People’s Republic of China
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11
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Haugh S, Cromwell P, Kirrane R, Heneghan H. Impact of antidepressant use on post-operative weight loss following bariatric surgery. Ir J Med Sci 2024; 193:903-908. [PMID: 37728725 DOI: 10.1007/s11845-023-03482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Antidepressant medication can be associated with weight gain. Consideration should be given to the specific agent prescribed to optimize bariatric surgery outcomes. AIM The aim of this study is to investigate if patients treated with antidepressants stratified by risk of weight gain are associated with less weight loss at 1 year postbariatric surgery. METHOD A single centre, retrospective analysis of all patients who underwent bariatric surgery between July 2018 and 2021 within St Vincent's University Hospital group. The exposure was antidepressant use, stratified for risk of weight gain, and the control group was patients who underwent surgery but no antidepressant use. The primary outcome was % TWL (total weight loss) at 6 weeks, 6 months and 12 months post-surgery. Multivariate linear regression analysis was used to estimate the impact of antidepressant treatment on post-surgery weight loss at 12 months using the variables of age, gender and pre-operative BMI. RESULTS Of the total cohort (n = 315), 70 patients (22.2%) were taking antidepressants. At 12 months, post-operatively patients taking medium risk for weight gain antidepressants had significantly less mean %TWL compared to those not taking antidepressants (p = 0.015). Overall, taking any antidepressant was not found to be a significant predictor of %TWL at 12 months after surgery (β = - 2.590, p = 0.0836). CONCLUSION Many patients undergoing bariatric surgery have concurrent psychiatric conditions. Given the complex relationship between bariatric surgery and mental health, psychotropic medications may be best managed by a specialist in the field such as a bariatric psychiatrist in order to optimize patient outcomes.
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Affiliation(s)
- Sinead Haugh
- Department of Psychiatry, Blanchardstown Mental Health Services, Connolly Hospital, Blanchardstown, Dublin, West, Ireland.
| | - Paul Cromwell
- Department of Surgery, National Bariatric Centre, St. Vincents University Hospital, Dublin, Ireland
| | - Richelle Kirrane
- Department of Psychiatry, Blanchardstown Mental Health Services, Connolly Hospital, Blanchardstown, Dublin, West, Ireland
| | - Helen Heneghan
- Department of Surgery, National Bariatric Centre, St. Vincents University Hospital, Dublin, Ireland
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12
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Mowoh DPM, Cole R, Sarvepalli S, Grover K, Abbas M, Khaitan L. Bariatric surgery efficacy in patients with mood disorders. Surgery 2024; 175:943-946. [PMID: 38171967 DOI: 10.1016/j.surg.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Mood disorders are comorbid in patients with obesity and found in approximately 22.0% to 54.8% of patients who are eligible for bariatric surgery. Given the unclear effect of mood disorders on bariatric surgery outcomes, we aimed this study to assess the impact of mood disorders index bariatric surgery weight loss outcomes. METHODS A retrospective study institutional database of index bariatric surgery patients at University Hospitals Cleveland Medical Center between 2016 and 2018. The primary outcome of body mass index was followed over a 4-year period. The secondary outcomes measured were mortality and suicide rates. Mood disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, included depressive and bipolar disorders obtained from electronic medical records International Classification of Diseases, Tenth Revision, coding. RESULTS A total of 790 patients underwent bariatric surgery between 2016 and 2018. Of these, 15 patients were excluded due to death in the postoperative period or insufficient weight loss data, and a total of 775 patients (620 women and 155 men) were included. Two hundred and ninety-five (38.1%) had an electronic medical record mood disorder diagnosis before surgery, while 480 (61.9%) did not. Both groups had a significant decrease in postoperative body mass index; however, there was no significant difference in the body mass index change between the mood disorder group (mean = 37.63, standard deviation = 9.88) and the control group (mean = 38.72, standard deviation = 9.54; t[294] = 1.40; P = .1634). CONCLUSION Patients with mood disorders are as successful with weight loss after index bariatric surgery as those without mood disorders. There was no significant difference in mortality rates between the mood disorder group and the control group. Hence, mood disorders should not be prohibitive for weight loss surgery.
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Affiliation(s)
| | - Rachel Cole
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Shravan Sarvepalli
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/ShravanSar63428
| | - Karan Grover
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrGroverSays
| | - Mujjahid Abbas
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/M_AbbasMD
| | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrLeenaK
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13
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Marek RJ, Ben-Porath YS, Heinberg LJ. Six-year postoperative associations between the Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) and weight recurrence, eating behaviors, adherence, alcohol misuse, and quality of life. Surg Obes Relat Dis 2024; 20:391-398. [PMID: 38216363 DOI: 10.1016/j.soard.2023.12.008] [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: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) leads to beneficial and sustained outcomes. However, many patients evidence weight recurrence and psychosocial functioning may be associated with weight recurrence. The Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) is validated for use in presurgical MBS evaluations and likely has clinical utility in understanding weight recurrence and other aspects of postoperative functioning. OBJECTIVE The objective of the current investigation is to understand how postoperative psychosocial functioning relates to weight recurrence and other behaviors and constructs 6 years after MBS. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS A sample of 163 participants consented to take a battery of self-report measures related to psychological functioning, eating behaviors, adherence, alcohol misuse, and quality of life along with their postoperative weight. MMPI-3 scale scores were prorated from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF) or scored from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form - Expanded (MMPI-2-RF-EX). RESULTS Weight recurrence was quite variable in this sample. Postoperative MMPI-3 scales related to emotional/internalizing dysfunction were modestly associated with higher weight recurrence. Postoperative MMPI-3 scale scores also demonstrated associations with other postoperative outcomes including measures of eating behaviors, adherence, alcohol misuse, and quality of life. CONCLUSIONS Postoperative psychosocial functioning as assessed by the MMPI-3 was associated with weight recurrence and a number of other problematic psychological outcomes beyond weight recurrence.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | | | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Gandotra S, Daza JF, Diep C, Mitani AA, Ladha KS, Wijeysundera DN. Psychological Distress After Inpatient Noncardiac Surgery: A Secondary Analysis of the Measurement of Exercise Tolerance Before Surgery Prospective Cohort Study. Ann Surg 2024; 279:450-455. [PMID: 37477019 DOI: 10.1097/sla.0000000000006031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To describe the incidence and natural progression of psychological distress after major surgery. BACKGROUND The recovery process after surgery imposes physical and mental burdens that put patients at risk of psychological distress. Understanding the natural course of psychological distress after surgery is critical to supporting the timely and tailored management of high-risk individuals. METHODS We conducted a secondary analysis of the "Measurement of Exercise Tolerance before Surgery" multicentre cohort study (Canada, Australia, New Zealand, and the UK). Measurement of Exercise Tolerance before Surgery recruited adult participants (≥40 years) undergoing elective inpatient noncardiac surgery and followed them for 1 year. The primary outcome was the severity of psychological distress measured using the anxiety-depression item of EQ-5D-3L. We used cumulative link mixed models to characterize the time trajectory of psychological distress among relevant patient subgroups. We also explored potential predictors of severe and/or worsened psychological distress at 1 year using multivariable logistic regression models. RESULTS Of 1546 participants, moderate-to-severe psychological distress was reported by 32.6% of participants before surgery, 27.3% at 30 days after surgery, and 26.2% at 1 year after surgery. Psychological distress appeared to improve over time among females [odds ratio (OR): 0.80, 95% CI: 0.65-0.95] and patients undergoing orthopedic procedures (OR: 0.73, 95% CI: 0.55-0.91), but not among males (OR: 0.87, 95% CI: 0.87-1.07) or patients undergoing nonorthopedic procedures (OR: 0.95, 95% CI: 0.87-1.04). Among the average middle-aged adult, there were no time-related changes (OR: 0.94, 97% CI: 0.75-1.13), whereas the young-old (OR: 0.89, 95% CI: 0.79-0.99) and middle-old (OR: 0.87, 95% CI: 0.73-1.01) had small improvements. Predictors of severe and/or worsened psychological distress at 1 year were younger age, poor self-reported functional capacity, smoking history, and undergoing open surgery. CONCLUSIONS One-third of adults experience moderate to severe psychological distress before major elective noncardiac surgery. This distress tends to persist or worsen over time among select patient subgroups.
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Affiliation(s)
- Sakshi Gandotra
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aya A Mitani
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Bartholomay EM, Cox S, Tabone L, Szoka N, Abunnaja S, Aylward L. The role of anxiety and depression in understanding the relationship between coping and weight loss 24 months after bariatric surgery. Surg Obes Relat Dis 2024; 20:304-314. [PMID: 38001014 DOI: 10.1016/j.soard.2023.10.004] [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: 06/07/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The relationship between coping (i.e., how a person deals with stress) and weight loss after bariatric surgery is relatively inconsistent. Anxiety and depression may contribute to the lack of consistent findings in this area. It is possible that coping, including interpersonal, intrapersonal, and maladaptive coping, predicts weight loss among individuals with higher levels of anxiety or depression but not among those with lower levels of anxiety and depression. OBJECTIVE The aim of this study was to examine the moderating role of anxiety and depression on the association between coping and weight loss in patients 24 months after bariatric surgery. SETTING University Hospital, West Virginia, U.S.A. METHODS Participants included 841 patients who underwent bariatric surgery, 396 of whom had 24-month weight loss data (mean age, 43.21 yr [SD, ±11.40 yr]). We ran 3 moderation models to test whether the relationship between various coping styles and postoperative weight loss was moderated by anxiety and depression symptoms. RESULTS There was a statistically significant interaction between anxiety and depression on the association between interpersonal coping and percent excess weight loss (%EWL). Anxiety and depression also moderated the relationship between maladaptive coping and %EWL. Anxiety and depression did not moderate the association between intrapersonal coping and %EWL, but intrapersonal coping positively predicted %EWL at 24 months after bariatric surgery. CONCLUSIONS Maladaptive coping predicted less weight loss for patients with high levels of anxiety and/or depression. Interpersonal coping predicted more weight loss for patients with low levels of anxiety and/or depression. Clinicians should take patient levels of anxiety and depression into account when making recommendations to promote weight loss among patients pursuing bariatric surgery.
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Affiliation(s)
- Emily M Bartholomay
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lawrence Tabone
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Salim Abunnaja
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
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16
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Tuli S, Lopez Lopez AP, Nimmala S, Pedreira CC, Singhal V, Bredella MA, Misra M. Two-Year Study on the Impact of Sleeve Gastrectomy on Depressive and Anxiety Symptoms in Adolescents and Young Adults with Moderate to Severe Obesity. Obes Surg 2024; 34:568-575. [PMID: 38177554 DOI: 10.1007/s11695-023-07025-z] [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: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Sleeve gastrectomy (SG), the most commonly performed weight loss surgery in adolescents and young adults with moderate to severe obesity, is highly effective for weight loss. Current literature regarding depressive and anxiety symptomatology following SG in youth is sparse and conflicting. We evaluated changes in depressive and anxiety symptoms in adolescents and young adults with moderate to severe obesity 2 years following SG compared with non-surgical controls (NS) followed for a similar duration. MATERIALS AND METHODS Forty-six youth 13-25 years old with moderate-severe obesity (33 female) were followed for 2 years; 21 underwent SG, and 25 were NS. Subjects underwent anthropometric measurements and completed self-report questionnaires. Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms and the State-Trait Anxiety Inventory (STAI)-X2 for anxiety symptoms. RESULTS Groups did not differ for age (18.4 ± 0.4 vs. 17.8 ± 0.5 years, p = 0.456). The SG group had a higher mean BMI vs. NS (47.5 (42.1, 52.4) vs. 41.6 (37.8, 46.5) kg/m2; p = 0.011). At 2-year follow-up, SG had greater reductions in weight and BMI vs. NS (p < 0.0001). Groups did not differ for changes in BDI-II and STAI scores (BDI-II: - 1.0 (- 6.0, 10.0) in SG vs. - 1.0 (- 6.0, 3.5) in NS, p = 0.37; STAI: 3.1 ± 3.2 in SG vs. - 1.1 ± 1.5 in NS, p = 0.24). CONCLUSION No change was found in depressive and anxiety symptomatology following surgery despite marked weight reduction over a 2-year period, underscoring the need to better evaluate psychopathology in youth undergoing SG to develop supportive therapeutic strategies. CLINICALTRIALS GOV IDENTIFIER NCT02557438 https://clinicaltrials.gov/ct2/show/NCT02557438?id=NCT02557438&draw=2&rank=1 ; The study was registered on 23 September 2015.
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Affiliation(s)
- Shubhangi Tuli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ana Paola Lopez Lopez
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Clarissa C Pedreira
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, 55, Fruit Street, Boston, MA, 02114, USA
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, 55, Fruit Street, Boston, MA, 02114, USA.
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Pehlke B, Oliveira F, Varnava C, Nehls F, Wiebringhaus P, Kueckelhaus M, Hirsch T, Dermietzel AF. Psychological well-being as a motive for and result of post-bariatric body contouring procedures. Obes Sci Pract 2024; 10:e719. [PMID: 38263992 PMCID: PMC10804339 DOI: 10.1002/osp4.719] [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: 07/05/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This study investigates whether psychological well-being in post-bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods An anonymous, nonrandomized, cross-sectional survey study was designed. Psychological well-being of four groups of post-bariatric-patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self-esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p < 0.001) and less insecure (p = 0.030) than patients who had not yet undergone body contouring procedures but sought it. Satisfaction with the result of the body contouring procedures was associated with lower depression levels (p < 0.001), higher self-esteem (p < 0.001) and a more positive body-image (p < 0.001). Conclusions Depressive symptoms or low self-esteem are not motivational factors for post-bariatric patients to seek body contouring procedures. Body contouring procedures are associated with improvement in psychological well-being in post-bariatric patients. Patients' satisfaction with the result of the body contouring procedures is significantly associated with positive psychological well-being.
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Affiliation(s)
- Britta Pehlke
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Filipa Oliveira
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Charalampos Varnava
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Fabian Nehls
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Philipp Wiebringhaus
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Maximilian Kueckelhaus
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Tobias Hirsch
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
| | - Alexander Frederik Dermietzel
- Division for Plastic SurgeryDepartment of Trauma, Hand and Reconstructive SurgeryUniversity Hospital MuensterMuensterGermany
- Plastic, Reconstructive, and Aesthetic Surgery, Hand SurgeryFachklinik HornheideMuensterGermany
- Department for Plastic and Reconstructive SurgeryInstitute for Musculoskeletal MedicineWestfaelische Wilhelms‐University MuensterMuensterGermany
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Shamsi F, Azadinia F, Shaygan M. Does brain entrainment using binaural auditory beats affect pain perception in acute and chronic pain?: a systematic review. BMC Complement Med Ther 2024; 24:34. [PMID: 38216943 PMCID: PMC10785528 DOI: 10.1186/s12906-024-04339-y] [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: 07/15/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Pain is a major clinical problem across all ages with serious social and economic consequences and a great negative impact on quality of life. Brain entrainment using binaural beats is a non-pharmaceutical intervention that is claimed to have analgesic effects in acute and chronic pain. We aimed to systematically review the available randomized clinical trials on the efficacy of binaural auditory beats in reducing adults' pain perception in acute and chronic pain. A systematic search in electronic databases including Medline (via PubMed), Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was performed. The search was completed through Google Scholar and a manual search of the reference lists of all included studies. Randomized clinical trials with full text available in English that investigated the effect of binaural auditory beats on pain perception in acute and chronic pain in adults were included. The risk of bias was assessed by the revised Cochrane risk-of-bias (RoB 2) tool. Furthermore, The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the quality of the evidence. Sixteen studies (three on chronic pain and thirteen on acute pain perception) fulfilled the eligibility criteria. Because of substantial heterogeneity of the studies, a meta-analysis was inappropriate and this review focused on the narrative interpretation of the results. The risk of bias in most studies was high and the quality of evidence was low to very low. Although the effects of binaural beats on pain perception seem to be influenced by the etiology of pain or medical procedures, our review identifies alpha or a combination of tones in the range of delta to alpha as a potential non-pharmacological intervention in reducing acute pain. However, drawing a conclusion regarding the efficacy of binaural beats for chronic pain requires more high-quality studies. REGISTRATION The protocol of this review was registered in PROSPERO (No. CRD42023425091).
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Affiliation(s)
- Fatemeh Shamsi
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, PO Box 71345-1359, Shiraz, Iran
| | - Fatemeh Azadinia
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Shaygan
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, PO Box 71345-1359, Shiraz, Iran.
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Dupont L, Alves A, Bui E, Lee Bion A, Meunier H, Briant A, Parienti JJ, Menahem B. Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders. Surg Endosc 2023; 37:8362-8372. [PMID: 37700014 DOI: 10.1007/s00464-023-10343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/30/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders. MATERIAL AND METHODS From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities. RESULTS Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years. CONCLUSION Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
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Affiliation(s)
- Ludovic Dupont
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France
| | - Eric Bui
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Psychiatry, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, U1237, PhIND «Physiopathology and Imaging of Neurological Disorders», NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, Caen University Hospital and Normandie University, Cyceron, 14000, Caen, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France.
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France.
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la cote de Nacre, 14032, Caen Cedex, France.
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Benítez T, Caixàs A, Rebasa P, Luna A, Crivillés S, Gutiérrez T, Deus J. Psychopathological profile before and after bariatric surgery. Sci Rep 2023; 13:16172. [PMID: 37758783 PMCID: PMC10533840 DOI: 10.1038/s41598-023-43170-2] [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: 07/06/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Presurgical psychopathological assessment usually focuses on detecting severe mental disorders. However, mild intensity psychopathology and eating behaviour pattern may also influence postsurgical outcomes. The aim was to identify psychopathology and eating behaviour pattern in candidates prepared for bariatric surgery compared to a normative population before and after surgery. A cohort of 32 patients seeking bariatric surgery in a university hospital between March 2016 and March 2017 were evaluated with Personality Assessment Inventory (PAI), 36-item EDE-Q and BES before and after surgery. Thirty-two patients before and 26 one year after surgery were included. The PAI presurgical psychometric profile suggested a mild mixed adjustment disorder focused on somatic complaints. After surgery, patients improved in somatic complaints (p < 0.001), and depression (p = 0.04). Related eating disorders were more common than those of the normative group and improved significantly after surgery in scores for compulsive intake (BES p < 0.001) and overall key behaviours of eating disorders and related cognitive symptoms (EDE-Q/G p < 0.001). In our cohort ready for bariatric surgery a mild psychopathological profile is still present and becomes closer to that of the normative group after surgery. Further studies are needed to evaluate the effects of mild psychopathology on outcomes after bariatric surgery.
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Affiliation(s)
- Tura Benítez
- Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain.
- Mental Health Department, Hospital Universitari Parc Taulí, 08208, Sabadell, Spain.
| | - Assumpta Caixàs
- Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain.
- Endocrinology and Nutrition Department, Hospital Universitari Parc Taulí, 08208, Sabadell, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, 08208, Sabadell, Spain.
| | - Pere Rebasa
- Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
- Department of Surgery, Hospital Universitari Parc Taulí, 08208, Sabadell, Spain
| | - Alexis Luna
- Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
- Department of Surgery, Hospital Universitari Parc Taulí, 08208, Sabadell, Spain
| | - Sara Crivillés
- Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Parc del Taulí, 1, 08208, Sabadell, Barcelona, Spain
- Mental Health Department, Hospital Universitari Parc Taulí, 08208, Sabadell, Spain
| | - Teresa Gutiérrez
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Joan Deus
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003, Barcelona, Spain
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Abdelaziz HA, Abdelbaki TN, Dean YE, Assem S. Is neuregulin-1 (NRG-1) a potential blood biomarker linking depression to obesity? A case-control study. BMC Psychiatry 2023; 23:670. [PMID: 37710187 PMCID: PMC10503040 DOI: 10.1186/s12888-023-05160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND AIM No definite biomarker linking depression and obesity has been found yet. Our study aimed to investigate neuregulin-1 (NRG-1) as a potential blood biomarker for this association. METHODS A case-control study was conducted on 108 obese subjects assigned for laparoscopic sleeve gastrectomy and 100 non-obese controls. Depression was assessed pre- and post-operatively. Serum NRG-1 was measured. RESULTS Pre-operatively depression was significantly higher among obese compared to non-obese patients. After the operation, 1.9% of the severely depressed subjects reported no depression, while 5.6% became moderately depressed; about 6% of the moderately depressed and 16% of the mildly depressed became not depressed. Serum NRG-1 level was significantly lower among obese and severely depressed compared to the controls. It was negatively correlated to the level of depression pre- and post-operative (r = -0.764 and -0.467 respectively). The sensitivity of serum NRG1 as a predictor for depression pre- and post-operative was 92.45% and 52.94% respectively. Specificity was 69.09% and 79.73% respectively at cut-off values of ≤ 3.5 and ≤ 2.5 ng/ml. CONCLUSION NRG-1 is a possible biomarker for the diagnosis of depression pre-bariatric surgery and the prediction of its prognosis post-operatively.
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Affiliation(s)
- Heba Ahmed Abdelaziz
- Family Health, Mental Heath Department, High Institute of Public Health, Alexandria, Egypt
| | - Tamer Nabil Abdelbaki
- Faculty of Medicine, General Surgery Department, Alexandria University, Alexandria, Egypt
| | - Yomna E Dean
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Sara Assem
- Faculty of Medicine, Medical Biochemistry Department, Alexandria University, Alexandria, Egypt
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Chahal-Kummen M, Våge V, Kristinsson JA, Mala T. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis 2023; 19:819-829. [PMID: 36870870 DOI: 10.1016/j.soard.2023.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes. OBJECTIVE To compare the prevalence of patient-reported chronic abdominal pain (CAP) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Secondarily, we compared other abdominal and psychological symptoms and quality of life (QoL). Preoperative predictors of postoperative CAP were also explored. SETTING Tertiary referral centers for bariatric surgery in Norway. METHODS Analyses of 2 separate prospective longitudinal cohort studies evaluating CAP, abdominal and psychological symptoms and QoL before and 2 years after RYGB and SG. RESULTS Follow-ups were attended by 416 patients (85.8%), 300/416 (72.1%) were females and 209/416 (50.2%) were RYGB procedures. At follow-up, the mean age was 44.9 (10.0) years, BMI 29.5 (5.4) kg/m2, and total weight loss 31.6 (10.3) %. The prevalence of CAP was 28/236 (11.9%) before and 60/209 (28.7%) after RYGB (P < .001) and 32/223 (14.3%) before and 50/186 (26.9%) after SG (P < .001). Gastrointestinal symptom rating scale scores showed greater deterioration of diarrhea and indigestion after RYGB and reflux after SG. The improvement in depression symptoms was greater after SG, as well as several QoL scores improved more after SG. Patients with CAP after RYGB experienced deterioration in several QoL scores, while these scores improved in patients with CAP after SG. Preoperative hypertension, bothersome reflux symptoms, and CAP predicted postoperative CAP. CONCLUSIONS The prevalence of CAP increased comparably after RYGB and SG, with worsening of gastroesophageal reflux after SG and greater deterioration of diarrhea and indigestion after RYGB. In patients with CAP at follow-up, several QoL scores improved more after SG than RYGB.
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Affiliation(s)
- Monica Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine and Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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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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Barbuti M, Carignani G, Weiss F, Calderone A, Fierabracci P, Salvetti G, Menculini G, Tortorella A, Santini F, Perugi G. Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study. Eat Weight Disord 2023; 28:49. [PMID: 37266717 DOI: 10.1007/s40519-023-01574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/14/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Subjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity disorder (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery. METHODS Subjects consecutively referred for pre-surgical evaluation at the Obesity Center of Pisa University Hospital were recruited. Psychiatric diagnoses were made through the Mini-International Neuropsychiatric Interview (MINI) and ADHD symptomatology was assessed with the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Emotional dysregulation was investigated through the WRAADDS and self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during follow-up. RESULTS Of the 99 participants recruited, 76 underwent surgery and 65 could be reevaluated 1 year after surgery. Subjects with insufficient weight loss (excess body mass index loss ≤ 53%, n = 15) had more frequent lifetime binge eating disorder (BED) and BED-mood disorders comorbidity than subjects with favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing emotional dysregulation, which represents a nuclear symptom of ADHD in adults. At the logistic regression analysis, older age, higher preoperative excess body mass index and greater affective instability were predictors of reduced weight loss at 1-year follow-up. CONCLUSION Emotional dysregulation seems to be associated with a worse outcome after bariatric surgery. Further studies with larger samples and longer follow-up are needed to confirm the influence of different psychiatric disorders and psychopathological traits on post-surgical outcome. LEVEL OF EVIDENCE V, prospective descriptive study.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Giulia Carignani
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Francesco Weiss
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alba Calderone
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paola Fierabracci
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guido Salvetti
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Ferruccio Santini
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulio Perugi
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy.
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Romagna EC, Mattos DMF, Lopes KG, Kraemer-Aguiar LG. Screening Risks of Alcohol Abuse, Depressive Symptoms, and Decreased Health-Related Quality of Life in Post-Bariatric Patients and Their Relations to Weight Regain. Obes Surg 2023:10.1007/s11695-023-06605-3. [PMID: 37097429 DOI: 10.1007/s11695-023-06605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes. MATERIAL AND METHODS Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m2) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey. RESULTS Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group. CONCLUSIONS HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
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Affiliation(s)
- Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom / Postgraduate Program on Electrical and Telecommunications Engineering (PPGEET), Fluminense Federal University, Niteroi, RJ, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de setembro, 77, Vila Isabel, Rio de Janeiro, RJ, Brazil.
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Pasi P, Kröll D, Siegfried A, Sykora M, Wildisen A, Milone C, Milos G, Horka L, Fischli S, Henzen C. Plasma concentrations of SSRI/SNRI after bariatric surgery and the effects on depressive symptoms. Front Psychiatry 2023; 14:1132112. [PMID: 37181889 PMCID: PMC10166804 DOI: 10.3389/fpsyt.2023.1132112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Depression and treatment with antidepressants SSRI/SNRI are common in people with morbid obesity who are candidates for bariatric surgery. There is few and inconsistent data about the postoperative plasma concentrations of SSRI/SNRI. The aims of our study were to provide comprehensive data about the postoperative bioavailability of SSRI/SNRI, and the clinical effects on depressive symptoms. Methods Prospective multicenter study including 63 patients with morbid obesity and therapy with fixed doses of SSRI/SNRI: participants filled the Beck Depression Inventory (BDI) questionnaire, and plasma levels of SSRI/SNRI were measured by HPLC, preoperatively (T0), and 4 weeks (T1) and 6 months (T2) postoperatively. Results The plasma concentrations of SSRI/SNRI dropped significantly in the bariatric surgery group from T0 to T2 by 24.7% (95% confidence interval [CI], -36.8 to -16.6, p = 0.0027): from T0 to T1 by 10.5% (95% 17 CI, -22.7 to -2.3; p = 0.016), and from T1 to T2 by 12.8% (95% CI, -29.3 to 3.5, p = 0.123), respectively.There was no significant change in the BDI score during follow-up (-2.9, 95% CI, -7.4 to 1.0; p = 0.13).The clinical outcome with respect to SSRI/SNRI plasma concentrations, weight change, and change of BDI score were similar in the subgroups undergoing gastric bypass surgery and sleeve gastrectomy, respectively. In the conservative group the plasma concentrations of SSRI/SNRI remained unchanged throughout the 6 months follow-up (-14.7, 95% CI, -32.6 to 1.7; p = 0.076). Conclusion In patients undergoing bariatric surgery plasma concentrations of SSRI/SNRI decrease significantly by about 25% mainly during the first 4 weeks postoperatively with wide individual variation, but without correlation to the severity of depression or weight loss.
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Affiliation(s)
- Patrick Pasi
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Dino Kröll
- Division of Visceral Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Alena Siegfried
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Martin Sykora
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Alessandro Wildisen
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Cristiana Milone
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Laura Horka
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Stefan Fischli
- Department of Internal Medicine, Division of Endocrinology, Cantonal Hospital, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Division of Endocrinology, Cantonal Hospital, Lucerne, Switzerland
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Coughlin JW, Nauman E, Wellman R, Coley RY, McTigue KM, Coleman KJ, Jones DB, Lewis KH, Tobin JN, Wee CC, Fitzpatrick SL, Desai JR, Murali S, Morrow EH, Rogers AM, Wood GC, Schlundt DG, Apovian CM, Duke MC, McClay JC, Soans R, Nemr R, Williams N, Courcoulas A, Holmes JH, Anau J, Toh S, Sturtevant JL, Horgan CE, Cook AJ, Arterburn DE. Preoperative Depression Status and 5 Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort. Ann Surg 2023; 277:637-646. [PMID: 35058404 PMCID: PMC9994793 DOI: 10.1097/sla.0000000000005364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether depression status before metabolic and bariatric surgery (MBS) influenced 5-year weight loss, diabetes, and safety/utilization outcomes in the PCORnet Bariatric Study. SUMMARY OF BACKGROUND DATA Research on the impact of depression on MBS outcomes is inconsistent with few large, long-term studies. METHODS Data were extracted from 23 health systems on 36,871 patients who underwent sleeve gastrectomy (SG; n=16,158) or gastric bypass (RYGB; n=20,713) from 2005-2015. Patients with and without a depression diagnosis in the year before MBS were evaluated for % total weight loss (%TWL), diabetes outcomes, and postsurgical safety/utilization (reoperations, revisions, endoscopy, hospitalizations, mortality) at 1, 3, and 5 years after MBS. RESULTS 27.1% of SG and 33.0% of RYGB patients had preoperative depression, and they had more medical and psychiatric comorbidities than those without depression. At 5 years of follow-up, those with depression, versus those without depression, had slightly less %TWL after RYGB, but not after SG (between group difference = 0.42%TWL, P = 0.04). However, patients with depression had slightly larger HbA1c improvements after RYGB but not after SG (between group difference = - 0.19, P = 0.04). Baseline depression did not moderate diabetes remission or relapse, reoperations, revision, or mortality across operations; however, baseline depression did moderate the risk of endoscopy and repeat hospitalization across RYGB versus SG. CONCLUSIONS Patients with depression undergoing RYGB and SG had similar weight loss, diabetes, and safety/utilization outcomes to those without depression. The effects of depression were clinically small compared to the choice of operation.
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Affiliation(s)
- Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | | | - Robert Wellman
- Kaiser Permanente Washington Health Research institute, Seattle, WA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research institute, Seattle, WA
| | - Kathleen M McTigue
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Daniel B Jones
- Department of Surgery, Beth israel Deaconess Medical Center and Harvard Medical School Boston, MA
| | - Kristina H Lewis
- Departments of Epidemiology & Prevention, and implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY
| | - Christina C Wee
- Department of Surgery, Beth israel Deaconess Medical Center and Harvard Medical School Boston, MA
| | | | | | - Sameer Murali
- Kaiser Permanente Southern California Medical Group, Oakland, CA
| | - Ellen H Morrow
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Ann M Rogers
- Penn State University College of Medicine, Penn State Health, Department of Surgery, Hershey, PA
| | - G Craig Wood
- Obesity Institute, Geisinger Medical Center, Danville, PA
| | | | | | | | | | - Rohit Soans
- Temple University Hospital, Philadelphia, PA
| | - Rabih Nemr
- Weill Cornell Medical College, New York, NY
| | | | | | - John H Holmes
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jane Anau
- Louisiana Public Health Institute, New Orleans, LA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Casie E Horgan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research institute, Seattle, WA
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28
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Murton LM, Plank LD, Cutfield R, Kim D, Booth MWC, Murphy R, Serlachius A. Bariatric Surgery and Psychological Health: A Randomised Clinical Trial in Patients with Obesity and Type 2 Diabetes. Obes Surg 2023; 33:1536-1544. [PMID: 36964319 PMCID: PMC10156786 DOI: 10.1007/s11695-023-06537-y] [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: 05/23/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE This study investigated the impact of either Roux-en-Y gastric bypass with silastic ring (SR-RYGB) or sleeve gastrectomy (SG) types of bariatric surgery on psychological health and explored the role of pre-existing depressive symptoms on weight loss. MATERIALS AND METHODS A total of 114 participants with obesity and type 2 diabetes were randomized to receive SR-RYGB or SG at a single centre. Data from the Hospital Anxiety and Depression Scale (HADS), RAND 36-item Health Survey and body weight were collected before surgery and annually for 5 years. RESULTS Sixteen patients were lost to follow-up at 5 years. Of the 98 patients who completed 5-year psychological follow-up assessments, 13 had mild to severe depressive symptoms (SR-RYGB n = 6, SG n = 7). SR-RYGB and SG resulted in similar psychological health improvement but percent weight loss at 5 years was greater for SR-RYGB by 10.6% (95% CI: 7.2 to 14.0, P < 0.0001). Scores for depressive symptoms and most RAND-36 domains improved significantly from baseline to 5 years in both groups. Patients with pre-existing depressive symptoms had similar percent weight loss at 5 years compared to patients without depressive symptoms, irrespective of procedural type. CONCLUSION Patients receiving either SR-RYGB or SG had comparable psychosocial functioning, which was maintained to 5 years post-surgery. Pre-existing depressive symptoms did not affect weight loss achieved at 5 years. These findings confirm previous longitudinal studies demonstrating that bariatric surgery is generally associated with improved psychosocial functioning.
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Affiliation(s)
- Lynn M Murton
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Lindsay D Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Rick Cutfield
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand
| | - David Kim
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand
| | - Michael W C Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
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29
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How Soon Do Depression and Anxiety Symptoms Improve after Bariatric Surgery? Healthcare (Basel) 2023; 11:healthcare11060862. [PMID: 36981519 PMCID: PMC10048012 DOI: 10.3390/healthcare11060862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Depression and anxiety are prevalent among bariatric surgery candidates, yet little is known about the course of symptoms after surgery. This study aimed to identify how soon changes in depression and anxiety occur after surgery. A retrospective review of patients treated at a university hospital was conducted. Participants attended a presurgical psychological evaluation, completed surgery, and attended follow-up visits with bariatric medical providers (2 weeks, 6 weeks, 3 months, and 6 months postoperatively). Depression and anxiety symptoms were assessed at all time points by the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety. Generalized estimating equations models with repeated measures by person over time were used to examine change in depression and anxiety symptoms across time. Among 27 patients, anxiety (incident rate ratio (IRR) = 0.81, p = 0.04) and depression (IRR = 0.78, p = 0.05) significantly improved both 6 weeks and 3–6 months after bariatric surgery, after controlling for education, marital status, surgery type, age, and baseline body mass index. This is the first known study to show faster improvement in anxiety compared to depression after bariatric surgery. Understanding reductions in anxiety and depression symptoms may be important for postoperative care and timing of weight maintenance interventions.
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30
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Woods R, Moga AM, Ribeiro PAB, Stojanovic J, Lavoie KL, Bacon SL. Evolution of depressive symptoms from before to 24 months after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2023; 24:e13557. [PMID: 36823768 DOI: 10.1111/obr.13557] [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: 06/09/2022] [Revised: 11/16/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023]
Abstract
AIMS Depression after bariatric surgery can lead to suboptimal health outcomes. However, it is unclear how depressive symptoms evolve over the 24 months after surgery. We determined the extent depressive symptoms changed up to 24 months after bariatric surgery and how this was impacted by measurement tool and surgical procedure. METHODS We conducted a systematic review and meta-analysis, searching five databases from database inception to June 2021 for studies that prospectively measured depressive symptoms before and up to 24 months after bariatric surgery. Change scores were converted to Hedge's g, and analyses were performed using mixed-effects models. Subgroup analyses examined differences across time of follow-up, measurement tool, and surgical procedure. FINDINGS Forty-six studies met inclusion criteria (32,342 patients). Meta-analysis indicated a postsurgical reduction in depressive symptom scores that were significant (large effect, g = 0.804; 95% CI: 0.73-0.88, I2 = 95.7%). Subgroup analyses found that symptom reductions did not differ between the timing of follow-up periods, measurement tool, and surgical procedure. CONCLUSIONS Depressive symptom scores reduced substantially following surgery; comparable decreases occurred 6 through 24 months after surgery. These findings can help inform practitioners of the typical evolution of depressive symptoms following surgery and where deviations from this may require additional intervention.
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Affiliation(s)
- Robbie Woods
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Ana M Moga
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jovana Stojanovic
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, University of Quebec at Montréal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
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31
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Rheinwalt KP, Fobbe A, Plamper A, Alizai PH, Schmitz SMT, Brol MJ, Trebicka J, Neumann UP, Ulmer TF. Health-related quality of life outcomes following Roux-en-Y gastric bypass versus one anastomosis gastric bypass. Langenbecks Arch Surg 2023; 408:74. [PMID: 36729181 DOI: 10.1007/s00423-023-02792-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/23/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are effective standard bariatric surgeries with comparable weight loss and remission of obesity-related comorbidities. As procedure-specific health-related quality of life (HrQoL) outcomes have not been directly compared thus far, we conducted this questionnaire-based study. METHODS Two hundred forty patients after undergoing either RYGB or OAGB between 2011 and 2016 were contacted and asked to fill out SF36 and BAROS questionnaires. All statistical analysis was performed with Microsoft Excel and GraphPad Prism. Primary objectives were procedure-dependent differences in HrQoL. Secondary objectives were weight loss and remission of comorbidities. RESULTS One hundred nineteen of 240 contacted patients (49.6%) replied, 58 after RYGB (48.7%) and 61 after OAGB (51.3%). Follow-up period was < 24 months in 52 and > 24 months in 64 evaluable patients. The mean age was 46 years (range 23 to 71). Regarding the < 24 months groups, both physical and psychological SF36 sum scales were comparably high. Only the subcategory "general health perception" was significantly better after RYGB. Significantly higher excess weight loss (EWL) after RYGB (88.81%) compared to OAGB (66.25%) caused significantly better global < 24 months BAROS outcomes, whereas remission of comorbidities and HrQoL was similar. Both > 24 months groups showed high SF36-HrQoL sum scales. Global mean BAROS results after > 24 months were "very good" in both procedures. EWL in RYGB (80.81%) and in OAGB (81.36%) were comparably excellent. CONCLUSION Concerning SF36 and BAROS evaluated HrQoL in early and late postoperative phases, both procedures demonstrated comparable and relevant improvements. Further (preferably randomized) studies should include evaluation of preoperative HrQoL.
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Affiliation(s)
- Karl Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schoensteinstrasse 63, 50825, Cologne, Germany.
| | - Anna Fobbe
- Department of General and Visceral Surgery, and Proctology, Klinikum Westfalen GmbH, Knappschaftskrankenhaus Dortmund, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Germany
| | - Andreas Plamper
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schoensteinstrasse 63, 50825, Cologne, Germany
| | - Patrick Hamid Alizai
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Sophia Marie-Therese Schmitz
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Maximilian Joseph Brol
- Department of Internal Medicine B, Westfälische Wilhelms-Universität, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jonel Trebicka
- Department of Internal Medicine B, Westfälische Wilhelms-Universität, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
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Hosseini SM, Amiri S, Akhavan-Moghadam J. Impact of Laparoscopic Sleeve Gastrectomy on Physical and Psychological Health in Patients with Obesity: A Prospective Study. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Seyed Morteza Hosseini
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Muacevic A, Adler JR, Allami HA, Almousa HM, Alobaid AS, Ismail DH, Bin Onayq AI. The Prevalence of Depression and Anxiety in Post-bariatric Surgery Patients at King Khalid University Hospital, Riyadh. Cureus 2022; 14:e32500. [PMID: 36644066 PMCID: PMC9837663 DOI: 10.7759/cureus.32500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity negatively impacts mental and physical health and is a leading cause of disease worldwide. Obesity affects 33% of Saudi adults, with 10% being morbidly obese (body mass index, BMI >40 kg/m2). This study explored the association between bariatric surgery (BS) and a predisposition or exacerbation of depressive and anxiety symptoms. Material and methods A cross-sectional study of patients who underwent bariatric surgery at the King Khalid University Hospital in Riyadh, Saudi Arabia, was conducted between February 2016 and December 2021. The patients were contacted by phone to complete a self-administered questionnaire on demographic information, chronic medical diseases, psychiatric diseases, body mass index, and type of bariatric surgery. In addition, they completed the patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) questionnaire to screen for patients' depression and anxiety symptoms. Results The findings of the 367 BS patients showed that 20.7% of the patients were considered to have mild anxiety, 11.2% had moderate anxiety, and 8.7% had high anxiety levels. However, regarding depression, 46.9% had extremely low levels of depression, followed by mild depression in 29.4% and moderate depression in 11.2%. Furthermore, another 8.2% of BS patients had moderately high depression levels, and 4.4% had severe depression. The anxiety and depression levels of the patients in this study did not show any statistically significant changes postoperatively in the short, medium, or long term. On the other hand, almost all of the patients 97% who underwent bariatric surgery were satisfied with the outcome of their surgery. Conclusion Few BS patients had high symptoms of depression and anxiety. We recommend pre- and postoperative psychiatric assessment for all bariatric surgery patients as surgical protocol.
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Monteleone AM, Globus I, Cascino G, Klomek AB, Latzer Y. Psychopathology predicts mental but not physical bariatric surgery outcome at 3-year follow-up: a network analysis study. Eat Weight Disord 2022; 27:3331-3340. [PMID: 36029369 PMCID: PMC9803758 DOI: 10.1007/s40519-022-01463-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This study aimed to explore the psychopathological variables that may predict bariatric surgery outcomes after 3 years. METHODS One hundred ninety-six candidates for bariatric surgery completed self-report questionnaires to assess eating attitudes, eating disorder (ED)-related psychopathology, affective symptoms, interpersonal and psycho-social functioning. One-hundred patients repeated this assessment 3 years after bariatric surgery. A network analysis was run including the pre-surgical measurements in the network. A composite score derived from the combination of the most central network nodes, as well as clinical and socio-demographical variables, was included in a multivariate regression analysis with weight loss, ED psychopathology and psycho-social functioning as outcomes. RESULTS Depression, stress, and shape concerns were the most central network nodes. The composite network score predicted higher ED psychopathology and worse psycho-social functioning at 3-year follow-up, but not weight loss. Higher age, restricting type of bariatric surgery and higher pre-operative BMI were further predictors of reduced weight loss and greater ED psychopathology. CONCLUSIONS Affective symptoms and shape concern play a central role in the psychopathology of candidates to bariatric surgery and predict post-surgery ED psychopathology and psycho-social functioning. These variables may allow to identify patients with higher pre-operative risk and in need of further psycho-social interventions. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort study.
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Affiliation(s)
| | - Inbal Globus
- School of Public Health, University of Haifa, Haifa, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Yael Latzer
- Eating Disorders Institution, Psychiatric Division, Rambam Medical Center, Haifa, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Nielsen C, Elander A, Staalesen T, Al Nouh M, Fagevik Olsén M. Depressive symptoms before and after abdominoplasty among post-bariatric patients - a cohort study. J Plast Surg Hand Surg 2022; 56:381-386. [PMID: 35294844 DOI: 10.1080/2000656x.2022.2050251] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The majority of post-bariatric patients suffer from excess skin after weight loss, impairing physical, psychosocial and mental health. The abdomen is the most common location for excess skin, and abdominoplasty is the most commonly required reconstructive procedure. Abdominoplasty removes excess abdominal skin and attenuates related symptoms, but knowledge regarding mental health-related effects is scarce. Here, we aimed to evaluate the symptoms and severity of depression before and after abdominoplasty in post-bariatric patients and to analyse the relationships between depressive symptoms, quality of life (QoL) and experience of excess skin. We enrolled 110 former obese patients undergoing abdominoplasty. Three questionnaires evaluating the symptoms of depression (Beck Depression Inventory (BDI-II)), experience of excess skin (Sahlgrenska Excess Skin Questionnaire (SESQ)) and QoL (36-item Short-Form Health Survey (SF-36)) were completed preoperatively and 1 year postoperatively. After abdominoplasty, symptoms of depression (BDI sum score) significantly decreased (5.8 vs. 3.0, p = .037). Scores on three BDI questions improved (p < .05), and the SESQ score normalised (p < .001), while the SF-36 score was unaffected. The BDI sum score was moderately correlated with the SF-36 mental composite score (preoperatively, rs = -0.69; postoperatively, rs = -0.66) and fairly correlated with the SF-36 physical composite score (rs = 0.32, rs = 0.26). The correlation between the BDI sum and SESQ scores was poor preoperatively (rs = -0.106) and fair postoperatively (rs = 0.232). The results indicate that abdominoplasty may reduce symptoms of depression in post-bariatric patients. However, the procedure did not affect SF-36 scores. Further studies are required to validate these results.
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Affiliation(s)
- Christina Nielsen
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Trude Staalesen
- Department of Clinical Sciences/Plastic Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Monika Fagevik Olsén
- Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Neuroscience and Physiology/Physical Therapy, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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36
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Judgment towards emotions as a mediator of the relationship between emotional eating and depression symptoms in bariatric surgery candidates. Eat Weight Disord 2022; 27:3675-3683. [PMID: 36449208 DOI: 10.1007/s40519-022-01508-1] [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: 06/28/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Emotional eating is common in bariatric surgery candidates, and often is associated with depression and poorer weight loss outcomes following surgery. However, less is known about other modifiable risk factors that may link depression and emotional eating. The aim of the current study was to examine facets of mindfulness as potential mediators of the relationship between emotional eating and depression severity in bariatric surgery candidates. METHODS Bariatric surgery candidates (n = 743) were referred by their surgeons for a comprehensive psychiatric pre-surgical evaluation that included self-report questionnaires assessing depression severity, emotional overeating, and facets of mindfulness. Mediation effects were examined for each mindfulness facet based on prior research. RESULTS Only the nonjudging mindfulness facet significantly mediated the relationship between emotional eating and depression, suggesting that greater emotional eating may be associated with greater depression severity through higher levels of judgement towards thoughts and emotions. A reverse mediation analysis showed that depression severity was not a significant mediator of the relationship between nonjudging and emotional eating. CONCLUSION Fostering a nonjudgmental stance towards thoughts and feelings may be helpful in improving eating habits that would support greater post-surgical success. Other clinical and research implications are discussed. LEVEL OF EVIDENCE Level V, descriptive study.
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The Factor Structure and Stability of the Beck Depression Inventory-II (BDI-II) in a Population Undergoing Bariatric Surgery. Obes Surg 2022; 32:3732-3739. [PMID: 36169910 DOI: 10.1007/s11695-022-06277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Depression is a multifaceted psychiatric condition that has been associated with suboptimal weight loss following bariatric surgery. Previous variations of Beck Depression Inventory-Second Edition (BDI-II) subscales been proposed, including those identified within bariatric populations; however, it is unclear whether the BDI-II items contained within these subscales would remain consistent after the procedure considering the physical and lifestyle changes that occur following bariatric surgery. MATERIALS AND METHODS A two-step analytic approach that comprised of exploratory (EFA) and confirmatory factor analyses (CFA) that aimed to identify a stable factor structure using pre- and 6-month post-surgical BDI-II responses. Baseline BDI-II responses of 149 patients (Group 1) were used to identify an initial EFA model. Five BDI-II models underwent CFA using BDI-II responses of a comparable pre-surgical group (Group 2; n = 142), and 6-month post-surgical data from Group 1. RESULTS EFA generated a two-factor solution. Of the five CFA models performed, the three-factor model that was initially identified by Hayes (2015) among patients undergoing bariatric surgery demonstrated superior fit across time and between groups. CONCLUSIONS Although the EFA initially identified a two-factor model, CFA determined that a previously defined three-factor model reliably fit both pre- and post-surgical BDI-II responses. This study supports using the Hayes (2015) subscales when monitoring pre- and post-bariatric surgery facets of depression specific to this population. Being able to accurately and reliably monitor depressive symptoms of patients that are undergoing bariatric surgery will allow for the provision and monitoring of targeted interventions aimed at improving their mental and physical health outcomes.
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Changes in Gait Self-Efficacy, Fear of Falls, and Gait Four and Eight Months after Bariatric Surgery. Behav Sci (Basel) 2022; 12:bs12080246. [PMID: 35892345 PMCID: PMC9332025 DOI: 10.3390/bs12080246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
After bariatric surgery, individuals improve walking characteristics related to fall risk. However, little is known about psychosocial factors, such as gait self-efficacy and fear of falling, after surgery. Our objectives were to (1) examine how weight loss affects psychosocial factors and gait four and eight months after bariatric surgery, as well as (2) determine if there is a relationship between gait self-efficacy and fear of falling. Fourteen adults scheduled to undergo bariatric surgery completed three visits: before surgery, four and eight months after surgery. Gait self-efficacy was measured with the Modified Gait Efficacy Scale, and fear of falls was measured with the Tinetti Falls Efficacy Scale. Gait measures were collected during five conditions: initial baseline and final baseline on flat ground, and crossing obstacles of three heights. Gait self-efficacy or fear of falling did not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower fear of falling were correlated with longer and faster steps during all conditions (all ps < 0.05). Focusing interventions on psychosocial measures related to gait may yield longer lasting improvements in walking after surgery, ultimately resulting in a decreased fall risk and higher quality of life.
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Nicolau J, Rodríguez I, Dotres K, Ayala L, Sanchís P, Tamayo MI, Pascual S, Cifuentes A, Masmiquel L. Long-term chronic joint pain after sleeve gastrectomy and its influence on clinical and psychological outcomes. ENDOCRINOL DIAB NUTR 2022; 69:401-408. [PMID: 35817545 DOI: 10.1016/j.endien.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Bariatric surgery (BS) is effective in improving chronic joint pain (CJP). However, the long-term effects on this comorbidity are poorly understood. OBJECTIVES To determine the prevalence of CJP in a sample of patients who had undergone BS with a minimum follow-up of 18 months. To determine whether or not there was any relationship between CJP and clinical or psychological outcomes after BS. MATERIAL AND METHODS Cross-sectional study. The Lattinen index (LI) was used to evaluate CJP, using the cut-off point of 10 to define significant CJP (SCJP). RESULTS Of the 110 subjects assessed, 31.2% (35/110) had SCJP. The patients with SCJP were older (57.4±13 vs 47.8±11.6 years; p<0.0001) and more time had elapsed since their BS (105.6±54.3 vs 78.5±39 months; p=0.023). The last BMI was higher in subjects with SCJP (35±5 vs 33.3±6.9kg/m2; p=0.05) and the percentage of patients who took significant regular exercise was lower (2.9% vs 68%; p<0.0001). Trauma problems after BS were more common in subjects with SCJP (61.8% vs 22.7%; p<0.0001). More patients with SCJP met depression criteria (47.1% vs 5.3%; p<0.0001) and/or were treated with antidepressants (38.2% vs 17.3%; p=0.003). Patients with SCJP reported fewer hours of sleep (6±1.4 vs 6.8±1.2h; p=0.003). CONCLUSIONS SCJP is highly prevalent in patients who have had BS once they reach the weight plateau phase. There is an association between having SCJP and worse psychological and functional status, with potential detrimental metabolic effects.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain.
| | - Irene Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain; Surgery Department, Hospital Universitario Son Llàtzer [Son Llàtzer University Hospital], Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Keyla Dotres
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Luisa Ayala
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Pilar Sanchís
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - María Isabel Tamayo
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Salvador Pascual
- Surgery Department, Hospital Universitario Son Llàtzer [Son Llàtzer University Hospital], Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Andrés Cifuentes
- Surgery Department, Hospital Universitario Son Llàtzer [Son Llàtzer University Hospital], Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Lluís Masmiquel
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, University Institute of Health Science Research (IUNICS) and Health Research Institute of Baleares (IdISBA), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
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Long-term chronic joint pain after sleeve gastrectomy and its influence on clinical and psychological outcomes. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alyahya RA, Alnujaidi MA. Prevalence and Outcomes of Depression After Bariatric Surgery: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e25651. [PMID: 35784972 PMCID: PMC9249077 DOI: 10.7759/cureus.25651] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
Abstract
Surgeons often focus on weight loss and improvement of obesity-related conditions as a primary outcome after bariatric surgery. However, the success of bariatric surgery also relies on the improvement of mental health status. Therefore, the current meta-analysis was carried out to reveal the prevalence of depressive symptoms and their subsequent impact on bariatric surgery outcomes. This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the recommendation of Cochrane Collaboration. All clinical studies reporting the prevalence and/or the outcomes of depression after bariatric surgery were included in the current meta-analysis. This meta-analysis encompassed 33 articles, including a total of 101,223 patients. The prevalence of post-bariatric surgery depression was 15.3% (95% confidence intervals {CI}: 15.0-15.5%, p<0.001) among which severe, moderate, and minimal depression accounted for 1.9% (95% CI: 1.5-2.4%, p<0.001), 5.1% (95% CI: 4.4-5.8%, p<0.001), and 64.9% (95% CI: 63.3-66.5%, p<0.001), respectively. Depression is negatively correlated with weight loss (correlation -0.135; 95% CI: -0.176 to 0.093; p<0.001) and positively correlated with eating disorder (correlation 0.164; 95% CI: 0.079-0.248; p<0.001). The prevalence of post-bariatric surgery depression is relatively high reaching up to 64.9%, with almost one in five patients affected by it. Depression is associated with weight regain, eating disorders, and quality of life.
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Affiliation(s)
- Rayyan A Alyahya
- Pediatrics and Neonatology, Prince Sultan Military Medical City, Riyadh, SAU
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Trigano C, Afchain F, Florent V, Bonnet A. [The effect of body mass index on outcome of body contouring surgeries]. ANN CHIR PLAST ESTH 2022; 67:68-72. [PMID: 35459581 DOI: 10.1016/j.anplas.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The generalization of bariatric surgery interventions has led in recent years to an explosion in demand for body contouring surgeries. These operations can be followed by postoperative complications; and residual obesity, defined by a BMI≥30, is traditionally considered as a relative contraindication. The objective is to study the influence of a BMI≥30 on the risk of postoperative complications. METHODS A retrospective study was conducted on all patients who underwent body contouring surgery between 2014 and 2020 at the Arras Hospital Center. Major complication rates were compared in obese and non-obese patients. RESULTS Two hundred twenty-three patients were included, representing a total of 247 surgeries: 124 in the BMI<30 group and 123 in the BMI≥30 group. Sixteen surgeries were followed by at least one major complication, 6 in group I versus 10 in group II (RR=1.7 (0.6-4.5), NS, P=0.29). Therefore there were not significantly more major complications in obese patients. CONCLUSION The incidence of major complications following body contouring surgeries is not modified by the presence of a BMI greater than 30, subject to a precautionary procedure adapted to each patient. BMI is therefore not a sufficient criterion to contraindicate this type of surgery.
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Affiliation(s)
- C Trigano
- Service de chirurgie plastique, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France.
| | - F Afchain
- Service de chirurgie plastique, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France
| | - V Florent
- Service de chirurgie plastique, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France
| | - A Bonnet
- Service de chirurgie plastique, centre hospitalier d'Arras, 3, boulevard Georges-Besnier, 62000 Arras, France
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Aylward L, Lilly C, Tabone L, Szoka N, Abunnaja S, Cox S. Anxiety Predicts Reduced Weight Loss 30 Months after Bariatric Surgery. Surg Obes Relat Dis 2022; 18:919-927. [DOI: 10.1016/j.soard.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Ibacache-Saavedra P, Jerez-Mayorga D, Carretero-Ruiz A, Miranda-Fuentes C, Cano-Cappellacci M, Artero EG. Effects of bariatric surgery on cardiorespiratory fitness: A systematic review and meta-analysis. Obes Rev 2022; 23:e13408. [PMID: 34927337 DOI: 10.1111/obr.13408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Although bariatric surgery (BS) is recognized as an effective strategy for body weight loss, its impact on cardiorespiratory fitness (CRF) is still unclear. We aimed to examine postoperative changes in CRF (VO2max/peak ) and its relationship with weight loss among adults undergoing BS. We systematically searched the WoS, PubMed, MEDLINE, and Scopus databases. Observational and intervention studies were selected reporting the presurgery and postsurgery CRF, measured by breath-by-breath VO2 or its estimation. Eleven articles (312 patients) revealed that BS leads to a reduction in absolute VO2max/peak in the short term (effect size, ES = -0.539; 95%CI = -0.708, -0.369; p < 0.001), and those patients who suffered a more significant decrease in BMI after BS also had a greater loss of absolute VO2max/peak . However, VO2max/peak relative to body weight increased after surgery (ES = 0.658; 95%CI = 0.473, 0.842; p < 0.001). An insufficient number of studies were found investigating medium and long-term changes in CRF after BS. This study provides moderate-quality evidence that the weight loss induced by BS can reduce CRF in the short term, which represents a therapeutic target to optimize BS outcomes. More high-quality studies are needed to evaluate the impact of BS on VO2max/peak in the short, medium, and long term including normalized values for fat-free mass.
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Affiliation(s)
- Paulina Ibacache-Saavedra
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Alejandro Carretero-Ruiz
- Department of Education and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almeria, Spain
| | - Claudia Miranda-Fuentes
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | | | - Enrique G Artero
- Department of Education and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almeria, Spain
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McGarrity LA, Terrill AL, Martinez PL, Ibele AR, Morrow EH, Volckmann ET, Smith TW. The Role of Resilience in Psychological Health Among Bariatric Surgery Patients. Obes Surg 2022; 32:792-800. [PMID: 35091900 DOI: 10.1007/s11695-021-05855-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Many individuals who undergo bariatric surgery have experienced repeated unsuccessful diet attempts and negative messages from healthcare providers, family, and others about their weight. Research pre- and post-operatively has taken a pathological or risk-based approach, investigating psychiatric problems and disordered eating. In contrast, the current study explores resilience in this population. METHODS Participants were 148 bariatric surgery patients. Participants completed measures pre-operatively and 1.5-3 years post-operatively, including the Binge Eating Scale, Eating Disorder Examination Questionnaire, Patient Health Questionnaire, Generalized Anxiety Questionnaire, Impact of Weight on Quality of Life, Coping Responses Inventory, and Duke Social Support and Stress Scales. The Connor-Davidson Resilience Scale was measured post-operatively. RESULTS Correlations demonstrated a significant association between post-operative resilience and lower symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life. Resilience was also associated with greater social support and less social stress, and greater use of approach coping strategies. Resilience was significantly associated with improvements in symptoms of binge eating, disordered eating, depression, anxiety, and impact of weight on quality of life from pre- to post-operative assessments. In regression models, associations remained significant after controlling for psychosocial variables at baseline (e.g., binge eating symptoms pre-operatively) and demographic covariates. CONCLUSIONS Psychological resilience has been under-studied in the literature on obesity and bariatric surgery, with a primary focus on risk factors for poor outcomes. This study was among the first to investigate associations between resilience and post-operative psychological outcomes. Results suggest the field would benefit from consideration of patient resilience in psychological assessments and interventions.
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Affiliation(s)
- Larissa A McGarrity
- University of Utah, Salt Lake City, UT, 84103, USA. .,Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, 84103, USA.
| | - Alexandra L Terrill
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, 84103, USA
| | - Paige L Martinez
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Anna R Ibele
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Ellen H Morrow
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Eric T Volckmann
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, 84103, USA
| | - Timothy W Smith
- University of Utah, Salt Lake City, UT, 84103, USA.,Department of Psychology, University of Utah, Salt Lake City, UT, 84103, USA
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Punt SE, Rhodes AC, Ilardi SS, Hamilton JL. Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery. J Clin Psychol Med Settings 2022; 29:808-817. [DOI: 10.1007/s10880-022-09850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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Troisi A. Emergence of bariatric psychiatry as a new subspecialty. World J Psychiatry 2022; 12:108-116. [PMID: 35111582 PMCID: PMC8783166 DOI: 10.5498/wjp.v12.i1.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery is the branch of surgery aimed at helping a person with obesity lose weight. The implementation of surgical treatment of obesity is growing at an impressive rate. As expected, the expanding implementation of bariatric procedures has progressively revealed critical issues that were not evident when the number of obese patients treated with surgery was relatively small. One critical issue is the importance of mental health assessment and care of bariatric patients. The aim of this review is to provide readers with an up-to-date summary of the goals, methods, and clinical strategies of bariatric psychiatry. The aims can be grouped into three distinct categories. First, to ascertain that there are no psychiatric contraindications to safe bariatric surgery. Second, to diagnose and treat pre-surgery mental conditions that could predict poor weight loss. Third, to diagnose and treat post-surgery mental conditions associated with poor quality of life. Although bariatric psychiatry has gained the status of a new subspecialty within the field of mental health and psychopathology, many clinical questions remain unsolved. We need more long-term data on outcome measures such as quality of life, adherence to behavioral guidelines, risk of suicide, and post-surgery prevalence of psychological disturbances and mental disorders.
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Affiliation(s)
- Alfonso Troisi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
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Tinós AMFG, Foratori-Junior GA, Marcenes W, Camargo FB, Groppo FC, Sales-Peres SHDC. IMPACT OF BARIATRIC SURGERY IN ANXIETY AND ORAL CONDITION OF OBESE INDIVIDUALS: A COHORT PROSPECTIVE STUDY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1615. [PMID: 35019127 PMCID: PMC8735262 DOI: 10.1590/0102-672020210002e1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity and bariatric surgery may be related with mental and oral disorders. AIM To evaluate the impact of bariatric surgery on anxiety, initial dental caries lesion and gingival bleeding in obese patients. METHODS Eighty-nine patients were divided in two groups: Control Group (CG) - obese patients and Experimental Group (EG) - patients submitted to bariatric surgery. EG was analyzed before and 12 months after bariatric surgery; for the CG, was respected an interval of 12 months between the evaluations. International Caries Detection and Assessment System, Gingival Bleeding Index and Trace-State Anxiety Inventory were used. Medical profile, anthropometrics data, sociodemographic and behavioral variables were considered. RESULTS There were no statistically significant differences between groups in evaluation times regarding to initial dental caries lesion and anxiety. However, the number of teeth with initial dental caries lesion (p=0.0033) and gingival bleeding (p<0.0001) increased significantly after bariatric surgery in EG. CONCLUSION These results reinforce the need for multi-professional team follow-up, including dental care, for both obese and bariatric patients.
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Affiliation(s)
- Adriana Maria Fuzer Grael Tinós
- University of São Paulo, Faculty of Dentistry of Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Gerson Aparecido Foratori-Junior
- University of São Paulo, Faculty of Dentistry of Bauru, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
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Adams RN, Athinarayanan SJ, McKenzie AL, Hallberg SJ, McCarter JP, Phinney SD, Gonzalez JS. Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction. J Behav Med 2022; 45:416-427. [PMID: 35084637 PMCID: PMC9160138 DOI: 10.1007/s10865-021-00272-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/13/2021] [Indexed: 01/02/2023]
Abstract
Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinical depressive symptoms decreased over the first 10 weeks and reductions were maintained out to 2 years. Increased frequency of blood ketone levels indicative of adherence to low carbohydrate eating predicted decreases in depressive symptoms. Concerns have been raised with recommending restrictive diets due to potential negative impacts on quality-of-life factors such as mood; however, results of the current study support positive rather than negative long-term impacts of closely monitored carbohydrate restriction on depressive symptoms.
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Affiliation(s)
- Rebecca N Adams
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA.
| | | | - Amy L McKenzie
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
| | - Sarah J Hallberg
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
- Indiana University Health Arnett, Lafayette, IN, USA
| | - James P McCarter
- Abbott Diabetes Care, Alameda, CA, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Pekcan YO, Tuncalı B, Erol V. Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:85-90. [PMID: 34848318 PMCID: PMC9801190 DOI: 10.1016/j.bjane.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGRAUND This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy. METHODS Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1st, 4th, 12th, and 24th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values obtained from the final model. RESULTS There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups. CONCLUSION In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.
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Affiliation(s)
- Yonca Ozvardar Pekcan
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Bahattin Tuncalı
- Başkent University School of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Varlık Erol
- Medicana Hospital Izmir, Department of General Surgery, Izmir, Turkey
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