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Benamran D, Chierici A, Bulsei J, Fontas E, Iannelli A. A Comprehensive Insight into the Economic Profile of People Receiving Metabolic and Bariatric Surgery Use in France. Obes Surg 2024; 34:3315-3323. [PMID: 39129041 DOI: 10.1007/s11695-024-07377-0] [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: 01/16/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The use of metabolic and bariatric surgery (MBS) is not uniformly distributed within the population, even if it is governed by established guidelines. This disparity seems to be associated, among other factors, with the economic profile of people receiving this surgery. OBJECTIVES We investigated the disparities in the use of MBS with respect to the socio-economic level in France based on socio-economic status (SES). MATERIALS AND METHODS A descriptive observational study was conducted to compare the population of individuals with obesity who underwent MBS (MBS group) with individuals with obesity with no history of MBS (obese group). Data were extracted from the French National Hospital discharge database ("Programme De Médicalisation des Systèmes d'Information," PMSI). Socio-economic status (SES) was assessed through the French Deprivation Index (FDep). RESULTS The use of MBS was significantly lower in patients having a higher SES compared to those having a lower one. There was no statistically significant difference in the use of MBS between individuals within the 4th and 5th SES quintiles compared to those in the 2nd and 3rd quintiles. No difference was found in the specific MBS procedures used depending on the SES. The obesity level was significantly lower in patients from the 1st and 3rd SES quintiles compared to the patients having a lower SES. CONCLUSION Our study provides valuable insights into the complex interrelationships between the use of MBS, patients' SES, and obesity levels according to the FDep. These findings underscore the importance of developing targeted interventions to address disparities in the use of bariatric care.
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Affiliation(s)
- Dorith Benamran
- University of Côte d'Azur, Nice, France
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France
| | - Andrea Chierici
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France
| | - Julie Bulsei
- Department of Clinical Research, University Hospital of Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- University of Côte d'Azur, Nice, France.
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France.
- Adipocible Research Consortium (Université Nice Côte d'Azur and Idex), Nice, France.
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 HospitalNice, 151 Route Saint Antoine de Ginestière, BP 3079, Cedex 3, Nice, France.
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Koball AM, Ames GE, Grothe K. Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity. Curr Obes Rep 2024; 13:574-583. [PMID: 38874702 DOI: 10.1007/s13679-024-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity. RECENT FINDINGS Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.
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Affiliation(s)
| | - Gretchen E Ames
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Karen Grothe
- Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA
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3
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Majstorovic M, Chur-Hansen A, Andrews JM, Burke A. Factors associated with progression or non-progression to bariatric surgery in adults: A systematic review. Obes Rev 2024; 25:e13698. [PMID: 38268336 DOI: 10.1111/obr.13698] [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: 11/27/2022] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Access to bariatric surgery is limited, and the factors related to undergoing or not undergoing the procedure are poorly understood. To this end, a systematic review of PubMed, Embase, PsycINFO, and CINAHL was conducted to deduce the factors associated with progression or non-progression to bariatric surgery. Quantitative and qualitative English-language articles ranging in date from database conception to September 2023 were included. Eligible studies employed adult participants (18 years of age or above) who had been referred for bariatric surgery. A total of 57 studies were identified. Fifteen key factors were found, alongside six less frequently studied factors: age, sex, BMI, race and ethnicity, distance to clinic, socio-economic status, insurance coverage, physical health, psychological health, eating history and habits, substance use and smoking, social influence and relationships, pre-surgery process and requirements, surgery-related concerns, choice of surgery, and others (emergency room visitation, COVID-19 virus, health literacy, appearance perceptions, time-off work, and stigma related to surgery). No factors were found to be reliably associated with progression or non-progression to bariatric surgery; however, the nature of these findings is tentative considering methodological flaws and limited research. Further studies are required to elucidate potential inequities in bariatric surgery access and educate policymakers and health professionals.
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Affiliation(s)
- Mia Majstorovic
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jane M Andrews
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Surgery Program, The Central Adelaide Local Health Network (CALHN), Adelaide, South Australia, Australia
| | - Anne Burke
- The School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, CALHN, Adelaide, South Australia, Australia
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4
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Hlavin C, Sebastiani RS, Scherer RJ, Kenkre T, Bernardi K, Reed DA, Ahmed B, Courcoulas A. Barriers to Bariatric Surgery: a Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery. Obes Surg 2023; 33:2874-2883. [PMID: 37537505 PMCID: PMC10623404 DOI: 10.1007/s11695-023-06761-6] [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: 03/08/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Populations most affected by obesity are not reflected in the patients who undergo bariatric surgery. Gaps in the referral system have been studied, but there is a lack of literature investigating obstacles patients encounter after first contact with bariatric surgery clinics. We aim to identify patient populations at risk for attrition during bariatric surgery evaluation and determine patient reported barriers to bariatric surgical care. MATERIALS AND METHODS This study was a single institution, retrospective, mixed methods study from 2012 to 2021 comparing patients who underwent bariatric surgery to those that withdrew. Surveys were performed of patients who withdrew, collecting information on patient knowledge, expectations, and barriers. RESULTS This study included 5982 patients evaluated in bariatric surgery clinic. Those who attained bariatric surgery (38.8%) were more likely to be White (81.2 vs. 75.6%, p<0.001), married (48.5 vs. 44.1%, p=0.004), and employed full time (48.2 vs. 43.8%, p=0.01). They were less likely to live in an area with low income (37.1 vs. 40.7%, p=0.01) or poverty (poverty rate 15.8 vs. 17.4, p<0.001). Of the 280 survey respondents, fear of complications, length of insurance approval process, and wait time between evaluation and surgery were the most reported barriers. CONCLUSION Patients who undergo bariatric surgery were more likely to be White, married, employed full time, and reside in more resourced environments which is not reflective of communities most affected by obesity. The complexity of insurance coverage requirements was a major barrier to bariatric surgery and should be a focus of future healthcare reform.
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Affiliation(s)
- Callie Hlavin
- Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA.
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
| | - Romano S Sebastiani
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Robert J Scherer
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Tanya Kenkre
- University of Pittsburgh Epidemiology Data Center, 4420 Bayard Street, Suite 600, Pittsburgh, PA, 15260, USA
| | - Karla Bernardi
- Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA
| | - Douglas A Reed
- Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA
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Tang RC, Yang IH, Lin FH. Current Role and Potential of Polymeric Biomaterials in Clinical Obesity Treatment. Biomacromolecules 2023; 24:3438-3449. [PMID: 37442789 DOI: 10.1021/acs.biomac.3c00388] [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: 07/15/2023]
Abstract
The rise of obesity and associated fatal diseases has taken a massive toll worldwide. Despite the existing pharmaceuticals and bariatric surgeries, these approaches manifest limited efficacy or accompany various side effects. Therefore, researchers seek to facilitate the prolonged and specific delivery of therapeutics. Or else, to mimic the essential part of "gastric bypass" by physically blocking excessive absorption via less invasive methods. To achieve these goals, polymeric biomaterials have gained tremendous interest recently. They are known for synthesizing hydrogels, microneedle patches, mucoadhesive coatings, polymer conjugates, and so forth. In this Review, we provide insights into the current studies of polymeric biomaterials in the prevention and treatment of obesity, inspiring future improvements in this regime of study.
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Affiliation(s)
- Rui-Chian Tang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - I-Hsuan Yang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 49, Fanglan Road, Taipei 10672, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 49, Fanglan Road, Taipei 10672, Taiwan
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Ngenge S, Xie L, McAdams C, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Marroquin E, Francis J, Kukreja S, Schneider BE, Messiah SE. Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients. Obes Surg 2023; 33:2166-2175. [PMID: 37217806 PMCID: PMC10202355 DOI: 10.1007/s11695-023-06652-w] [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: 01/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. METHODS This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. RESULTS The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men. CONCLUSIONS Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.
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Affiliation(s)
- Sophia Ngenge
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA.
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7
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Rosen CB, Roberts SE, Sharpe J, Gershuni V, Altieri MS, Kelz RR. A study analyzing outcomes after bariatric surgery by primary language. Surg Endosc 2023:10.1007/s00464-023-10127-5. [PMID: 37266743 DOI: 10.1007/s00464-023-10127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication is key to success in bariatric surgery. This study aims to understand how outcomes after bariatric surgery differ between patients with a non-English primary language and those with English as their primary language. METHODS This retrospective, observational cohort study of bariatric surgery patients age ≥ 18 years utilized the Michigan, Maryland, and New Jersey State Inpatient Databases and State Ambulatory Surgery and Services Databases, 2016 to 2018. Patients were classified by primary spoken language: English and non-English. Primary outcome was complications. Secondary outcomes included length of stay (LOS) and cost, with cost calculated using cost-to-charge ratios provided by Healthcare Cost and Utilization Project and reported in 2019 United States dollars. Multivariable regression models (logistic, Poisson, and quantile) were used to examine associations between primary language and outcomes. Given the uneven distribution of race by primary language, interaction terms were used to examine conditional effects of race. RESULTS Among 69,749 bariatric surgery patients, 2811 (4.2%) spoke a non-English primary language. Covariates, notably race distribution, and unadjusted outcomes differed significantly by primary language. However, after adjustment, non-English primary language was not associated with significantly increased odds of complications (odds ratio 1.24, p = 0.389), significantly different LOS (- 0.02 days, p = 0.677), nor significantly different mean healthcare costs (- $265, p = 0.309). There were no significant conditional effects of race seen among outcomes. CONCLUSIONS Though non-English primary language was associated with a significantly different distribution of observable characteristics (including race, income quartile, and insurance type), after adjustment, non-English primary language was not associated with significant differential risk of adverse outcomes after bariatric surgery, and there were no significant conditional effects of race. As such, this study suggests that disparities in bariatric surgery by primary spoken language more likely related to access to care, or the pre- and post-hospital care continuum, rather than index hospitalization after surgery.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA.
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - James Sharpe
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Maria S Altieri
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
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8
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Martin MI, Ha V, Fasola L, Dalgarno N, Zevin B. Self-withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives. Clin Obes 2023; 13:e12558. [PMID: 36207808 DOI: 10.1111/cob.12558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 01/19/2023]
Abstract
The objective of the study was to explore the experience of patients who self-withdrew from their scheduled bariatric surgery (BS) after completing the lengthy multidisciplinary assessment and optimization process, and to examine how these withdrawals affect healthcare providers (HCPs) in a Bariatric Centre of Excellence (BCoE). Interviews were conducted with patients who self-withdrew, within 1 month, from scheduled BS. Additionally, a focus group with HCPs from the same BCoE was completed. The data were analysed using an inductive, emergent thematic approach with open coding in NVivo 12, with comparative analysis to identify common themes between groups. Eleven patients and 14 HCPs participated. HCPs identified several behavioural and logistical red flags among patients who self-withdrew from scheduled BS. Patients and HCPs felt the decision was appropriate, owing to a patient's lack of mental preparedness for change, social supports, or fears of postoperative complications. HCPs reported frustration and described negative impacts on clinic efficiency. Additional mental health resources for patients contemplating self-withdrawal, such as peer support, were suggested. In conclusion, a patient's decision to self-withdraw from a scheduled BS is often sudden, definite, and associated with anxiety, fear of surgical risks and post-operative complications. Additional mental health resources at a BCoE may be beneficial to support patients at risk of self-withdrawal from scheduled BS.
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Affiliation(s)
- Mary I Martin
- Centre for Studies in Primary Care, Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Laurie Fasola
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Arterburn D, Tuzzio L, Anau J, Lewis CC, Williams N, Courcoulas A, Stilwell D, Tavakkoli A, Ahmed B, Wilcox M, Fischer GS, Paul K, Handley M, Gupta A, McTigue K. Identifying barriers to shared decision-making about bariatric surgery in two large health systems. Obesity (Silver Spring) 2023; 31:565-573. [PMID: 36635226 DOI: 10.1002/oby.23647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Prior research suggests shared decision-making (SDM) could improve patient and health care provider communication about bariatric surgery. The aim of this work was to identify and prioritize barriers to SDM around bariatric surgery to help guide implementation of SDM. METHODS Two large US health care systems formed multidisciplinary teams to facilitate the implementation of SDM around bariatric surgery. The teams used a nominal group process approach involving (1) generation of multilevel barriers, (2) round-robin recording of barriers, (3) facilitated discussion, and (4) selection and ranking of barriers according to importance and feasibility to address. RESULTS One health system identified 13 barriers and prioritized 5 as the most important and feasible to address. The second health system identified 14 barriers and prioritized 6. Both health systems commonly prioritized six barriers: lack of insurance coverage; lack of understanding of insurance coverage; lack of organizational prioritization of SDM; lack of knowledge about bariatric surgery; lack of interdepartmental clarity between primary and specialty care; and limited training on SDM conversations and tools. CONCLUSIONS Health systems face numerous barriers to SDM around bariatric surgery, and these can be easily identified and prioritized by multistakeholder teams. Future research should seek to identify effective strategies to address these common barriers.
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Affiliation(s)
- David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diana Stilwell
- Shared Decision Making Solutions Consultants, Boston, Massachusetts, USA
| | - Ali Tavakkoli
- Division of General and GI Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margie Wilcox
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Gary S Fischer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Paul
- Washington Permanente Medical Group, Seattle, Washington, USA
| | - Matt Handley
- Washington Permanente Medical Group, Seattle, Washington, USA
| | - Anirban Gupta
- Bariatric Surgery, Digestive Health Institute (DHI), Swedish Medical Center, Seattle, Washington, USA
| | - Kathleen McTigue
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Murtha JA, Venkatesh M, Liu N, Jawara D, Hanlon BM, Hanrahan LP, Funk LM. Association between neighborhood food environments and bariatric surgery outcomes. Surg Obes Relat Dis 2022; 18:1357-1364. [PMID: 36123294 PMCID: PMC9722637 DOI: 10.1016/j.soard.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/22/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Individual characteristics associated with weight loss after bariatric surgery are well established, but the neighborhood characteristics that influence outcomes are unknown. OBJECTIVES The objective of this study was to determine if neighborhood characteristics, including social determinants and lifestyle characteristics, were associated with weight loss after bariatric surgery. SETTING Single university healthcare system, United States. METHODS In this retrospective cohort study, all patients who underwent primary bariatric surgery from 2008 to 2017 and had at least 1 year of follow-up data were included. Patient-level demographics and neighborhood-level social determinants (area deprivation index, urbanicity, and walkability) and lifestyle factors (organic food use, fresh fruit/vegetable consumption, diet to maintain weight, soda consumption, and exercise) were analyzed. Median regression with percent total body weight (%TBW) loss as the outcome was applied to examine factors associated with weight loss after surgery. RESULTS Of the 647 patients who met inclusion criteria, the average follow-up period was 3.1 years, and the mean %TBW loss at the follow-up was 22%. In adjusted median regression analyses, Roux-en-Y gastric bypass was associated with greater %TBW loss (11.22%, 95% confidence interval [8.96, 13.48]) compared to sleeve, while longer follow-up time (-2.42% TBW loss per year, 95% confidence interval [-4.63, -0.20]) and a preoperative diagnosis of diabetes (-1.00% TBW loss, 95% confidence interval [-1.55, -0.44]) were associated with less. None of the 8 neighborhood level characteristics was associated with weight loss. CONCLUSIONS Patient characteristics rather than neighborhood-level social determinants and lifestyle factors were associated with weight loss after bariatric surgery in our cohort of bariatric surgery patients. Patients from socioeconomically deprived neighborhoods can achieve excellent weight loss after bariatric surgery.
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Affiliation(s)
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Natalie Liu
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Dawda Jawara
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Lawrence P Hanrahan
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial VA, Madison, Wisconsin.
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11
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Armstrong A, Jungbluth Rodriguez K, Sabag A, Mavros Y, Parker HM, Keating SE, Johnson NA. Effect of aerobic exercise on waist circumference in adults with overweight or obesity: A systematic review and meta-analysis. Obes Rev 2022; 23:e13446. [PMID: 35383401 PMCID: PMC9540641 DOI: 10.1111/obr.13446] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Excess visceral adiposity contributes to elevated cardiometabolic risk, and waist circumference is commonly used as a surrogate measure of visceral adipose tissue. Although regular aerobic exercise is known to improve abdominal obesity, its effect on waist circumference is unclear. A systematic review and meta-analysis was performed to determine (1) the effect of aerobic exercise on waist circumference in adults with overweight or obesity; (2) the association between any change in waist circumference and change in visceral adipose tissue and/or bodyweight with aerobic exercise interventions; and (3) if reductions in waist circumference with exercise are moderated by clinical characteristics or components of aerobic exercise prescription. Twenty-five randomized controlled trials (1686 participants) were included. Regular aerobic exercise significantly reduced waist circumference by 3.2 cm (95% confidence interval [CI] -3.86, -2.51, p ≤ 0.001) versus control. Change in waist circumference was associated with change in visceral adipose tissue (β = 4.02; 95% CI 1.37, 6.66, p = 0.004), and vigorous intensity produced superior reduction (-4.2 cm, 95% CI -4.99, -3.42, p < 0.0001) in waist circumference compared with moderate intensity (-2.50 cm, 95% CI -3.22, -1.79, p = 0.058). These findings suggest regular aerobic exercise results in modest reductions in waist circumference and associated visceral adipose tissue and that higher intensity exercise may offer superior benefit to moderate intensity.
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Affiliation(s)
- Alex Armstrong
- Faculty of Medicine and Health, Discipline of Exercise and Sport ScienceUniversity of SydneySydneyNew South Wales
- Charles Perkins CentreUniversity of SydneyCamperdownNew South Wales
| | | | - Angelo Sabag
- NICM Health Research InstituteWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Yorgi Mavros
- Faculty of Medicine and Health, Discipline of Exercise and Sport ScienceUniversity of SydneySydneyNew South Wales
- Charles Perkins CentreUniversity of SydneyCamperdownNew South Wales
| | - Helen M. Parker
- Faculty of Medicine and Health, Discipline of Exercise and Sport ScienceUniversity of SydneySydneyNew South Wales
| | - Shelley E. Keating
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQueenslandAustralia
| | - Nathan A. Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport ScienceUniversity of SydneySydneyNew South Wales
- Charles Perkins CentreUniversity of SydneyCamperdownNew South Wales
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Murtha JA, Alagoz E, Breuer CR, Finn A, Raffa SD, Voils CI, Funk LM. Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study. Am J Surg 2021; 224:429-436. [PMID: 34963509 DOI: 10.1016/j.amjsurg.2021.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. METHODS Adults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. RESULTS Of the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its "tipping point," concerns about dietary changes, lack of social support, and patient characteristics influencing referral. CONCLUSIONS Patient and provider education should address patient fears of surgery and the belief that surgery is a "last resort." Bariatric surgery programs should strengthen social support networks for patients.
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Affiliation(s)
- Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Alex Finn
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Susan D Raffa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 905 W Main St, Durham, NC, 27701, USA; Veterans Health Administration National Center for Health Promotion and Disease Prevention, 3022 Croasdaile Dr, Durham, NC, 27705, USA
| | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA.
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13
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Mundo W, Platnick C, Rozwadowski J, Bruman W, Morton A, Pieracci FM. Providing access to affordable bariatric surgery for uninsured Denver County residents: description of a successful public health initiative. Surg Obes Relat Dis 2021; 17:994-999. [PMID: 33583733 DOI: 10.1016/j.soard.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Severe obesity disproportionately affects medically underserved communities. However, patients from these communities are the least likely to have access to affordable bariatric surgery. Few studies have described successful initiatives to mitigate this disparity. OBJECTIVES To describe the implementation of a public health initiative that provided affordable bariatric surgery to uninsured patients at our hospital. SETTING Denver Health Medical Center (DHMC), a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited safety-net hospital. METHODS Context regarding Denver city and county, DHMC, and bariatric surgery accreditation are provided, followed by a detailed description of the intervention. RESULTS Successful implementation of the initiative centered around: (1) MBSAQIP accreditation; (2) identification of existing institutional charity care programs, (3) enlistment of support/buy-in from key parties; (4) presentation of both general and institutional-specific outcome data following bariatric surgery to hospital administration; (5) framing of the argument as primarily financial, rather than moral; (6) delineation of initial volume and risk expectations; and (7) outcome monitoring. CONCLUSION We successfully provided access to affordable bariatric surgery for uninsured patients at our accredited safety-net hospital.
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Affiliation(s)
- William Mundo
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado; University of Colorado Anschutz Medical Campus, School of Public Health, Aurora, Colorado.
| | - Carson Platnick
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado
| | - Jeanne Rozwadowski
- Department of Primary Care, Denver Health Medical Center, Denver, Colorado
| | | | - Alex Morton
- Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado
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