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Pugin F, Burgard M, Cherbanyk F, Egger B. Performance of a predictive weight loss model in terms of rapid detection of inadequate weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:670-676. [PMID: 38461056 DOI: 10.1016/j.soard.2024.01.020] [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: 07/12/2023] [Revised: 12/24/2023] [Accepted: 01/28/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Predictive weight loss models can help patients meet their expectations after bariatric surgery and assist physicians in responding to deviations from the predicted weight. A model published by Seyssel et al. appears to accurately predict postoperative body mass index. OBJECTIVES We aimed to demonstrate this model's performance in terms of rapid detection of insufficient weight loss (surgical nonresponse). SETTING Cantonal Hospital, Switzerland. METHODS We retrospectively analyzed weight and body mass index deviations at 2 years postoperatively, based on values predicted by the model of Seyssel et al. The primary outcome was the timing of detection of surgical nonresponse. The secondary outcome was how patients' weight loss expectations influenced their real weight loss. RESULTS Between 2016 and 2019, 190 patients underwent Roux-en-Y gastric bypass. Of these patients, 36 were lost to follow-up and 154 were included in this study. At 24 months, 16 patients had surgical nonresponse, defined as a real weight of +1 standard deviation higher than that predicted. Among these patients, 44% had a weight of ≥+1 standard deviation higher than predicted at 3 months, and 63% at 12 months. The positive and negative predictive values at 12 months were 59% and 95%, respectively. Patients with a lower hypothetically wanted weight (38.5%) exhibited greater weight loss (P < .05). CONCLUSIONS The predictive weight loss model of Seyssel et al. enables rapid detection of surgical nonresponse, allowing physicians to react as early as 3 months postsurgery. Patients' overestimation of postoperative weight loss was positively correlated with the actual weight loss achieved.
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Affiliation(s)
- Francois Pugin
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Marie Burgard
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Floryn Cherbanyk
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland.
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Mercier LA, Fortin A, Atto EJ, Lavoie KL. The nature of expectations of bariatric surgery in patients during the pre- and post-operative period: A unicentric, qualitative study of patient perspectives. Clin Obes 2023; 13:e12621. [PMID: 37691491 DOI: 10.1111/cob.12621] [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: 04/17/2023] [Revised: 07/13/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
Many patients (20%-30%) experience suboptimal weight loss (WL) after bariatric surgery (BS), and unrealistic preoperative WL expectations may be a contributing factor. This study aimed to describe the nature of patients' general expectations of BS during the pre-surgical period, and how patients determined whether their expectations and WL goals (WLGs) were realistic. The extent to which patients' expectations and WLGs were met and/or changed during the post-surgical period was also assessed. Semi-structured interviews were conducted with 15 preoperative patients recruited approximately 6-months before surgery. Focus groups were also conducted with 14 post-operative patients recruited approximately 6-months after surgery. Interviews and focus groups were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. Preoperative patients reported expectations that BS would positively impact physical and psychological health, social relationships, as well as quality of care. Preoperative patients perceived that they and their health care professionals had unrealistically high expectations of WL. Post-operative patients reported being generally satisfied with the outcomes of surgery, even though many did not reach their expected WL. Finally, most post-operative patients reported changing their expectations from pre- to post-surgery. This study provides data that may help inform the development of preoperative interventions focusing on helping patients set realistic expectations for WL and related outcomes, which could better prepare patients for the challenges they will face after surgery.
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Affiliation(s)
- Li Anne Mercier
- Department of Psychology, University of Quebec at Montreal, Montreal, Canada
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Montreal, Canada
| | - Annabelle Fortin
- Department of Psychology, University of Quebec at Montreal, Montreal, Canada
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Montreal, Canada
| | - Essé Julien Atto
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Montreal, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montreal, Canada
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSS-NIM), Montreal, Canada
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Lam CS, Alagoz E, Jawara D, Murtha JA, Breuer CR, Pati B, Eierman L, Farrar-Edwards D, Voils CI, Funk LM. Patient and Provider Perceptions About Communication After Bariatric Surgery: A Qualitative Analysis. J Surg Res 2023; 291:58-66. [PMID: 37348437 PMCID: PMC10524725 DOI: 10.1016/j.jss.2023.05.029] [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: 12/02/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Communication between patients and providers can strongly influence patient behavior after surgery. The objective of this study was to assess patient and provider perceptions of how communication affected weight-related behaviors after bariatric surgery. MATERIALS AND METHODS Semistructured interviews with bariatric surgery patients and providers were conducted from April-November 2020. Patients who had Medicaid within 3 y of surgery were defined as socioeconomically disadvantaged. Interview guides were derived from Andersen's Behavioral Model of Health Services and Torain's Framework for Surgical Disparities. Participants described postoperative experiences regarding diet, physical activity, and follow-up care. A codebook was developed deductively based on the two theories. Directed content analysis identified themes pertaining to patient-provider communication. RESULTS Forty-five participants were interviewed, including 24 patients (83% female; 79% White), six primary care providers, four health psychologists, five registered dietitians, and six bariatric surgeons. Four themes regarding communication emerged: (1) Patients experiencing weight regain did not want to follow-up with providers to discuss their weight; (2) Patients from socioeconomically disadvantaged backgrounds had less trust and required more rapport-building from providers to enhance trust; (3) Patients felt that providers did not get to know them personally, which was perceived as a lack of personalized communication; and (4) Providers often changed their language to be simpler, so patients could understand them. CONCLUSIONS Patient-provider communication after bariatric surgery is essential, but perceptions about the elements of communication differ between patients and providers. Reassuring patients who have attained less weight loss than expected and establishing trust with socioeconomically vulnerable patients could strengthen care after bariatric surgery.
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Affiliation(s)
- Chloe S Lam
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Dawda Jawara
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Bhabna Pati
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Lindsey Eierman
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin.
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Wright C, Kelly JT, Campbell KL, Healy R, Musial J, Hamilton K. A mixed-method study to inform the development and implementation of eHealth in a bariatric surgery service in an Australian public hospital. Nutr Diet 2023; 80:425-434. [PMID: 37096344 DOI: 10.1111/1747-0080.12812] [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: 12/23/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
AIM This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. METHODS This mixed-method study (survey and semi-structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. RESULTS This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two-thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. CONCLUSION This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.
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Affiliation(s)
- Charlene Wright
- School of Applied Psychology, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Katrina L Campbell
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Bowen Hills, Queensland, Australia
| | - Rebecca Healy
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jane Musial
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Health Sciences Research Institute, University of California, Merced, California, USA
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Streith LD, Yip SJY, Brown CJ, Karimuddin AA, Raval MJ, Phang PT, Ghuman A. Effectiveness of a rectal cancer education video on patient expectations. Colorectal Dis 2022; 24:1040-1046. [PMID: 35396809 DOI: 10.1111/codi.16143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
AIM Discrepancy between patient expectations and outcomes can negatively affect patient satisfaction and quality of life. We aimed to assess patient expectations of bowel, urinary, and sexual function after rectal cancer treatments, and whether a preoperative education video changed expectations. METHODS A total of 45 patients were assessed between January 2018 and January 2021 in a tertiary care hospital in Vancouver, Canada. Patients included were rectal cancer patients who had neoadjuvant chemoradiation and were listed for low anterior resection but had not yet had surgery. Following surgical consultation but before surgery, a questionnaire assessing expectations of lifestyle after treatments was administered. Patients then watched an educational video and repeated the questionnaire to assess for changes in expectations. RESULTS Patient scores indicated expectation that control of bowel movements, urination, and sexual function would sometimes be problematic, but had a range from occasionally problematic to good function. Significant change after the video was seen in the expectation of needing medications for bowel control, and 44%-69% of individual patient answers changed from prevideo to post-video, depending on the question. The education video was scored as helpful or very helpful by 82% of patients. CONCLUSIONS Patients have varying expectations of problematic control of bowel, urinary, and sexual function following rectal cancer treatments. A pretreatment education video resulted in a trend toward changed expectations for functional outcomes in most patients. Further educational modalities for patients may provide more uniform expectations of function and increase patient satisfaction after rectal cancer treatments.
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Affiliation(s)
- Lucas D Streith
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Silas J Y Yip
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl J Brown
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Manoj J Raval
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - P Terry Phang
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Amandeep Ghuman
- Division of General Surgery, Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Experiences of the Bariatric Pre-Surgery Evaluation Process in a National Health Service—An Interpretative Phenomenological Analysis. SURGERIES 2021. [DOI: 10.3390/surgeries2020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is currently little understanding of bariatric patients’ experiences and expectations of the bariatric pre-surgery evaluation (PSE) process. This is especially true for patients within the National Health Service (NHS) in the UK. Consequently, this study undertakes a qualitative study to explore the experiences and expectations of the bariatric PSE amongst patients who had undergone bariatric surgery within the NHS in the UK, using the Interpretative Phenomenological Analysis. Three inter-related superordinate themes were presented: (i) ‘PSE was challenging but essential’, (ii) ‘Coping processes to deal with the PSE’, and (iii) ‘Staff and service evaluation’. Most participants had conflicting feelings about the PSE process as it had both positive and negative impacts on their wellbeing. The process was considered essential for preparation and successful post-surgery adjustment, though the uncertainty of approval was experienced as very distressing. Consequently, participants utilised both external and internal coping strategies, such as social support, researching, or ‘toeing the line’. Participants’ experiences encouraged them to provide feedback about the staff and service, which revealed a preference for a tailored evaluation process. The emerged themes represent an initial framework for helping healthcare providers and researchers to involve patients in service delivery thereby facilitating a patient-centred approach. A starting point is to audit patients’ perspectives routinely. Further investigations are needed to better define, validate, and understand constructs and processes identified in this study.
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Pottier E, Boulanouar L, Bertrand M, Estrade A, Croiset A, Martineau C, Plantec JY, Escourou B, Ritz P. A MOOC About Bariatric Surgery Improves Knowledge and Promotes Patients' Soft Skills. Obes Surg 2021; 30:1600-1604. [PMID: 31471766 DOI: 10.1007/s11695-019-04143-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The ASMBS recommends that patients should be provided with educational materials to improve informed consent about bariatric surgery. Massive online open courses (MOOCs) are learning sources which are free, online, and available to people in remote situations. A French language MOOC regarding preparation for obesity surgery targets patients, as well as HCP, and people curious about this treatment. The patients' knowledge and skills after completion of the 5-week learning sessions (evaluated with semi-direct interviews) improved. Soft skills such as feeling empowered to ask questions to their HCP and explaining their plan to their relatives improved. This study suggests that MOOC can be a resource to improve knowledge and soft skills in patients for a better consent to surgery and follow-up.
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Affiliation(s)
- E Pottier
- Nutrition Department, CIO and CHU, Toulouse, France
| | - L Boulanouar
- Nutrition Department, CIO and CHU, Toulouse, France
| | - M Bertrand
- Nutrition Department, CIO and CHU, Toulouse, France
| | - A Estrade
- Nutrition Department, CIO and CHU, Toulouse, France
| | - A Croiset
- Nutrition Department, CIO and CHU, Toulouse, France
| | - C Martineau
- Dietetics Department, CIO and CHU, Toulouse, France
| | | | - B Escourou
- Département Universitaire de Médecine Générale, University Paul Sabatier, Toulouse, France
| | - P Ritz
- Nutrition Department, CIO and CHU, Toulouse, France.
- Inserm U1027, University Paul Sabatier, Toulouse, France.
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Motivation and Weight Loss Expectations in Bariatric Surgery Candidates: Association with 1- and 2-Year Results After Bariatric Surgery. Obes Surg 2020; 30:4411-4421. [DOI: 10.1007/s11695-020-04811-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022]
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Köhler H, Dorozhkina R, Gruner-Labitzke K, de Zwaan M. Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study. Obes Facts 2020; 13:166-178. [PMID: 32208386 PMCID: PMC7250322 DOI: 10.1159/000505837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. METHODS Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12-74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. RESULTS The pre- and postoperative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). CONCLUSION The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany,
| | - Renata Dorozhkina
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Kerstin Gruner-Labitzke
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Schlottmann F, Nayyar A, Herbella FAM, Patti MG. Preoperative Evaluation in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:925-929. [PMID: 30004270 DOI: 10.1089/lap.2018.0391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An adequate preoperative workup is critical for the success of bariatric surgery. A key component of the preoperative evaluation involves a comprehensive patient education about surgical outcomes and the postoperative behavioral regimen required. A complete medical evaluation should include the study of the cardiovascular, pulmonary, and gastrointestinal systems as well as a metabolic status assessment. The nutrition professional should be in charge of the nutritional assessment, preoperative weight loss efforts, and diet education regarding postoperative eating behaviors. A psychological evaluation is also needed because psychosocial factors have a significant impact on the long-term outcomes of bariatric surgery, including adherence to recommended postoperative lifestyle regimen, emotional adjustment, and weight loss outcomes. We recommend preoperative abdominal ultrasound to assess for biliary tract pathology, steatosis, fibrosis, and presence of nonalcoholic steatohepatitis. A routine preoperative esophagogastroduodenoscopy is also recommended to evaluate common gastrointestinal disorders associated with obesity. Preoperative weight loss should be strongly encouraged.
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Affiliation(s)
- Francisco Schlottmann
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Apoorve Nayyar
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Fernando A M Herbella
- 3 Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo , Sao Paulo, Brazil
| | - Marco G Patti
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,4 Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
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Groller KD, Teel C, Stegenga KH, El Chaar M. Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement. Surg Obes Relat Dis 2018; 14:785-796. [PMID: 29703505 DOI: 10.1016/j.soard.2018.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/10/2018] [Accepted: 02/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.
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Affiliation(s)
- Karen D Groller
- Moravian College, Helen S. Breidegam School of Nursing, Bethlehem, Pennsylvania.
| | - Cynthia Teel
- University of Kansas School of Nursing, Kansas City, Kansas
| | | | - Maher El Chaar
- Medical School of Temple University, St. Luke's University Hospital and Health Network, Allentown, Pennsylvania
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Nickel F, Schmidt L, Sander J, Tapking C, Bruckner T, Müller-Stich BP, Fischer L. Patient Perspective in Obesity Surgery: Goals for Weight Loss and Improvement of Body Shape in a Prospective Cohort Study. Obes Facts 2018; 11:466-474. [PMID: 30537759 PMCID: PMC6341368 DOI: 10.1159/000493372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/26/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Obesity surgery provides sustainable weight loss, improvement of comorbidities, and improved quality of life (QOL). There is few evidence on the patient perspective and goals. This study compared expected and achieved weight loss, body shape, and QOL. METHODS Patients completed the Moorehead-Ardelt QOL questionnaire (MAQOL) and questionnaires on actual and expected weight loss and body shape, comorbidities, and goals of obesity surgery preoperatively and within 24 months postoperatively. RESULTS 44 patients completed questionnaires pre- and postoperatively. BMI, MAQOL and comorbidities significantly improved postoperatively. Patients' expected weight loss goal corresponded to a postoperative BMI of 32.6 ± 5.6 kg/m2 and was not different from their achieved BMI within 24 months after surgery (33.9 ± 6.3 kg/m2, p = 0.276). Self-reported body shape improved but did not reach preoperatively expected goals. During the weight loss period, patients adapted their weight loss and body shape goals to higher levels. Patients attributed a higher part of their success in weight loss to surgery postoperatively (79.5 ± 22.0 vs. 89.1 ± 18.4%, p = 0.028). CONCLUSION Patients lost as much weight as they had expected and later modified the goals to even greater weight loss. Body shape improved but did not reach expected levels. QOL improved independently from weight loss and body shape. Patients attributed successful weight loss predominantly to surgery.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany,
| | - Lukas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Sander
- Obesity Clinic, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Christian Tapking
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Beat-Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General and Visceral Surgery, Hospital Mittelbaden, Baden-Baden, Germany
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Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
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Homer CV, Tod AM, Thompson AR, Allmark P, Goyder E. Expectations and patients' experiences of obesity prior to bariatric surgery: a qualitative study. BMJ Open 2016; 6:e009389. [PMID: 26857104 PMCID: PMC4746450 DOI: 10.1136/bmjopen-2015-009389] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/24/2015] [Accepted: 11/17/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions. DESIGN A qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques. SETTING Areas served by two bariatric surgery multidisciplinary teams in the north of England. PARTICIPANTS 18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams. RESULTS The experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of 'normality'. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed. CONCLUSIONS The unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period.
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Affiliation(s)
| | - Angela Mary Tod
- School of Nursing and Midwifery, University of Sheffield, Sheffield UK
| | - Andrew R Thompson
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Allmark
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Elizabeth Goyder
- Section of Public Health, School of Health And Related Research, University of Sheffield, Sheffield, UK
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15
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Sogg S, Friedman KE. Getting Off on the Right Foot: The Many Roles of the Psychosocial Evaluation in the Bariatric Surgery Practice. EUROPEAN EATING DISORDERS REVIEW 2015; 23:451-6. [DOI: 10.1002/erv.2395] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Stephanie Sogg
- Massachusetts General Hospital Weight Center and Harvard Medical School; Boston MA 02114 USA
| | - Kelli E. Friedman
- Duke University Medical Center; Departments of Psychiatry and Behavioral Sciences and Surgery; Durham NC 27708 USA
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da Silva SSP, Maia ÂDC. Patients' experiences after bariatric surgery: a qualitative study at 12-month follow-up. Clin Obes 2013; 3:185-93. [PMID: 25586735 DOI: 10.1111/cob.12032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 06/24/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
This study used a qualitative approach to understand patients' experiences in post-surgery adaptation related to bariatric surgery, 12 months after this procedure. The study population included 30 obese adults, with a mean age of 40.17 years, who were interviewed 12 months after bariatric surgery. Individual interviews, using open-ended questions, were audiotaped, transcribed and coded according to the grounded theory methodology. The data showed that the subjects described themselves as belonging to one of two opposite and separate groups: success or failure. In both groups, two core categories emerged from the data: outcomes and treatment. Previous expectations were reached by the patients who described themselves as successful, with some remaining concerns related to future weight maintenance and aesthetics issues. The failure group emphasized their unmet expectations and the expectancy that surgery would change their lives remained. Treatment in the successful cases integrated lifestyle changes and bariatric surgery, highlighting the personal commitment required to achieve the objectives. The failure group emphasized bariatric surgery without personal commitment, and healthy eating behaviour was understood as a sacrifice. The post-surgical adaptation experiences were diverse: the cases that were described as a success highlighted lifestyle changes, personal efforts and commitment with the global treatment process. External understanding and the desire for a miracle surgery characterized the cases described as a failure. According to these results, it is necessary to promote adequate information about the whole process and skills required to ensure commitment in all treatment dimensions.
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Affiliation(s)
- Susana Sofia Pereira da Silva
- Granted by Foundation for Science and Technology (SFRH/BD/37069/2007), School of Management and Industrial Studies, Vila do Conde, Portugal
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An assessment of patient behavioral requirements pre- and post-surgery at accredited weight loss surgical centers. Obes Surg 2012; 21:1950-7. [PMID: 21337000 DOI: 10.1007/s11695-011-0366-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Without changes to diet and exercise behaviors, weight losses achieved through surgical procedures may be short lived. There is no data currently available on how accredited bariatric facilities are implementing best-practice guidelines related to behavioral and psychological care to help patients make long-lasting change. METHODS One hundred twenty-three ACS-accredited facility websites were analyzed using document and content analyses to determine behavioral and psychological services. Categories of common facility practices were identified according to best-practice recommendations and website data was coded by category. Descriptive statistics were then generated to summarize the implementation of services. RESULTS Behavioral and psychological services were more likely to be required prior to surgery than after surgery. In addition, there is great variance in the staff employed by facilities to assist patients, with more facilities employing dietary staff than exercise staff. Data patterns are reported across the categories of psychological assessment, pre- and post-surgical behavioral requirements, type of support groups, follow-up protocol, and staffing. CONCLUSIONS Most facilities implement some type of dietary counseling or consultation; however, few include services related to helping patients improve physical activity patterns. Greater incorporation of behavioral and psychological services following surgery is recommended to prevent weight regain and to help patients adopt and maintain regular physical activity.
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18
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West-Smith L, Sogg S. Creating a credential for bariatric behavioral health professionals: potential benefits, pitfalls, and provider opinion. Surg Obes Relat Dis 2010; 6:695-701. [PMID: 20688579 DOI: 10.1016/j.soard.2010.03.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/25/2010] [Accepted: 03/27/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Since the 1991 recommendation by the National Institutes of Health-sponsored consensus development conference, preoperative psychosocial evaluation of weight loss surgery patients has been adopted by >80% of weight loss surgery programs. Although some published suggestions for conducting evaluations exist, no formal guidelines have been published specifying the qualifications, content knowledge, or clinical experience for the behavioral health professionals who conduct them. As a result, the backgrounds of behavioral health professionals working with bariatric surgery patients are varied, and no mechanism exists to ensure consistent quality of care. To obtain expert opinion on this issue, a survey of the American Society for Metabolic and Bariatric Surgery membership was conducted using an Internet-based survey. METHODS American Society for Metabolic and Bariatric Surgery members of all disciplines were invited by electronic mail to complete an Internet-based survey. Separate forms were created for behavioral health providers and for members of other disciplines. RESULTS A total of 409 American Society for Metabolic and Bariatric Surgery members responded (60 behavioral health and 349 nonbehavioral health). Of the 409 respondents, 95% indicated a belief that it is important for behavioral health providers to have specialty knowledge; 87% indicated a belief that specialty experience is important; and 70.6% favored the development of a specialty credential for bariatric behavioral health providers to regulate the quality of patient care. However, the respondents also reported concerns about creating such a credential. CONCLUSION Our results reflect widespread opinion that the provision of bariatric behavioral health services requires specialty knowledge and experience and that a credentialing system would help regulate the standard of care in the field. However, some concerns about credential development remain.
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Affiliation(s)
- Lisa West-Smith
- Bariatric Center, Georgetown Community Hospital, Georgetown, Kentucky 40324, USA.
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19
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Psychosocial correlates of binge eating in Hispanic, African American, and Caucasian women presenting for bariatric surgery. Eat Behav 2010; 11:79-84. [PMID: 20188290 DOI: 10.1016/j.eatbeh.2009.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/11/2009] [Accepted: 10/07/2009] [Indexed: 11/21/2022]
Abstract
Research suggests that that binge eating, stress, and depression are prevalent among individuals seeking bariatric surgery. However, ethnic differences in the prevalence of binge eating and binge eating disorder (BED) in this population remain unclear, as does the impact of depression and stress on any such relationship. Further, no studies to date have examined the prevalence of binge eating in Hispanic women presenting for bariatric surgery. This study sought to (a) compare the prevalence and severity of binge eating symptomatology and BED diagnosis in Hispanic, African American, and Caucasian women presenting for gastric bypass surgery, (b) examine the impact of depressive symptoms and stress on binge eating symptomatology, and (c) investigate whether ethnicity moderated any relationship between depression, stress, and binge eating. Results indicated that Hispanic women exhibited equal rates of binge eating symptomatology, BED, and depressive symptomatology as African American and Caucasian women. However, Caucasian women exhibited greater binge eating symptomatology than African American women, and African American women endorsed greater levels of stress than Caucasian women. Across all ethnic groups, depressive symptomatology, but not stress, significantly predicted binge eating severity. These findings suggest that Hispanic women presenting for bariatric surgery report binge eating rates equivalent to Caucasian and African American women, and that depressive symptoms are an important predictor of binge eating in female bariatric surgery candidates across ethnic groups.
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Gohier B, Richard-Devantoy S, Denès D, Sallé A, Becouarn G, Topart P, Garré JB. Le psychiatre et la chirurgie bariatrique. ANNALES MEDICO-PSYCHOLOGIQUES 2010. [DOI: 10.1016/j.amp.2010.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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21
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Gerweck C, Curran Celentano J. The Real Weighty Issue: Losing Is Just the Beginning. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827609357310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are numerous strategies, including bariatric surgery, for obese and super-obese patients to achieve weight loss, but weight regain and attrition are well documented, and long-term success rates for maintaining weight loss are not favorable. Many patients have unrealistic expectations for weight loss and may either be unaware or may minimize the effort required to maintain their weight loss. The skilled nutrition professional, the registered dietitian, can help optimize patient success by teaching the patient the necessary new eating and drinking behaviors and coaching him or her in “mindful eating” techniques.
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Affiliation(s)
- Catherine Gerweck
- Department of Clinical Nutrition, New York Institute of Technology, Old Westbury, New York,
| | - Joanne Curran Celentano
- Department of Molecular Cellular and Biomedical Sciences, University of New Hampshire, Furham
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22
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Leahey TM, Bond DS, Irwin SR, Crowther JH, Wing RR. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? Surg Obes Relat Dis 2008; 5:99-102. [PMID: 19071068 DOI: 10.1016/j.soard.2008.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 08/04/2008] [Accepted: 10/02/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment. However, it is unknown whether these interventions are best delivered pre- or postoperatively. The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention, before or after surgery. METHODS A total of 32 pre- and postoperative patients were referred to a 10-week intervention designed to reduce eating behaviors associated with postoperative weight gain (e.g., loss of control while eating, grazing). The sample was 78.1% female and 84.4% white, with an average age of 49.43 +/- 9.13 years and a body mass index of 44.22 +/- 6.48 kg/m(2). Of the 32 patients, 21 were referred preoperatively and 11 were referred postoperatively (5.63 +/- 2.91 months after surgery). These patients were tracked prospectively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention. RESULTS Compared with the preoperative patients, the postoperative patients were more likely to follow-up with their referral and initiate treatment [chi(2)(1) = 10.06, P = .002]. Of the postoperative patients, 100% attended the first intervention session compared with only 43% of preoperative patients. The postoperative patients also attended more intervention sessions [t(18) = 2.51, P = .02] and were more likely to complete the intervention [chi(2)(1) = 7.21, P = .007]. Only 14% of the preoperative referral patients completed the program compared with 91% of the postoperative patients. CONCLUSION Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery.
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Affiliation(s)
- Tricia M Leahey
- Department of Psychology, Kent State University, Kent, Ohio, USA
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Psychosocial evaluation for bariatric surgery: the Boston interview and opportunities for intervention. Obes Surg 2008; 19:369-77. [PMID: 18795379 DOI: 10.1007/s11695-008-9676-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/28/2008] [Indexed: 01/14/2023]
Abstract
The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.
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