Health and health-related quality of life: differences between men and women who seek gastric bypass surgery

Changes in use and hospital outcomes of bariatric surgery in Spain (2016-2022): analysis of the role of type 2 diabetes using propensity score matching

INTRODUCTION

The objectives of this study were to examine temporal trends in the incidence of bariatric surgery (Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)) in patients with and without type 2 diabetes mellitus (T2DM). Outcomes of hospitalization and the impact of T2DM on these outcomes were also analyzed.

RESEARCH DESIGN AND METHODS

We performed an observational study with the Spanish national hospital discharge database. Obese patients with and without T2DM who underwent RYGB and SG between 2016 and 2022 were identified. Propensity score matching (PSM) and logistic regression were used to compare patients with and without T2DM and to evaluate the effect of T2DM and other variables on outcomes of surgery. A variable "severity" was created to cover patients who died in hospital or were admitted to the intensive care unit (ICU).

RESULTS

A total of 32,176 bariatric surgery interventions were performed (28.86% with T2DM). 31.57% of RYGBs and 25.53% of SG patients had T2DM. The incidence of RYGB and SG increased significantly between 2016 and 2022 (p<0.001), with a higher incidence in those with T2DM than in those without (incidence rate ratio 4.07 (95% CI 3.95 to 4.20) for RYGB and 3.02 (95% CI 2.92 to 3.14) for SG). In patients who underwent SG, admission to the ICU and severity were significantly more frequent in patients with T2DM than in those without (both p<0.001). In the multivariate analysis, having T2DM was associated with more frequent severity in those who received SG (OR 1.23; 95% CI 1.07 to 1.42).

CONCLUSIONS

Between 2016 and 2022, bariatric surgery procedures performed in Spain increased in patients with and without T2DM. More interventions were performed on patients with T2DM than on patients without T2DM. RYGB was the most common procedure in patients with T2DM. The presence of T2DM was associated with more severity after SG.

Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required

In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m2 ) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (M = 43.20, SD = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (N = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.

The Relationship Between Childhood Trauma and Body Image, Self-Esteem and Eating Attitudes in Patients undergoing Bariatric Surgery

OBJECTIVE

Psychiatric evaluation of candidate patients before bariatric surgery (BS) has an important place in the success of the treatment. In this study, it was aimed to examine the relationship between childhood trauma (CT) and body image, self-esteem and eating attitudes of individuals who applied for BS.

METHOD

A total of 87 BS candidate patients with morbid obesity, 57 women and 30 men, were included in the study. Sociodemographic Information Form, Childhood Trauma Questionnaire (CTQ), Body Perception Scale (BPS), Rosenberg Self-Esteem Scale (RSES), and Eating Attitude Test (EAT-40) were used as data collection tools in the study.

RESULTS

CT was detected in 47.1% of the cases. RSES (t=3.296; p<0.01) and BPS (t=3.267; p<0.01) scores were found to be significantly higher in those with a history of CT. A positive and significant relationship was found between EAT-40 and CTQ -sexual abuse (SA) sub-dimension (r=0.570; p<0.01). A significant relationship was found between all subdimensions of CTQ and RSES. A significant relationship was found between CTQ physical neglect (PN), emotional neglect (EN), and emotional abuse (EA) sub-dimensions and BPS. In addition, CTQ total score was found to significantly and negatively predict self-esteem (β=- 4.432; p<0.001) and body image (β=-3.700; p<0.001).

CONCLUSION

In our study, it was found that those with CT were dissatisfied with their bodies and had lower self-esteem. Questioning CT in the psychological evaluation of pre-BS cases may contribute to the understanding of the etiology of obesity and may play an important role in planning the follow-up after BS.

Did the COVID-19 pandemic change the weight reduction in patients with obesity after bariatric surgery?

BACKGROUND

The COVID-19 pandemic has significantly impacted healthcare services worldwide, including bariatric surgery. There is a concern that the pandemic-induced stay-at-home orders and social restrictions may negatively affect weight reduction outcomes post-bariatric surgery. This study aimed to examine the impact of the COVID-19 on weight loss up to six months after three types of bariatric surgeries including One-Anastomosis Gastric Bypass (OAGB), RY Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) before and two time periods during the COVID-19 pandemic.

METHODS

We conducted a retrospective study using data from a comprehensive database of bariatric surgery patients in Iran. We recruited 882 patients who underwent bariatric surgery from the initiation of COVID-19 to 6 months before public vaccination (Time period 3); among them, 311 patients underwent surgery in the first six months of the pandemic (Time period 2). These patients were compared with 1368 ones in the control group who completed their 6 months follow-up before the pandemic. The study compared the BMI reduction, excess weight loss (EWL), and total weight loss (TWL) outcomes between these groups using Generalized Estimating Equations (GEE) with gamma distribution to adjust for factors that were unevenly distributed across the groups.

RESULTS

The age of participants in time periods 2 and 3 had a mean (standard deviation) of 38.97 (10.99) and 38.84 (10.71), respectively. In all groups, the majority of patients were females, accounting for 76.02%, 71.06%, and 75.74% for the control group and time periods 2 and 3, respectively. There was no significant difference between the groups in terms of weight reduction, as measured by BMI reduction, EWL, and TWL (related P values: 0.283, 0.465 and 0.169). Regression analysis indicated that higher baseline BMI values were associated with greater BMI reduction (0.04, 95% CI: 0.03-0.05), but this did not translate to higher EWL or TWL. Males showed greater BMI reduction (0.33, 95% CI: 0.18-0.49) and EWL (1.58, 95% CI: 0.79-2.37) than females, while females achieved higher TWL compared to males. Among different types of surgery, the OAGB resulted in more weight reduction among patients in the study.

CONCLUSION

In conclusion, our study reveals that bariatric surgery remains effective for weight reduction during the first 6 months of the pandemic in Iran. Implementation of pandemic protocols ensures comparable efficacy to non-pandemic times. However, caution is needed in generalizing results beyond our specific context due to study limitations. Further research is essential to comprehensively assess the pandemic's broader impact on bariatric surgery outcomes under varying conditions.

Sexual Dysfunction in Men and Women with Diabetes: A Reflection of their Complications?

BACKGROUND

Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality.

OBJECTIVE

The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes.

METHODS

A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic.

RESULTS

Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs.

CONCLUSION

Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.

Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery

Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.

Higher Edmonton Obesity Staging System scores are independently associated with postoperative complications and mortality following bariatric surgery: an analysis of the MBSAQIP

INTRODUCTION

Bariatric surgery is an evidence-based approach for sustained weight loss in patients with severe obesity. The most common procedures in North America are the laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The Edmonton Obesity Staging System (EOSS) is a tool that assigns patients a score of 0 to 4 according to their obesity-related comorbidities and functional status. Previous research demonstrates that increasing EOSS score is associated with overall non-operative mortality risk.

OBJECTIVE

We sought to assess the association of the EOSS with major 30-day postoperative complications following LSG or LRYGB.

METHODS

Primary LSG or LRYGB patients were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Patients were assigned EOSS scores according to their comorbidities and functional limitations extracted from the database. Multivariable logistic regression analysis was conducted to evaluate the relationship between EOSS score, age, sex, BMI, type of procedure, or operative time with 30-day major complications.

RESULTS

From 2015 to 2017, 430,238 patients (79.4% female) who underwent primary LSG or LRYGB were identified. The relative frequencies of patients by EOSS score were: 0 and 1 (23.9%), 2 (62.8%), 3 (10.5%), and 4 (2.9%). Mean preoperative BMI was 45.4 (SD 7.9) kg/m² and mean age was 44.6 (SD 12.0) years. The overall 30-day major complication rate was 3.5%. EOSS 2, 3, and 4 were significantly associated with major complications. The strongest associations with major complications were EOSS 4 (OR 2.30; 95% CI 2.11-2.51, p < 0.001) and LRYGB versus LSG (OR 2.03; 95% CI 1.97-2.11, p < 0.001). EOSS 3 and 4 were most strongly associated with death.

CONCLUSION

Higher EOSS scores are independently associated with 30-day major postoperative complications and mortality. The EOSS provides utility in staging patients and identifying those at greater risk of postoperative complications.

Association of Pain, Severe Pain, and Multisite Pain with the Level of Physical Activity and Sedentary Behavior in Severely Obese Adults: Baseline Data from the DieTBra Trial

The study aimed to assess the prevalence of pain, severe pain, and pain in four or more regions associated with physical activity and sedentary behavior, as well as other associated factors in severely obese adults (Body Mass Index ≥ 35 kg/m2). Baseline data from the DieTBra Trial were analyzed. The outcome variables were pain (yes/no) and pain in four or more sites (yes/no), as identified by the Brazilian version of the Nordic Musculoskeletal Questionnaire, along with the presence of severe pain (yes/no), identified based on the Numerical Pain Rating Scale (≥8). The main independent variables were moderate to vigorous physical activity (MVPA), light physical activity, and sedentary behavior, assessed by triaxial accelerometry. The variables were analyzed using multiple hierarchical Poisson regression. In 150 individuals (men, 14.67%; and women, 85.33%), with a mean age of 39.6 ± 0.7 years, there was a high prevalence of pain (89.33%), severe pain (69.33%), and pain in four or more regions (53.33%). The associated factors were shorter MVPA time with pain (p = 0.010); arthritis/arthrosis (p = 0.007) and the use of muscle relaxants (p = 0.026) with severe pain; and economic class C (p = 0.033), and economic class D (p = 0.003), along with arthritis and arthrosis (p = 0.025) with pain in four or more sites. There were no significant associations between sedentary behavior and any of the three outcomes analyzed. These findings indicate that, in severely obese individuals, shorter MVPA time is associated with a higher prevalence of pain. Future studies on physical activity intervention may contribute to the reduction in the prevalence and severity of pain in adults with severe obesity.

Lifestyles and sexuality in men and women: the gender perspective in sexual medicine

Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.

Oral Health–Related Quality of Life After Gastric Bypass Surgery

Objective

The aim was to examine how individuals treated for obesity with gastric bypass (GBP) surgery perceived their oral health and oral health–related quality of life (OHRQoL).

Method

All individuals in one Swedish region who had undergone GBP surgery (n = 1182) were sent a postal questionnaire 2 years after surgery. The questionnaire comprised items on sociodemographics, oral symptoms and the Oral Health Impact Profile-49 to assess the OHRQoL.

Results

The mean age was 47.6 years with 75% females, response rate 55.3%. The self-perceived oral health was rated low by 45% of the respondents. Gender differences were seen, for instance, regarding hypersensitive teeth (men 18.8%, women 30.8%, p = 0.003). Nine out of ten reported at least one oral impact experienced sometimes, fairly or very often, according to the Oral Health Impact Profile-49 (OHIP-49). The mean additive OHIP-49 score was 30.3 (SD 36.1). The associations between self-reported oral health and OHRQoL were consistent throughout. Tooth hypersensitivity generated an OR of 2.28 (95% CI 2.28–8.46) of having ≥ 2 impacts on OHRQoL.

Conclusion

A large proportion of individuals having undergone GBP surgery reported problems with their oral health and impacts on their OHRQoL, indicating a need for medical and dental staff—surgeons and general practitioners as well as other health professionals—to offer oral health promotion and prevention measures.

Sexual Dysfunctions in Obese Women Before and After Bariatric Surgery

Background

Obesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women.

Material/Methods

60 obese women (mean initial BMI of 43.7±5.9 kg/m²; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m²). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m²; mean age of 36.4±10.7 years).

Results

Our findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold.

Conclusions

These findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.

Sexual behaviors, risks, and sexual health outcomes for adolescent females following bariatric surgery

BACKGROUND

Adolescents females with severe obesity are less likely to be sexually active, but those who are sexually active engage in risky sexual behaviors.

OBJECTIVES

To examine patterns and predictors of sexual risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did or did not undergo bariatric surgery across 4 years.

SETTING

Five academic medical centers.

METHODS

Using a prospective observational controlled design, female adolescents undergoing bariatric surgery (n = 111; M_age = 16.95 ± 1.44 yr; body mass index: M_BMI = 50.99 ± 8.42; 63.1% white) and nonsurgical comparators (n = 68; M_age = 16.18 ± 1.36 yr; M_BMI = 46.47 ± 5.83; 55.9% white) completed the Sexual Activities and Attitudes Questionnaire at presurgery/baseline and 24- and 48-month follow-up, with 83 surgical females (M_BMI = 39.27 ± 10.08) and 49 nonsurgical females (M_BMI = 48.56 ± 9.84) participating at 48 months.

RESULTS

Most experienced sexual debut during the 4-year study period, with a greater increase in behaviors conferring risk for sexually transmitted infections (STIs) for surgical females (P = .03). Half (50% surgical, 44.2% nonsurgical, P = .48) reported partner condom use at last sexual intercourse. The proportion of participants who had ever contracted an STI was similar (18.7% surgical, 14.3% nonsurgical). Surgical patients were more likely to report a pregnancy (25.3% surgical, 8.2% nonsurgical, P = .02) and live birth (16 births in 15 surgical, 1 nonsurgical), with 50% of offspring in the surgical cohort born to teen mothers (age ≤19 yr).

CONCLUSIONS

Bariatric care guidelines and practices for adolescent females must emphasize the risks and consequences of teen or unintended pregnancies, sexual decision-making, dual protection, and STI prevention strategies to optimize health and well-being for the long term.

An assessment of the relative impact of hidradenitis suppurativa, psoriasis, and obesity on quality of life

Background

Hidradenitis suppurativa (HS) and psoriasis are inflammatory skin diseases associated with obesity. Each disease is likely to impact the quality of life of patients, but the relative impact of each disease is unknown.

Objectives

This study aimed to determine whether skin disease or obesity is more distressing to obese patients who have either psoriasis or HS.

Methods

A cohort of obese patients with psoriasis and HS was surveyed using a time-trade-off utility. T-tests and regression analysis were used to compare differences in impact on quality of life between skin disease and obesity for patients with HS and psoriasis. Further analyses were adjusted for degree of obesity and severity of disease.

Results

A total of 79 subjects completed the survey. Obese patients with HS were heavier than patients with psoriasis (mean body mass index 38.1 kg/m² vs. 34.9 kg/m²). Obese patients with either HS or psoriasis were both willing to trade a significantly higher proportion of their life to live without skin disease than to live at a normal weight (p = .01). This effect persisted after controlling for disease severity and weight. Patients with HS were willing to trade significantly more years of life to live at a normal weight than obese patients with psoriasis (14 vs. 7; p < .04).

Limitations

This was a small study conducted at an academic institution.

Conclusion

In this study population, obesity was more severe in patients with HS than in those with psoriasis. Even after controlling for relative severity, HS was more problematic for subjects in this study than weight when these conditions existed concomitantly.

Body mass index and health-related quality of life

OBJECTIVE

There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains.

METHODS

This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity.

RESULTS

A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7).

CONCLUSIONS

This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.

Surgical weight loss as a life-changing transition: The impact of interpersonal relationships on post bariatric women

Surgical Weight Loss as A Life-changing Transition: The Impact of Interpersonal Relationships on Post-Bariatric Women BACKGROUND: Although women account for 80% of patients having bariatric surgery (BS), the complex psychosocial mechanisms that accompany this transformation process have not been well established.

PURPOSE

The purpose of this study is to explore the lived experience of women transitioning in their interpersonal relationships post BS.

METHODS

A semi-structured interview with four questions was used. Six women, from six to 12 months post BS, were interviewed. The interviews were recorded, transcribed and analyzed using thematic analysis.

MAIN FINDINGS

By seeking support systems prior to undergoing BS, adequate social support was received during their recovery period. Attending bariatric support group meetings and using social media were significant to these women's satisfactory recovery. Relationship adjustments were sometimes needed, but overall these women established fulfilling social lives. Within the first year post bariatric surgery, women began to gain emotional strength and inspire others to lose weight as well.

CONCLUSIONS

By inquiring about the psychosocial concerns of women who have undergone BS, healthcare providers can provide a more practical wellness plan.

Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada

Background

In Canada, severe obesity (BMI ≥ 35 kg/m²) affects 5% or 1.2 million adults. Bariatric surgery is the only effective treatment for severe obesity, but the demand for publicly funded procedures is high and capacity limited. Little is known in Canada about the types of patients undergoing these procedures, especially laparoscopic sleeve gastrectomy (LSG). The study objective is to examine the socio-demographic profile, morbidity and HRQoL of patients accessing LSG in one Canadian province.

Methods

Health status and HRQoL were examined in patients (n = 195) undergoing LSG. HRQoL was assessed using the EQ-5D-3L, SF-12v2 and the Impact of Weight on Quality of Life-lite questionnaire.

Results

Mean age and BMI were 44 and 49 kg/m² and most were women (82%). Pre-surgery, comorbidities were sleep apnea (65%), dyslipidemia (48%), hypertension (47%) and osteoarthritis (44%). Patients reported impaired HRQoL with 44-67% reporting problems in mobility, usual activities, pain and anxiety/depression. Physical health was impaired more than mental health. There were few socio-demographic differences between women and men, but significant differences in comorbid conditions such as sleep apnea, dyslipidemia, hypertension and gout exist (p < .05). Women reported fewer problems with self-care (9.5% vs. 25.0%, p < .05), and better overall health (VAS 61.5 vs. 52.0, p < .05) and General Health (39.3 vs. 32.9, p < .05), but greater impairment in self-esteem (27.3 vs. 44.1, p < .01) and sexual life (49.2 vs. 63.6, p < .05).

Conclusions

Before LSG, patients reported significant morbidity and impaired HRQoL. Although baseline characteristics were similar between men and women, gender specific differences were observed in comorbid profile and HRQoL.

A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life

This is the first systematic review of reviews to assess the effect of obesity and weight loss on health-related quality of life (HRQoL). We identified 12 meta-analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre-intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non-surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight-loss interventions. We recommend longer-term studies, using both generic and obesity-specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.

Contextual care of the patient following weight-loss surgery: Relational views and maintenance activities of couples

BACKGROUND AND PURPOSE

Weight-loss surgery (WLS) is a popular means toward achieving weight loss. Numerous studies report on the psychological and physical benefits of the procedure. Patients who have supportive others often demonstrate improved outcomes as compared to those who may not have support. The present study examines relationship maintenance activities that may contribute to a couple's positive adjustment following WLS, along with relational views that may modify and evolve as patients continue to lose weight.

METHOD

Eleven heterosexual couples in which the female had WLS participated in in-depth, semistructured interviews. A deductive method of analysis was used to categorize relationship maintenance activities; an inductive method was used to examine relational views.

CONCLUSIONS

Six types of relationship maintenance activities proved beneficial following WLS: (1) openness, (2) assurances, (3) food/meals as shared tasks, (4) joint activities, (5) antisocial, and (6) affection. In describing their relational views, participants spoke to the increasing independence, confidence, and self-focus of those who had had WLS. A persistent fat identity was also reported.

IMPLICATIONS FOR PRACTICE

The findings can provide advanced practice nurses and other clinicians additional insight into, and strategies to assist, couples who have experienced, or will experience, WLS within their relationship.

The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass

Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p < 0.05). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales (p < 0.05) and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery.

Quality of life as a mediator in the association between body mass index and negative emotionality in overweight and obese non-clinical sample

PURPOSE

The present study investigates the differences in physical health-related quality of life (HRQoL) among overweight and obese people, as well as the correlates of HRQoL in this population and the association between BMI, depression, anxiety, and potential mediating effects of HRQoL.

METHODS

The research was conducted on a sample of overweight and obese adults who visited their primary care physician. A total of 143 women and 130 men were enrolled in the study, 43% of the subjects were overweight, and 57% of the subjects were obese. The subjects ranged in age between 21 and 60 years. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, and HRQoL was evaluated using the Medical Outcome Study Short-Form 36.

RESULTS

The analysis of variance results showed that women in comparison to men have lower physical HRQoL (e.g. worst physical functioning, more bodily pain), and that severely obese patients have lower physical HRQoL in comparison to overweight ones. The regression analysis results indicated that some of the aspects of physical HRQoL (e.g. physical functioning, role limitations) mediate the relationship between BMI and depression only in women. The higher level of body mass decreased the physical HRQoL, which became a potential risk factor for the development of depressive symptoms.

CONCLUSIONS

The results from the present study show that a different pattern of functioning exists between men and women. It is important to identify the factors that can effectively motivate and stimulate obese people to change their lifestyle and to consider the differences in psychological functioning between women and men.

Taste, smell and appetite change after Roux-en-Y gastric bypass surgery

BACKGROUND

It is apparent from day-to-day practice that patients frequently report changes to their appetite, taste and smell after weight loss surgery. There has been surprisingly little written in the literature on this. The aim of the current study was to assess these parameters in a cohort of patients undergoing Roux-en-Y gastric bypass surgery.

METHODS

Questionnaires relating to appetite, taste and smell were administered to 188 patients who had undergone Roux-en-Y gastric bypass surgery at our institution during the years 2000-2011.

RESULTS

Responses were received from 103 patients (55%). Sensory changes in appetite, taste and smell were noted by 97, 73 and 42% of patients, respectively. Seventy-three percent of patients reported aversion to specific foods after surgery, with meat products the most commonly cited (33%). Patients who experienced food aversions experienced more postoperative weight loss and reduction in BMI, compared to their counterparts without these features.

CONCLUSIONS

This study indicates that subjective changes in appetite, taste and smell are very common after Roux-en-Y gastric bypass. Patients are now routinely counselled about these changes as part of the informed consent process for surgery.

Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences.

Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient

OBJECTIVES

To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care.

STUDY DESIGN

Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids).

RESULTS

WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL.

CONCLUSIONS

WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.

The impact of a primary care-based weight loss intervention on the quality of life

OBJECTIVE

This study investigated changes in the quality of life of men and women who participated in a primary care-based weight loss intervention program.

METHODS

Participants were enrolled in a 2-year randomized clinical trial (POWER-UP) conducted at the University of Pennsylvania and in six affiliated primary care practices. Inclusion criteria included the presence of obesity (body mass index of 30-50 kg m(-2)) and at least two components of the metabolic syndrome.

MAIN OUTCOME MEASURES

Quality of life was assessed by three measures: the Short Form Health Survey (SF-12); the Impact of Weight on Quality of Life-Lite; and the EuroQol-5D.

RESULTS

Six months after the onset of treatment, and with a mean weight loss of 3.9 ± 0.3 kg, participants reported significant improvements on all measures of interest with the exception of the Mental Component Score of the SF-12. These changes remained significantly improved from baseline to month 24, with the exception of the EuroQol-5D. Many of these improvements were correlated with the magnitude of weight loss and, for the most part, were consistent across gender and ethnic group.

CONCLUSIONS

Individuals with obesity and components of the metabolic syndrome reported significant improvements in most domains of the quality of life with a modest weight loss of 3.7% of initial weight, which was achieved within the first 6 months of treatment. The majority of these improvements were maintained at month 24, when participants had lost 3.0% of their weight.

Effect of intensive lifestyle intervention on sexual dysfunction in women with type 2 diabetes: results from an ancillary Look AHEAD study

OBJECTIVE

Sexual dysfunction is a prevalent problem in obese women with type 2 diabetes. This study examined the effects of intensive lifestyle intervention (ILI) in these women.

RESEARCH DESIGN AND METHODS

Look AHEAD is a 16-center, randomized, controlled trial evaluating the health effects of ILI compared with a control group (diabetes support and education [DSE]). The Look AHEAD Sexual Function Ancillary study included 375 female participants at five Look AHEAD sites. Participants completed the Female Sexual Function Inventory (FSFI) and Beck Depression Inventory (BDI), and assessments of weight and cardiovascular risk factors at baseline and 1 year were made.

RESULTS

At baseline, 50% of the 229 participants who reported being sexually active met criteria for female sexual dysfunction (FSD); only BDI score was related to FSD. One-year weight losses were greater in the ILI group than in the DSE group (7.6 vs. 0.45 kg; P<0.001). Among women with FSD at baseline, those in the ILI group (N=60) compared with those in the DSE group (N=53) were significantly more likely to remain sexually active (83 vs. 64%; P<0.008), reported greater improvement in total FSFI scores and in most FSFI domains (P<0.05), and were more likely to experience remission of FSD (28 vs. 11%; P<0.04) at 1 year. No significant differences between ILI and DSE were seen in women who did not have FSD at baseline.

CONCLUSIONS

Participation in ILI appeared to have beneficial effects on sexual functioning among obese women with diabetes, particularly in those who had FSD at baseline.

A Systematic Review of Quality of Life Measures in Pregnant and Postpartum Mothers

Quality of life has emerged as an essential health component that broadens the traditionally narrow concerns focused on only morbidity and life expectancy. Although a growing number of tools to measure quality of life are in circulation, there is a lack of guidelines as well as rigorous assessment for their use with pregnant and postpartum populations. It is also unclear whether these instruments could validly be employed to measure patient-reported outcomes in comparative effectiveness research of maternal care interventions. This paper reviews articles cited in CINAHL, COCHRANE, EMBASE, PSYCINFO, and PUBMED that addressed quality of life in pregnant and postpartum populations. Instruments used to measure quality of life in selected articles were assessed for their adherence to international guidelines for health outcomes instrument development and validation. The authors identified 129 articles that addressed quality of life in pregnant and/or postpartum women. Out of these, only 64 quality (generic and specific) scales were judged relevant to be included in this study. Analysis of measurement scales used in the pregnant and/or postpartum populations revealed important validity, reliability and psychometric inadequacies that negate their use in comparative effectiveness analysis in pregnant and post-partum populations. Valid, reliable, and responsive instruments to measure patient-reported outcomes in pregnant and postpartum populations are lacking. To demonstrate the effectiveness of various treatment and prevention programs, future research to develop and validate a robust and responsive quality of life measurement scale in pregnant and postpartum populations is needed.

Trends in utilization and outcomes of bariatric surgery in obese people with and without type 2 diabetes in Spain (2001-2010)

AIM

Bariatric surgery is associated with a significant improvement in glucose control and even diabetes remission. There are no studies investigating national trends in the use of bariatric surgery in people with type 2 diabetes. We examine trends in the use of bariatric surgery in patients with and without type 2 diabetes between 2001 and 2010 in Spain.

METHODS

We identified patients who underwent bariatric surgery using national hospital discharge data. Discharges were grouped by diabetes status. Incidence of discharges due to bariatric surgery were calculated and stratified by diabetes status, procedure and year. We calculated length of stay (LOS) and in-hospital mortality (IHM).

RESULTS

From 2001 to 2010 13,038 bariatric surgery procedures were performed. Over the study period 23.6% (n=3080) of all patients undergoing bariatric procedure had DM as a co-diagnosis. This prevalence increased from 17.3% in 2001 to 25.5% in 2010. LOS and IHM were similar among patients with and without type 2 diabetes.

CONCLUSION

The proportion of subjects with type 2 diabetes among bariatric surgery patient has increased over time, in part due to an increase in the use of laparoscopic techniques.

Profile of sexuality in Moroccan chronic low back pain patients

Background

Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP) as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL).

Methods

One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL) was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance.

Results

Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at −10.4 ± 4.8 per month. SQOL score mean was at 44.6 ± 17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p = 0.02). Men had worse SQOL than women (respectively 38.9 ± 17.2 vs. 50.3 ± 15.7%; p = 0.001). Univariate and multivariate analysis showed that advanced age (p = 0.009), poor functional status (p = 0.03), male gender (p = 0.03) and sexual intercourse frequency decrease (p = 0.005) were the independent variables associated with the SQOL disturbance.

Conclusion

Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients.

Characteristics of the population eligible for and receiving publicly funded bariatric surgery in Canada

Background

Bariatric surgery is the most effective current treatment for severe obesity. Capacity to perform surgery within Canada’s public health system is limited and potential candidates face protracted wait times. A better understanding of the gaps between demand for surgery and the capacity to provide it is required. The purpose of this study was to quantify and characterize the bariatric surgery-eligible population in Canada in comparison to surgery-ineligible subjects and surgical recipients.

Methods

Data from adult (age > 20) respondents of the 2007–09 nationally representative Canadian Health Measures Survey (CHMS) were analyzed to estimate the prevalence and characteristics of the surgery-eligible and ineligible populations. Federally mandated administrative healthcare data (2007–08) were used to characterize surgical recipients.

Results

In 2007–09, an estimated 1.5 million obese Canadian adults met eligibility criteria for bariatric surgery. 19.2 million were surgery-ineligible (3.4 million obese and 15.8 million non-obese). Surgery-eligible Canadians had a mean BMI of 40.1 kg/m² (95% CI 39.3 to 40.9 kg/m²) and, compared to the surgery-ineligible obese population, were more likely to be female (62 vs. 44%), 40–59 years old (55 vs. 48%), less educated (43 vs. 35%), in the lowest socioeconomic tertile (41 vs. 34%), and inactive (73 vs. 59%). Self-rated mental health and quality of life were lower and comorbidity was higher in surgery-eligible respondents compared with the ineligible populations. The annual proportion of Canadians eligible for surgery that actually underwent a publicly funded bariatric surgery between 2007–09 was 0.1%. Surgical recipients (n = 847) had a mean age of 43.6 years (SD 11.1) and 82% were female. With the exception of type 2 diabetes, obesity-related comorbidity prevalence was much lower in surgical recipients compared to those eligible for surgery.

Conclusions

The proportion of bariatric surgery-eligible Canadians that undergo publicly funded bariatric surgery is very low. There are notable differences in sociodemographic profiles and prevalence of comorbidities between surgery-eligible subjects and surgical recipients.

Changes in health-related quality of life in people with morbid obesity attending a learning and mastery course. A longitudinal study with 12-months follow-up

BACKGROUND

Severe obesity is a complex condition that is associated with a wide range of serious health complications and reduced health-related quality of life (HRQoL). In addition to physiological factors, activity and participation, environmental factors, and personal factors are related to an individual's overall quality of life HRQoL. In Norway, a course based on cognitive behavioral principles is offered to people seeking medical treatment for weight management. The aim is to assist participants to achieve a healthier lifestyle and thereby improve their HRQoL. We therefore investigated changes in HRQoL in participants after they attended this learning and mastery course, and explored how well sociodemographic variables, paid work, social support, personal factors, and surgery predicted HRQoL at 12-month follow-up.

METHODS

A single-group longitudinal study was conducted. Data were collected by self-reported questionnaires. This article reports on those who had completed the questionnaire at the 12-month (n = 69) follow-up. HRQoL was assessed with the EQ-5D. Other standardized instruments measured employment, social support, self-efficacy, and surgery.

RESULTS

At the 12-month follow-up, participants scored higher on all dimensions of the EQ-5D and on the EQ-VAS. Generalized linear model showed that having paid work, and social support were statistically significant predictors of HRQoL at the 12-month follow-up. Sex, self-efficacy, and surgery were not statistically significant associated with HRQoL.

CONCLUSIONS

Participation in paid work, and receiving social support from persons with whom they had a close relationship were strongly related to HRQoL in obese people 12 months after participating in a learning and mastery course.

TRIAL REGISTRATION

The study is registered in Clinical Trials: NCT01336725.

Psychological disturbances and quality of life in obese and infertile women and men

Anovulatory cycles and endometriosis are the main causes of female infertility. The most frequently anovulatory cycles are related to polycystic ovary syndrome (PCOS) commonly associated with obesity and hormonal disturbances in the course of obesity. Recently published studies revealed that infertility affects about one in six couples during their lifetime and is more frequent in obese. Obesity is also associated with male infertility related to erectile dysfunction, hormonal disturbances and lower semen quality. Any of these above mentioned disorder is the important risk factor of psychological disturbances and poor quality of life among women and men in the reproductive age. On the other hand the mood disorders may exacerbate the hormonal disturbances and worsen the effectiveness of infertility management. Infertility, its therapy with accompanying psychological disturbances may also significantly affect the partners relationships. The review summarize the results described in the current literature on the association between obesity and infertility and psychological disturbances as well as their impact on quality of life and sexual functioning in women and men. Moreover, the impact of infertility and psychological disturbances on partners relationships is discussed.

Psychometric evaluation of the IWQOL-Lite (Spanish version) when applied to a sample of obese patients awaiting bariatric surgery

BACKGROUND

Obesity may have an impact on key aspects of health-related quality of life (HRQOL). In this context, the Impact of Weight Quality of Life (IWQOL) questionnaire was the first scale designed to assess HRQOL. The aim of the present study was twofold: to assess HRQOL in a sample of Spanish patients awaiting bariatric surgery and to determine the psychometric properties of the IWQOL-Lite and its sensitivity to detect differences in HRQOL across groups.

METHODS

Participants were 109 obese adult patients (BMI ≥ 35 kg/m(2)) from Barcelona, to whom the following measurement instruments were applied: IWQOL-Lite, Depression Anxiety Stress Scales, Brief Symptom Inventory, and self-perception items.

RESULTS

Descriptive data regarding the IWQOL-Lite scores obtained by these patients are reported. Principal components analysis revealed a five-factor model accounting for 72.05% of the total variance, with factor loadings being adequate for all items. Corrected item-total correlations were acceptable for all items. Cronbach's alpha coefficients were excellent both for the subscales (0.88-0.93) and the total scale (0.95). The relationship between the IWQOL-Lite and other variables supports the construct validity of the scale. Finally, sensitivity analysis revealed large effect sizes when comparing scores obtained by extreme BMI groups.

CONCLUSIONS

This is the first study to report the application of the IWQOL-Lite to a sample of Spanish patients awaiting bariatric surgery and to confirm that the Spanish version of the instrument has adequate psychometric properties.

Cardiorespiratory fitness and health-related quality of life in bariatric surgery patients

Health-related quality of life (HRQOL) is impaired in severely obese individuals presenting for bariatric surgery. Little is known about the relationship between cardiorespiratory fitness (CRF) and HRQOL in these individuals. We hypothesized that better HRQOL would be reported by those with higher CRF. In 326 gastric bypass patients (mean BMI = 46.5 ± 7.0; mean age=40.9 ± 10.1; 83.4% female), pre-surgical CRF was quantified as duration (minutes) of a submaximal treadmill test to 80% of age-predicted maximal heart rate (MHR). Patients completed both a general measure of HRQOL [the Medical Outcome Short Form 36 (SF-36)] and a weight-specific measure of HRQOL [Impact of Weight on Quality of Life--Lite]. Mean HRQOL scores were examined, controlling for age, gender, and BMI. Mean treadmill duration was 9.9 ± 3.1 min, and percent age-predicted MHR was 81.2 ± 3.0%. Higher cardiorespiratory fitness tended to be associated with better physical and weight-specific HRQOL. Adjustment for differences in gender, age, and BMI attenuated the significance of associations between fitness and physical measures from the SF-36, whereas adjustment eliminated significance of associations between fitness and weight-specific HRQOL in most cases. Results suggest that CRF confers some HRQOL benefits in severely obese adults, though these benefits may largely be explained by differences in age, gender, and BMI.

Differences in outcomes of laparoscopic gastric bypass

BACKGROUND

Although several risk factors affecting weight loss outcomes with bariatric procedures have been identified, the effect of age, gender, race, and illness severity on postoperative outcomes of laparoscopic gastric bypass has not been extensively examined.

METHODS

The University HealthSystem Consortium database is an administrative and financial database that provides information on the inpatient stay. A retrospective analysis of patient outcomes was performed using 4-year discharge data from the University HealthSystem Consortium database.

RESULTS

A total of 37,765 patients underwent laparoscopic gastric bypass. The women exhibited significantly reduced mortality, morbidity, intensive care unit (ICU) admissions (9.87% male versus 6.73% female; P <.001), duration of hospitalization (2.72 ± 4.03 d for men versus 2.59 ± 2.88 d for women; P <.001), and hospital costs ($17,346 ± $15,397 for men versus $14,383 ± $11,170 for women; P <.001). Blacks demonstrated significantly greater 30-day readmission rates, duration of hospitalization, and costs compared with whites. Hispanics had lower ICU admission and hospital costs compared with whites. With increasing age, an increased risk of overall morbidity, ICU admissions, duration of hospitalization, and costs was observed. Compared with the minor severity group, the major/extreme severity group had significantly greater observed mortality, overall morbidity, ICU admissions, duration of hospitalization, and hospital costs.

CONCLUSION

The present study identified gender, race, age, and illness severity as risk factors affecting postoperative outcomes after laparoscopic gastric bypass. Male gender and increasing age were overall associated with an increased risk of complications. Significant racial disparities in the outcome measures were observed with blacks having an increased risk of adverse events. Illness severity was shown to adversely affect the surgical outcomes in laparoscopic gastric bypass.

Sexual functioning in obese adults enrolling in a weight loss study

The authors assessed sexual functioning among treatment-seeking obese men (n = 91) and women (n = 134) using the comprehensive validated Sexual Functioning Questionnaire. Scores were lower for women than for men, indicating reduced sexual functioning. Men's scores fell between those of a group of cancer survivors and a general population group, whereas women generally had lower scores than both of these groups. Increasing body mass index was associated with decreasing sexual functioning only for arousal and behavior. Sexual functioning was also reduced on most subscales for individuals who reported sexual inactivity in the past month.

Health-related quality of life in severely and morbidly obese patients waiting for bariatric surgery in Finland

BACKGROUND

important outcome measurements in bariatric surgery include the improvement or resolvement of medical comorbid conditions caused by obesity, and the possible changes in quality of life. The health-related quality of life (HRQoL) among Finnish obese subjects awaiting bariatric surgery has not previously been compared to age- and gender-standardized general population.

METHODS

the HRQoL in 75 obese subjects waiting for bariatric surgery was assessed by the generic 15D instrument. The resulting 15D profile and single index score were compared to those of a sample of age- and gender-standardized general population (n = 4955).

RESULTS

The patients were significantly worse off than the age- and gender-standardized general population on 11 of the 15 dimensions. The mean total 15D score among patients scheduled for bariatric surgery was 0.844 compared to 0.934 in the control group (P < 0.001).

CONCLUSION

the Finnish patients awaiting bariatric surgery suffer from a very poor HRQoL compared with age- and gender-standardized general population.

Changes in quality of life and body image after gastric bypass surgery

BACKGROUND

Improvements in psychosocial status are an important aspect of successful outcomes after bariatric surgery. Relatively few studies have investigated the changes in psychosocial functioning at a number of points in the first few postoperative years. The present study was undertaken to assess the changes in quality of life and body image after gastric bypass surgery. The present study was performed at an academic medical center.

METHODS

A total of 200 men and women were enrolled in the study and completed psychometric measures of quality of life and body image before surgery and again 20, 40, and 92 weeks postoperatively.

RESULTS

The participants reported significant improvements in several domains of health- and weight-related quality of life, as well as changes in body image, after surgery. These changes were correlated with the percentage of weight loss.

CONCLUSION

Those who undergo gastric bypass surgery experienced significant improvements in quality of life and body image within the first few months after surgery. These changes were, with few exceptions, maintained into the second postoperative year.

Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic

Although rates of obesity have increased universally in the United States over the past 30 y, it is clear that certain individuals are more susceptible to weight gain than others. Extreme obesity [body mass index (in kg/m(2)) > 40] is increasing at rates greater than any other class of obesity in the United States. Severely obese patients often suffer from a wide variety of comorbidities. Although weight-loss surgery is the most effective treatment, it offers little in the way of large-scale containment due to its costly and invasive nature. Lifestyle interventions that induce modest weight loss and improve fitness can significantly lower disease risk. As medical professionals in the field of nutrition, we must focus first on the patient cohort that suffers most from the modern obesogenic environment. Lifestyle interventions specifically targeted toward the class III obese cohort should be a high priority in nutrition medicine.

Prevalence and degree of sexual dysfunction in a sample of women seeking bariatric surgery

BACKGROUND

Sexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery.

METHODS

The FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2-36). A FSFI total cutoff score of <or=26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls.

RESULTS

Of the 102 women, 61 (59.8%) had FSFI total scores of <or=26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar.

CONCLUSION

Women seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.