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Carpenter SM, Shetty A, Hetzel SJ, Garza K, Porter LS, Gray KE, Shaw RJ, Lewis MA, Mao L, Pabich S, Johnson HM, Yancy WS, Elwert F, Voils CI. A non-randomized comparison of engagement and outcomes for in-person versus virtual delivery of the Partner2Lose weight management trial. Obes Sci Pract 2024; 10:e778. [PMID: 39045420 PMCID: PMC11265462 DOI: 10.1002/osp4.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective Existing behavioral weight management interventions produce clinically meaningful weight loss. The onset of the COVID-19 pandemic led to the quick transition of such interventions from in-person to virtual platforms. This provided a unique opportunity to compare engagement and outcomes for an in-person versus virtually delivered weight management intervention. Methods A non-randomized comparison of engagement and weight outcomes was performed between two cohorts who participated in a weight management intervention in person (N = 97) versus three who participated virtually via videoconference (N = 134). Various metrics of engagement were examined, including group class and individual phone call attendance and duration, and retention for weight assessments. Behavioral targets of daily caloric intake and step-counts and the clinical weight outcome were explored. Results Cohorts (mean [standard deviation] age 47.3 (11.5), 67.1% women: 86.8% White) that participated virtually attended more group sessions (p < 0.001) and had maintenance telephone calls that were of a longer duration (p < 0.001). No other engagement or weight outcomes significantly differed by delivery modality. Conclusions Virtual weight management programs are promising and may generate similar outcomes to those delivered in-person. Future research should seek to understand how best to promote and sustain engagement in virtual interventions.
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Affiliation(s)
| | - Armaan Shetty
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Scott J. Hetzel
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Katya Garza
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Laura S. Porter
- Psychiatry & Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kristen E. Gray
- Department of Veterans Affairs Puget Sound Health Care SystemHealth Services Research & DevelopmentSeattleWashingtonUSA
- Health Systems and Population HealthSchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Ryan J. Shaw
- School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | - Megan A. Lewis
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Lu Mao
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Samantha Pabich
- Department of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness InstituteBaptist Health South FloridaCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - William S. Yancy
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Felix Elwert
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of SociologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corrine I. Voils
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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2
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Ecker AH, Amspoker AB, Johnston W, Walder A, Lindsay JA, Hogan JB. The role of depression and anxiety symptom severity in remotely delivered mental health care. Psychol Serv 2024; 21:42-49. [PMID: 37347915 PMCID: PMC10739638 DOI: 10.1037/ser0000775] [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] [Indexed: 06/24/2023]
Abstract
This study examined differences in mental health characteristics of Veterans who received VA Video Connect (VVC) or audio-only care during initial phases of the COVID-19 pandemic. A cohort of Veterans with primary diagnoses of depressive or anxiety disorders (diagnosed between March 2019 and February 2020) was identified, and data were obtained for Veterans who engaged in virtual care from April to December 2020. Two groups were created: Veterans receiving audio-only care (n = 161,071) and Veterans receiving two or more VVC visits (n = 84,505). Multiple logistic regression models examined symptom severity in the year before COVID as a predictor of treatment modality during COVID. Chi-square tests examined associations between modality and the number of assessments. Symptom severity as evaluated by the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder-7 significantly predicted modality of encounters during the pandemic such that those who had moderate or severe symptoms prior to COVID-19 were more likely than those with low or no symptoms to have two or more VVC encounters during the pandemic. Of those who received VVC, 55.62% had no Patient Health Questionnaire-9 assessments compared to 68.96% of those who received audio-only. In the VVC group, 70.36% had no Generalized Anxiety Disorder-7 assessments compared to 81.02% in the audio-only group. Taken together, these findings suggest that VVC, when compared to audio-only, was used during the pandemic to reach Veterans with more severe mental health symptomatology and to engage in administration of measurement-based care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Anthony H Ecker
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Amber B Amspoker
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | | | - Annette Walder
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Jan A Lindsay
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
| | - Julianna B Hogan
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
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3
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Kruschitz R, Fahrnberger M, Felsenreich DM, Ress C, Andersen B, Aydinkoc-Tuzcu K, Ciardi C, Huber SL, Kiefer FW. [Prevention and management of postinterventional weight regain]. Wien Klin Wochenschr 2023; 135:743-750. [PMID: 37821697 PMCID: PMC10567866 DOI: 10.1007/s00508-023-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Decreasing levels of patient motivation or compliance are far from being the only causes of postinterventional weight regain after lifestyle, psychological, pharmacological and surgical interventions. Weight regain originates from a complex and individually varying set of central and peripheral mechanisms, with the overall purpose of increasing food intake by both stimulating hunger and reducing satiety (mediated by gastrointestinal hormones) and decreasing the body's energy demands (via metabolic adaption). These mechanisms counteract any attempts to reduce or maintain body weight in today's increasingly prevalent adipogenic environments. The knowledge about the biological mechanisms of body weight regulation should be taken into consideration when planning treatment programs for long-term weight reduction, including follow-up treatment for the prevention and individualized treatment of postinterventional weight regain. Therapeutic measures as well as the frequency of medical follow-ups should be based on the extent of weight regain.
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Affiliation(s)
- Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen, Klagenfurt, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Claudia Ress
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz, Zams, Österreich
| | - Simone Leonore Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Florian W Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Barenbaum SR, Zhao AS, Saunders KH, Aronne LJ, Shukla AP. Management of Weight Regain Following Bariatric Surgery: Behavioral Intervention and Pharmacotherapy. Expert Rev Endocrinol Metab 2022; 17:405-414. [PMID: 35912876 DOI: 10.1080/17446651.2022.2101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Bariatric surgery is the most effective intervention currently available for significant and durable weight loss, but weight regain after surgery is not uncommon. This paper focuses on updates in behavioral interventions and pharmacotherapy to combat weight regain after bariatric surgery. AREAS COVERED This paper critically reviews both prospective and retrospective studies assessing pharmacotherapy in post-bariatric surgical patients published within the past 5 years. It also evaluates updates in behavioral therapies and delivery of the therapies in this patient population. EXPERT OPINION Weight regain after bariatric surgery is common. Patients who experience weight regain should be evaluated and treated by a multidisciplinary team. Antiobesity pharmacotherapy should be considered for those who qualify as an adjunct to lifestyle modifications, along with behavioral interventions such as cognitive behavioral therapy.
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Affiliation(s)
- Sarah R Barenbaum
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Alice S Zhao
- Weill Cornell Medical College, New York, NY, USA
| | - Katherine H Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
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Kiernan M, Baiocchi MT. Casting New Light on Statistical Power: An Illuminating Analogy and Strategies to Avoid Underpowered Trials. Am J Epidemiol 2022; 191:1500-1507. [PMID: 35292796 PMCID: PMC9989344 DOI: 10.1093/aje/kwac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2022] [Accepted: 01/28/2022] [Indexed: 01/28/2023] Open
Abstract
Current standards for methodological rigor and trial reporting underscore the critical issue of statistical power. Still, the chance of detecting most effects reported in randomized controlled trials in medicine and other disciplines is currently lower than winning a toss of a fair coin. Here we propose that investigators who retain a practical understanding of how statistical power works can proactively avoid the potentially devastating consequences of underpowered trials. We first offer a vivid, carefully constructed analogy that illuminates the underlying relationships among 3 of the 5 essential parameters-namely, statistical power, effect size, and sample size-while holding the remaining 2 parameters constant (type of statistical test and significance level). Second, we extend the analogy to a set of critical scenarios in which investigators commonly miss detecting intervention effects due to insufficient statistical power. Third, we highlight effective pragmatic strategies for the design and conduct of sufficiently powered trials, without increasing sample size.
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Affiliation(s)
- Michaela Kiernan
- Correspondence to Dr. Michaela Kiernan, Stanford Prevention Research Center, Stanford University School of Medicine, 3180 Porter Drive, MC 5702, Palo Alto, CA 94304-1212 (e-mail: )
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Jake-Schoffman DE, Carrera Seoane M, Cooper K, Rajoria M, McVay MA. Engaging adults with obesity in organic online communities to support weight loss: a mixed methods pilot study. Psychol Health 2022:1-20. [PMID: 35726546 DOI: 10.1080/08870446.2022.2087073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 04/20/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Organic online communities have shown potential for aiding weight loss, but few adults use them. We sought to test strategies to encourage adults to select and engage in online communities for weight loss. DESIGN 4-week single-arm, mixed-methods pilot. MAIN OUTCOME MEASURES Quantitative and qualitative data on selection of online community, engagement with community, and engagement and satisfaction with tasks. RESULTS On average, participants (n = 25) were female (80.0%) and white (68.0%), 45.2 ± 18.1 years old, with a BMI of 36.2 ± 6.5 kg/m2. Selection of online community varied across participants (13 MyFitnessPal, 5 Facebook, 5 Reddit). In qualitative analyses, reasons for selection included experience with community, privacy considerations, and seeking people similar to them. Most tasks were fully or partially completed by a majority of participants (>80.0%). For most tasks, ∼50% of participants felt the task helped them with weight loss support. Variability in response was observed, especially between tasks that requested reading compared to posting/commenting in the community. Frequent reading of community content throughout the study was reported by >70.0% of participants, though posting/commenting was less frequent. Barriers to further engagement included concerns about privacy, judgement, and misinformation. CONCLUSIONS This study provides insights about strategies for engaging individuals in online health communities.
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Affiliation(s)
- Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Montserrat Carrera Seoane
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Kellie Cooper
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Melinda Rajoria
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
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7
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Hayotte M, Gioda J, d'Arripe-Longueville F. Effects and Acceptability of Technology-Based Physical Activity Interventions in Bariatric Surgery: a Scoping Review. Obes Surg 2022; 32:2445-2456. [PMID: 35501637 DOI: 10.1007/s11695-022-06049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
The aim of this scoping review is to highlight current trends in the emerging field of technology-based physical activity interventions (TbPAI) in pre- and post-bariatric surgery. Original articles published between 2000 and 2020 on eHealth, bariatric surgery, and physical activity were identified through electronic searches of eight databases. Screening, data extraction, and charting were performed independently by two authors and disagreements were resolved by consensus. Nine full-text articles were included in this review. The studies reported that the physical activity outcomes had improved and the interventions were positively perceived by the target population. We highlight some consistent findings, as well as knowledge gaps, and suggest how future studies could be improved.
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8
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McVay MA, Cooper KB, Donahue ML, Carrera Seoane M, Shah NR, Webb F, Perri M, Jake‐Schoffman DE. Engaging primary care patients with existing online tools for weight loss: A pilot trial. Obes Sci Pract 2022; 8:569-584. [PMID: 36238223 PMCID: PMC9535672 DOI: 10.1002/osp4.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low‐dose, flexible intervention was developed that aims to enhance weight‐related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher‐created) weight loss‐focused social media community and online self‐monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single‐arm, 12‐week pilot. Methods PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow‐up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post‐appointment, and week 12. Primary care providers and patients completed semi‐structured interviews. Results All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID‐19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre‐appointment kickoff was high. Twenty‐four patients reported discussing weight‐related topics at their primary care appointment and all were satisfied with the discussion. Twenty‐two patients completed 12‐week assessments. Of these, 15 reported engaging with the self‐monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction. Conclusions The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.
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Affiliation(s)
- Megan A. McVay
- Department of Health Education & Behavior University of Florida Gainesville FL
| | - Kellie B Cooper
- Department of Health Education & Behavior University of Florida Gainesville FL
| | | | | | - Nipa R. Shah
- Department of Community Health and Family Medicine University of Florida College of Medicine Jacksonville FL
| | - Fern Webb
- Department of Surgery University of Florida Jacksonville FL
| | - Michael Perri
- College of Public Health and Health Professions University of Florida Gainesville
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Abstract
BACKGROUND Pilot studies test the feasibility of methods and procedures to be used in larger-scale studies. Although numerous articles describe guidelines for the conduct of pilot studies, few have included specific feasibility indicators or strategies for evaluating multiple aspects of feasibility. In addition, using pilot studies to estimate effect sizes to plan sample sizes for subsequent randomized controlled trials has been challenged; however, there has been little consensus on alternative strategies. METHODS In Section 1, specific indicators (recruitment, retention, intervention fidelity, acceptability, adherence, and engagement) are presented for feasibility assessment of data collection methods and intervention implementation. Section 1 also highlights the importance of examining feasibility when adapting an intervention tested in mainstream populations to a new more diverse group. In Section 2, statistical and design issues are presented, including sample sizes for pilot studies, estimates of minimally important differences, design effects, confidence intervals (CI) and nonparametric statistics. An in-depth treatment of the limits of effect size estimation as well as process variables is presented. Tables showing CI around parameters are provided. With small samples, effect size, completion and adherence rate estimates will have large CI. CONCLUSION This commentary offers examples of indicators for evaluating feasibility, and of the limits of effect size estimation in pilot studies. As demonstrated, most pilot studies should not be used to estimate effect sizes, provide power calculations for statistical tests or perform exploratory analyses of efficacy. It is hoped that these guidelines will be useful to those planning pilot/feasibility studies before a larger-scale study.
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Affiliation(s)
- Jeanne A. Teresi
- Columbia University Stroud Center at New York State
Psychiatric Institute, 1051 Riverside Drive, Box 42, Room 2714, New York, New York,
10032-3702, USA
- Research Division, Hebrew Home at Riverdale, 5901 Palisade
Avenue, Riverdale New York 10471
| | - Xiaoying Yu
- Office of Biostatistics, Department of Preventive Medicine
and Population Health, University of Texas Medical Branch at Galveston, 301
University Boulevard, Galveston, Texas, 77555-1147
| | - Anita L. Stewart
- University of California, San Francisco, Institute for
Health & Aging, 490 Illinois St., 12 floor, Box 0646, San
Francisco, CA 94143
| | - Ron D. Hays
- University of California, Los Angeles; Division of General
Internal Medicine and Health Services Research, 1100 Glendon Avenue, Suite 850, Los
Angeles, California 90024
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10
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Murtha JA, Alagoz E, Breuer CR, Finn A, Raffa SD, Voils CI, Funk LM. Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study. Am J Surg 2021; 224:429-436. [PMID: 34963509 DOI: 10.1016/j.amjsurg.2021.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. METHODS Adults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. RESULTS Of the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its "tipping point," concerns about dietary changes, lack of social support, and patient characteristics influencing referral. CONCLUSIONS Patient and provider education should address patient fears of surgery and the belief that surgery is a "last resort." Bariatric surgery programs should strengthen social support networks for patients.
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Affiliation(s)
- Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Alex Finn
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Susan D Raffa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 905 W Main St, Durham, NC, 27701, USA; Veterans Health Administration National Center for Health Promotion and Disease Prevention, 3022 Croasdaile Dr, Durham, NC, 27705, USA
| | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA.
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11
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Weight Loss Outcomes and Lifestyle Patterns Following Sleeve Gastrectomy: an 8-Year Retrospective Study of 212 Patients. Obes Surg 2021; 31:4836-4845. [PMID: 34403078 DOI: 10.1007/s11695-021-05650-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) is an effective treatment for extreme obesity; however, long-term weight loss outcomes remain largely understudied. We aimed to examine the long-term weight changes following SG and patient characteristics and lifestyle patterns related to weight loss outcomes. MATERIALS AND METHODS Data from medical records of patients operated in a tertiary university medical center between 2008 and 2014 were reviewed, along with information derived from a telephone questionnaire. Information included the following: current medical status, medications, side effects, behavior, lifestyle habits, and weight changes. RESULTS A total of 212 patients (69.3% females) were included, with a median follow-up duration of 8 years post-SG. Mean age and baseline body mass index (BMI) of participants were 39.7 ± 12.0 years and 42.2 ± 4.9 kg/m2, respectively. Mean BMI, percentage excess weight loss, and percentage total body weight loss were 33.1 ± 6.1, 55.5 ± 27.5%, and 21.7 ± 10.7%, respectively. Higher baseline BMI was found to be the strongest independent predictor for insufficient weight loss (OR = 0.90, P = 0.001, 95% CI 0.85, 0.96). Sweetened beverage intake, usage of psychiatric medications, higher initial BMI, and lower age were significant predictors for increased weight gain from nadir weight (P < 0.0001, P = 0.005, P = 0.035, and P < 0.0001, respectively). CONCLUSIONS SG patients were found to maintain a notable long-term weight loss. Nevertheless, weight regain and insufficient weight loss were prevalent in the long-term post-operative period, and were related to certain lifestyle patterns. Clinical practice should emphasize the relationship between post-operative weight loss outcomes and specific behaviors. Efforts should be made to educate patients on the need for lifelong follow-up and support.
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12
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Funk LM, Breuer CR, Venkatesh M, Muraveva A, Alagoz E, Hanlon BM, Raffa SD, Voils CI. Protocol and short-term results for a feasibility randomized controlled trial of a video intervention for Veterans with obesity: The TOTAL (Teaching Obesity Treatment Options to Adult Learners) pilot study. Contemp Clin Trials Commun 2021; 23:100816. [PMID: 34258469 PMCID: PMC8256180 DOI: 10.1016/j.conctc.2021.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/18/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction All three evidence-based treatment options for adults with severe obesity – behavioral weight management, weight management medications (WMM), and bariatric surgery – are underutilized in the Veterans Health Administration (VHA) system. Our objective in this study was to develop and pilot-test the TOTAL (Teaching Obesity Treatment Options to Adult Learners) intervention, which seeks to increase Veteran participation in obesity treatment. Methods In this single-site, parallel, pilot RCT, Veterans with severe obesity with an upcoming behavioral weight management visit were sent a recruitment letter after meeting inclusion/exclusion criteria via electronic health record screening. Eligible Veterans were randomized to TOTAL or usual care. TOTAL consisted of an 18-min video highlighting obesity health risks and treatment outcomes, eligibility criteria, and pros/cons of all three evidence-based obesity treatments. The primary outcomes were trial design feasibility (recruitment and retention rates) and acceptability to Veterans, which was assessed via semi-structured interviews with participants one week after randomization to TOTAL. Secondary outcomes included attitudes and self-efficacy to initiate treatment one week post-randomization and BMI change six months post-randomization (assessed via Cohen's d). Results Forty-two Veterans were randomized (recruitment rate = 47.2%), and 40/42 completed one-week assessments (retention rate = 95.2%). The mean participant age was 59.2 ± 11.9 years. Female and non-White participants comprised 14.3% and 11.9% of the cohort, respectively. Semi-structured interviews with all 20 participants who received TOTAL suggested that the delivery logistics and content of TOTAL were acceptable to Veterans. Attitudes toward behavioral weight management and bariatric surgery and weight loss improved in TOTAL vs. usual care patients (Cohen's d ranging from 0.3 to 0.6). Conclusions TOTAL was feasible to implement, acceptable to Veterans, and has the potential to increase obesity treatment participation in VHA. An adequately powered RCT is warranted to assess its impact on population-level weight loss. Trial registration ClinicalTrials.gov NCT03856320.
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Affiliation(s)
- Luke M Funk
- Department of Surgery, William S. Middleton VA, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Manasa Venkatesh
- Department of Surgery, William S. Middleton VA, Madison, WI, USA
| | - Anna Muraveva
- Department of Surgery, William S. Middleton VA, Madison, WI, USA
| | - Esra Alagoz
- Department of Surgery, William S. Middleton VA, Madison, WI, USA
| | - Bret M Hanlon
- Department of Surgery, William S. Middleton VA, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Susan D Raffa
- Department of Veterans Affairs, National Center for Health Promotion and Disease Prevention, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Corrine I Voils
- Department of Surgery, William S. Middleton VA, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
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13
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Athanasiadis DI, Hernandez E, Hilgendorf W, Roper A, Embry M, Selzer D, Stefanidis D. How are bariatric patients coping during the coronavirus disease 2019 (COVID-19) pandemic? Analysis of factors known to cause weight regain among postoperative bariatric patients. Surg Obes Relat Dis 2020; 17:756-764. [PMID: 33390351 PMCID: PMC7699156 DOI: 10.1016/j.soard.2020.11.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/28/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
Background The global coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on society. Bariatric patients are more prone to severe infection due to their high body mass index (BMI) and are more vulnerable to the effects of isolation, such as depression or disruption of their health habits. Objectives To quantify the impact of self-quarantine on bariatric patients and self-quarantine’s relationship with weight gain. Setting Academic hospital, United States. Methods A 30-item survey examining several known contributors to weight regain was distributed among the postoperative bariatric patients of our clinic. Changes in eating habits, exercise, depression, social support, loneliness, and anxiety were studied, among others. Results A total of 208 patients completed the survey (29.3% response rate). A large percentage of patients reported increases in their depression (44.2%), loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when eating (48.2%), and binge eating (19.5%) and decreases in their social support (23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in accessing vitamins was reported by 13%. Patients more than 18 months out of surgery regained more than 2 kg during an average of 47 days. Risk factors for weight regain were found to be loss of control when eating, increases in snacking and binge eating, reduced consumption of healthy food, and reduced physical activity. Conclusion Bariatric patients are negatively affected by the COVID-19 pandemic and subsequent social isolation on many levels. This patient population is vulnerable to crisis situations; thus, additional intervention is needed to address behaviors that lead to weight regain.
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Affiliation(s)
| | - Edward Hernandez
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - William Hilgendorf
- Department of Surgery, Indiana University Health North Hospital, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexandra Roper
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Marisa Embry
- Department of Surgery, Indiana University Health North Hospital, Indianapolis, Indiana
| | - Don Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, Indiana University Health North Hospital, Indianapolis, Indiana
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery, Indiana University Health North Hospital, Indianapolis, Indiana.
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Cuthbert K, Hardin S, Zelkowitz R, Mitchell K. Eating Disorders and Overweight/Obesity in Veterans: Prevalence, Risk Factors, and Treatment Considerations. Curr Obes Rep 2020; 9:98-108. [PMID: 32361915 DOI: 10.1007/s13679-020-00374-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Eating disorders (EDs) and overweight/obesity (OW/OB) have a significant impact on veterans. This review highlights current research on EDs and OW/OB in this population. RECENT FINDINGS Prevalence estimates for both EDs and OW/OB among veterans remain consistent with and possibly higher than those in the general population. Both diagnoses share multiple risk factors, including trauma history, and mental health comorbidities. Although weight loss treatments have been fairly well studied among veteran samples, there are no published investigations on psychotherapies for EDs in this population. The Veterans Healthcare Administration is working to train providers in ED treatments. VHA treatments for OW/OB show some benefits and areas for improvement. Areas for future research include structured assessments for EDs and disordered eating behaviors in veterans to clarify prevalence estimates. There is a need for interventions that consider common mechanisms for ED and OW/OB, and there is a need for more research on the associations between different types of trauma and ED/OW/OB in veterans.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Sabrina Hardin
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Rachel Zelkowitz
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Karen Mitchell
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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15
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Yeo C, Ahmed S, Oo AM, Koura A, Sanghvi K, Yeo D. COVID-19 and Obesity-the Management of Pre- and Post-bariatric Patients Amidst the COVID-19 Pandemic. Obes Surg 2020; 30:3607-3609. [PMID: 32385668 PMCID: PMC7210102 DOI: 10.1007/s11695-020-04670-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Charleen Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Saleem Ahmed
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aung Myint Oo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aaryan Koura
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kaushal Sanghvi
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Danson Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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