1
|
Mendes C, Carvalho M, Martins C, Rodrigues LM, Gregório J. Design and Development of a Nurse-Led Program for the Management of Bariatric Surgery Patients-The NURLIFE Program. Prof Case Manag 2024; 29:229-234. [PMID: 39058569 DOI: 10.1097/ncm.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Cláudia Mendes
- Cláudia Mendes, MSc , Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal. She is affiliated with Centro Responsabilidade Integrada de Cirurgia da Obesidade eMetabólica, Évora, Portugal, CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal, d Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain and CHRC-Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
- Manuel Carvalho, MD , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal and CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- Catarina Martins, RN , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal
- Luis Monteiro Rodrigues, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
- João Gregório, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
| | - Manuel Carvalho
- Cláudia Mendes, MSc , Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal. She is affiliated with Centro Responsabilidade Integrada de Cirurgia da Obesidade eMetabólica, Évora, Portugal, CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal, d Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain and CHRC-Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
- Manuel Carvalho, MD , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal and CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- Catarina Martins, RN , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal
- Luis Monteiro Rodrigues, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
- João Gregório, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
| | - Catarina Martins
- Cláudia Mendes, MSc , Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal. She is affiliated with Centro Responsabilidade Integrada de Cirurgia da Obesidade eMetabólica, Évora, Portugal, CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal, d Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain and CHRC-Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
- Manuel Carvalho, MD , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal and CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- Catarina Martins, RN , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal
- Luis Monteiro Rodrigues, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
- João Gregório, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- Cláudia Mendes, MSc , Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal. She is affiliated with Centro Responsabilidade Integrada de Cirurgia da Obesidade eMetabólica, Évora, Portugal, CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal, d Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain and CHRC-Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
- Manuel Carvalho, MD , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal and CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- Catarina Martins, RN , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal
- Luis Monteiro Rodrigues, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
- João Gregório, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
| | - João Gregório
- Cláudia Mendes, MSc , Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal. She is affiliated with Centro Responsabilidade Integrada de Cirurgia da Obesidade eMetabólica, Évora, Portugal, CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies Lisbon, Portugal, d Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain and CHRC-Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
- Manuel Carvalho, MD , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal and CRI.COM - Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- Catarina Martins, RN , is affiliated with Hospital Espírito Santo de Évora - Unidade Local de Saúde do Alentejo Central, Évora, Portugal
- Luis Monteiro Rodrigues, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
- João Gregório, PhD , is affiliated with CBIOS - Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lisbon, Portugal
| |
Collapse
|
2
|
Wnuk S, Azim B, Guimond TH, Gougeon L, Sockalingam S. Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery. Obes Surg 2024; 34:2438-2445. [PMID: 38664283 DOI: 10.1007/s11695-024-07246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.
Collapse
Affiliation(s)
- Susan Wnuk
- Department of Psychiatry, University of Toronto, 250 College Street, Room 814B, Toronto, ON, M5T 1R8, Canada.
- Bariatric Surgery Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Main Pavilion 4th Floor, Room 325, Toronto, M5T 2S8, Canada.
| | - Batool Azim
- Bariatric Surgery Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Main Pavilion 4th Floor, Room 325, Toronto, M5T 2S8, Canada
| | - Tim H Guimond
- Department of Psychiatry, University of Toronto, 250 College Street, Room 814B, Toronto, ON, M5T 1R8, Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Lorraine Gougeon
- Department of Psychiatry, University of Toronto, 250 College Street, Room 814B, Toronto, ON, M5T 1R8, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, 250 College Street, Room 814B, Toronto, ON, M5T 1R8, Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
- Centre for Mental Health, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
- Bariatric Surgery Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Main Pavilion 4th Floor, Room 325, Toronto, M5T 2S8, Canada
| |
Collapse
|
3
|
Bi Y, He L, Yan F, Liu Y, Zhang Y, Gong R. Personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery: a systematic synthesis of mixed methods research. Acta Diabetol 2024:10.1007/s00592-024-02319-9. [PMID: 38888635 DOI: 10.1007/s00592-024-02319-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
AIMS To offer a holistic view of the personal, external, and psychological factors influencing adherence to nutrition and diet in patients undergoing metabolic/bariatric surgery. METHODS This systematic synthesis of mixed methods research involved a comprehensive search for articles in English databases, including PubMed, Cochrane Library, Web of Science, EBSCO, Scopus, and Embase, as well as Chinese databases. The search encompassed articles published from the inception of the database up to June 2023. Following the evaluation of literature quality and extraction of relevant information from the selected studies, data from both quantitative and qualitative studies were integrated. The extracted data were analyzed separately, and themes were identified and summarized to elucidate the factors influencing adherence to nutritional and dietary guidelines. The methodology adhered to the guidelines recommended by the Joanna Briggs Institute (JBI) for mixed methods systematic evaluations. RESULTS Three themes and their corresponding descriptive elements were identified, including: (1) Personal factors: subjective factors (attitude, capability, awareness, behaviors), objective factors (age, sex, work status, economic level, physical activity, dietary habits, weight change); (2) External factors: medication (quantity of pills, complexity of intake times, side effects, unpleasant smell or taste), surgery factor, social influences (family members, dietitians, and peers); (3) Psychological factors: self-efficacy, attachment anxiety, and mental health problems. CONCLUSIONS The synthesis provided a comprehensive overview of the factors influencing postoperative compliance of nutrition and diet among patients undergoing metabolic and bariatric surgery. It emphasizes the necessity for clinical staff to tailor interventions based on these diverse factors, as well as to attach importance to patients' mental health, giving multidimensional dietary guidance and health care.
Collapse
Affiliation(s)
- Yaxin Bi
- Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Lijun He
- Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Fang Yan
- Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Yi Liu
- Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Yu Zhang
- School of Nursing, Yangzhou University, Yangzhou, People's Republic of China
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Jiangsu Key Laboratory of Zoonosis, Yangzhou University, Yangzhou, People's Republic of China
| | - Ronghua Gong
- Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China.
| |
Collapse
|
4
|
Punt SE, Caicedo MR, Rhodes AC, Ilardi SS, Hamilton JL. A semi-structured interview is associated with bariatric surgery outcomes. J Behav Med 2024; 47:483-491. [PMID: 38393445 DOI: 10.1007/s10865-024-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
Collapse
Affiliation(s)
- Stephanie E Punt
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Mariana Rincon Caicedo
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Ashley C Rhodes
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd, Lawrence, KS, 66045, USA
| | - Jessica L Hamilton
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| |
Collapse
|
5
|
Jacobs A, Monpellier VM, Torensma B, Antoniou EE, Janssen IMC, Tollenaar RAEM, Jansen ATM. Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024; 25:e13729. [PMID: 38450930 DOI: 10.1111/obr.13729] [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: 12/02/2022] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss. METHOD Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately. RESULTS In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. CONCLUSION Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
Collapse
Affiliation(s)
- Anne Jacobs
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Machado Carvalhais R, Siochi C, Harutyunyan G, Segura Torres D, Shahmoradi V, Sobieraj P, Canuto Miller A, Jesmajian S. Differences in the Impact of Obesity and Bariatric Surgery on Patients Hospitalized for Atrial Flutter and Atrial Fibrillation: A Nationwide Analysis, 2016-2020. Cureus 2024; 16:e62284. [PMID: 39006678 PMCID: PMC11245680 DOI: 10.7759/cureus.62284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The "obesity paradox" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA). RESULTS Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population. CONCLUSION Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.
Collapse
Affiliation(s)
- Ricardo Machado Carvalhais
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Christian Siochi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Gohar Harutyunyan
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Danny Segura Torres
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Vahe Shahmoradi
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Peter Sobieraj
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Aressa Canuto Miller
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Stephen Jesmajian
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| |
Collapse
|
7
|
Chan JKY, Vartanian LR. Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review. Obes Sci Pract 2024; 10:e741. [PMID: 38404933 PMCID: PMC10893879 DOI: 10.1002/osp4.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.
Collapse
Affiliation(s)
- Jade K. Y. Chan
- School of PsychologyUNSW SydneySydneyNew South WalesAustralia
| | | |
Collapse
|
8
|
Aderinto N, Olatunji G, Kokori E, Olaniyi P, Isarinade T, Yusuf IA. Recent advances in bariatric surgery: a narrative review of weight loss procedures. Ann Med Surg (Lond) 2023; 85:6091-6104. [PMID: 38098582 PMCID: PMC10718334 DOI: 10.1097/ms9.0000000000001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.
Collapse
Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
| | | | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | - Peter Olaniyi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
| | | | | |
Collapse
|
9
|
Mendes C, Carvalho M, Oliveira L, Rodrigues LM, Gregório J. Nurse-led intervention for the management of bariatric surgery patients: A systematic review. Obes Rev 2023; 24:e13614. [PMID: 37607837 DOI: 10.1111/obr.13614] [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: 11/02/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/24/2023]
Abstract
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.
Collapse
Affiliation(s)
- Cláudia Mendes
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
- Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - Leandro Oliveira
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - João Gregório
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| |
Collapse
|
10
|
Ji M, Negriff SL, Slezak JM, Taylor BL, Paz SR, Bhakta BB, Macias M, Arterburn DE, Crawford CL, Drewnowski A, Lewis KH, Moore DD, Murali SB, Young DR, Coleman KJ. Baseline Psychosocial, Environmental, Health, and Behavioral Correlates of 1- and 3-Year Weight Loss After Bariatric Surgery. Obes Surg 2023; 33:3198-3205. [PMID: 37612577 PMCID: PMC10765815 DOI: 10.1007/s11695-023-06791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Weight loss surgery is an effective, long-term treatment for severe obesity but individual response to surgery varies widely. The purpose of this study was to test a comprehensive theoretical model of factors that may be correlated with the greatest surgical weight loss at 1-3 years following surgery. Such a model would help determine what predictive factors to measure when patients are preparing for surgery that may ensure the best weight outcomes. MATERIALS AND METHODS The Bariatric Experience Long Term (BELONG) study collected self-reported and medical record-based baseline information as correlates of 1- and 3-year % total weight loss (TWL) in n = 1341 patients. Multiple linear regression was used to determine the associations between 120 baseline variables and %TWL. RESULTS Participants were 43.4 ± 11.3 years old, Hispanic or Black (52%; n = 699), women (86%; n = 1149), and partnered (72%; n = 965) and had annual incomes of ≥ $51,000 (60%; n = 803). A total of 1006 (75%) had 3-year follow-up weight. Regression models accounted for 10.1% of the variance in %TWL at 1-year and 13.6% at 3 years. Only bariatric operation accounted for a clinically meaningful difference (~ 5%) in %TWL at 1-year. At 3 years after surgery, only bariatric operation, Black race, and BMI ≥ 50 kg/m2 were associated with clinically meaningful differences in %TWL. CONCLUSIONS Our findings combined with many others support a move away from extensive screening and selection of patients at the time of surgery to a focus on improving access to this treatment.
Collapse
Affiliation(s)
- Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Sonya L Negriff
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Jeff M Slezak
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Brianna L Taylor
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Silvia R Paz
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Bhumi B Bhakta
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Mayra Macias
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cecelia L Crawford
- Kaiser Permanente Southern California Regional Nursing Research Program, Pasadena, CA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, IL, USA
| | - Sameer B Murali
- Department of Surgery, Center for Obesity Medicine & Metabolic Performance, University of Texas McGovern Medical School, Houston, TX, USA
| | - Deborah R Young
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, 100 S. Los Robles, Pasadena, CA, 91101, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| |
Collapse
|
11
|
Noom M, Remmel S, Sandstrom R, Padilla G, Mhaskar R, Diab ARF, Sujka JA, Docimo S, DuCoin CG. Mental health status as a predictor of emergency department visits and hospital readmissions post bariatric surgery: a retrospective cohort study. Surg Endosc 2023; 37:8091-8098. [PMID: 37679583 DOI: 10.1007/s00464-023-10369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This retrospective cohort study aims to investigate emergency department (ED) visits and readmission after bariatric surgery among patients with a history of anxiety and/or depression. We predict that patients with a reported history of anxiety and/or depression will have more ED visits in the year following surgery than patients without a history of mental illness. METHODS Data were collected from the charts of all consecutive patients who underwent sleeve gastrectomy or gastric bypass surgery between March 2012 and December 2019. Data on baseline body mass index, mental health diagnosis and treatment and emergency department visits and hospital readmissions were retrospectively reviewed over the first year following surgery. RESULTS One thousand two hundred ninety-seven patients were originally included in this study and 1113 patients were included in the final analysis. Patients with a history of depression (OR 1.23; 95% CI 0.87-1.73), anxiety (OR 1.14; 95% CI 0.81-1.60), or both (OR 1.17; 95% CI 0.83-1.65) did not have a statistically significant increase in ED visits compared to patients without these disorders. Patients with a history of depression (OR 1.49; 95% CI 0.86-2.61), anxiety (OR 1.45; 95% CI 0.80-2.65) or both (OR 1.47; 95% CI 0.94-2.29) did not have a statistically significant increase in hospital readmissions in the first year after surgery compared to patients without these disorders. Patients treated with a sleeve gastrectomy were readmitted due to postoperative complications less frequently than those treated with other surgeries (OR 0.20; 95% CI 0.05-0.83). CONCLUSION Patients with a history of anxiety, depression or both did not have an increased rate of emergency department visits and hospital readmissions within the first year following bariatric surgery. This contradicts current literature and may be due to the multidisciplinary program patients undergo at this study's home institution.
Collapse
Affiliation(s)
- Madison Noom
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Shelby Remmel
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Reagan Sandstrom
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - George Padilla
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Abdul-Rahman Fadi Diab
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Joseph Adam Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Christopher Garnet DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA.
| |
Collapse
|
12
|
Henao Carrillo DC, Gómez AM, Muñoz OM, Rubio C, Rodríguez N, Ursida V, Forero AM, Pinzón F, Mikler R. Factors associated with different patterns of weight change after bariatric surgery: A longitudinal study. Obes Sci Pract 2023; 9:477-483. [PMID: 37810525 PMCID: PMC10551117 DOI: 10.1002/osp4.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/03/2023] [Accepted: 04/16/2023] [Indexed: 10/10/2023] Open
Abstract
Background The mean weight loss (WL) after successful bariatric surgery is approximately one third of the initial body weight, which is mainly achieved between the first 2 years of follow-up. However, 15%-35% of patients do not achieve a significant percentage of total WL (%TWL). Information on factors associated with a higher or lower WL after bariatric surgery is limited. This study aimed to assess the change in %TWL and describe the factors associated with greater or lesser WL over time. Methods This prospective longitudinal study included patients treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Baseline data were recorded before surgery. Follow-up was performed at 3 (n = 141), 6 (n = 208), 9 (n = 115), 12 (n = 216), 24 (n = 166), and 36 months (n = 99). Generalized estimating equation analysis was performed to assess the changes in %TWL over time and factors associated with different patterns of WL. Results In total, 231 patients were included (women, 82.2%; basal body mass index (BMI) 41.4 ± 5.1 kg/m2). The tendencies to increase %TWL (32 ± 6.5) were evident in the first year and stabilized thereafter. Sustained nutritionist follow-up (2.3%, p = 0.004), baseline BMI >40 kg/m2 (0.4%, p < 0.001), and WL ≥ 10 kg before surgery (0.3%, p = 0.001) were associated with a higher %TWL. Patients who performed physical activity >30 min/day after surgery reduced their %TWL by 0.6% (p = 0.002). Conclusions Modifiable factors such as nutritional monitoring and WL before surgery are associated with a significant increase in %TWL over time. Basal BMI was associated with a significant decrease in %TWL.
Collapse
Affiliation(s)
| | - Ana María Gómez
- Pontificia Universidad JaverianaBogotáColombia
- Endocrinology UnitHospital Universitario San IgnacioBogotáColombia
| | - Oscar M. Muñoz
- Pontificia Universidad JaverianaBogotáColombia
- Internal Medicine DepartmentHospital Universitario San IgnacioBogotáColombia
| | - Claudia Rubio
- Endocrinology UnitHospital Universitario San IgnacioBogotáColombia
- Surgery DepartmentHospital Universitario San IgnacioBogotáColombia
| | | | | | | | - Fabio Pinzón
- Nutrition DepartmentHospital Universitario San IgnacioBogotáColombia
| | - Rami Mikler
- Nutrition DepartmentHospital Universitario San IgnacioBogotáColombia
| |
Collapse
|
13
|
Hany M, Hafez Mohammad MK, Abd Elhafeez NA, Shafiq Agayby AS, Torensma B. A cross-sectional survey of patients attending follow-up visits after sleeve gastrectomy: Factors affecting weight loss. OBESITY PILLARS (ONLINE) 2022; 3:100029. [PMID: 37990722 PMCID: PMC10662034 DOI: 10.1016/j.obpill.2022.100029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2023]
Abstract
Background Bariatric surgery offers long-term weight loss and maintenance for patients with obesity. Several factors may be associated with patients' inability to achieve successful excess weight loss (EWL) after the surgery. The purpose of this study was to identify factors associated with improved or in-progress EWL among patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods This original clinical investigation was conducted at the Outpatient Surgical Department-Medical Research Institute Hospital at Alexandria University in Egypt. A sample size of 100 adult surgical patients who had undergone LSG was selected from patients who attended follow-up in the study setting. Group A had an EWL% ≥50 and group B had an EWL <50. Body Mass Index (BMI) classes were defined as 25-30 kg/m2, >30-35 kg/m2, >35-40 kg/m2, >40 ≥ 45 kg/m2. Results Post-operatively, after six months, 100% of the patients in group A had a BMI between 25 and 30 mg/m2, compared to 0% in group B. Nevertheless, patients in group EWL<50 (group B) who had pre-operatively BMI class ≥45 mg/m2, had a reduction in weight of 89.5% post-operatively, (n = 2 still had a BMI >45 kg/m2 post operatively), In total, 63.9% of the patients in group B managed to get towards a BMI of 30-35 kg/m2 post-operatively. The main factors associated with group B (less %EWL after 6 months) were found to be related to higher preoperative BMI, the onset of obesity started in childhood, less preoperative weight loss, longer postoperative duration towards weight reduction, and lower postoperative compliance to dietary instructions (P = 0.0001, 0.048, 0.0001, 0.017, and 0.016, respectively). Conclusion Routine cross-sectional surveying can help clinicians in understanding patients' post-operative follow-up routines. Special attention to pre-operative BMI, weight-loss regimens, and childhood-onset as well as post-operative duration, low responders, and compliance with clinical assessment can improve weight loss outcomes.
Collapse
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | | | | | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, the Netherlands
| |
Collapse
|
14
|
Perna S, Salman M, Gasparri C, Cavioni A, Faliva MA, Mansueto F, Naso M, Patelli Z, Peroni G, Tartara A, Riva A, Petrangolini G, Rondanelli M. Two, Six, and Twelve-Month Dropout Rate and Predictor Factors After a Multidisciplinary Residential Program for Obesity Treatment. A Prospective Cohort Study. Front Nutr 2022; 9:851802. [PMID: 35711533 PMCID: PMC9197160 DOI: 10.3389/fnut.2022.851802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction The aim of the present study was to assess the dropout rate at 2, 6, and 12 months after an inpatient multidisciplinary residential program (MRP) for the treatment of obesity. Furthermore, this study assessed anthropometric and biochemical predictors associated with the dropout. Methods Adult and elderly patients (age 59 ± 14 years) with obesity had undergone an MRP, were followed up from 2 to 12 months. Biochemical and anthropometric markers have been assessed at the beginning of the follow-up period after the MRP. Results The study enrolled 178 subjects, 117 women and 61 men. The overall dropout rate at 2 months was 21.3%, after 6 months was 44.4%, and after 1 year was 68.5%. There was no difference by gender recorded. Furthermore, patients under medical treatment with psychiatric disorders did not show an association with the dropout rate. Patients with a higher level of body mass index (BMI) at the discharge of MRP showed +48% of dropout at 6 months. After the MRP, the baseline values of uricemia and white blood cells (WBCs) resulted as predictors of dropout at 2 months (p > 0.05). Furthermore, the excess percentage of fat mass lost during the MRP was associated with the risk of dropout at 2, 6, and 12 months (p > 0.05). Conclusion The MRP for obesity is an opportunity for losing weight for patients with established criteria. The future challenge will be addressing the best strategic plans in order to reduce the dropout rate after this intervention. Investigating deeply the main predictors could be an opportunity to improve the long-term efficacy of MRP.
Collapse
Affiliation(s)
- Simone Perna
- Department of Biology, College of Science, University of Bahrain, Sakhir, Bahrain
| | - Majeda Salman
- Department of Mathematics, College of Science, University of Bahrain, Sakhir, Bahrain
| | - Clara Gasparri
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Alessandro Cavioni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Milena Anna Faliva
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Francesca Mansueto
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Maurizio Naso
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Zaira Patelli
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | - Alice Tartara
- Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona 'Istituto Santa Margherita', University of Pavia, Pavia, Italy
| | | | | | - Mariangela Rondanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
15
|
Coleman KJ, Paz SR, Bhakta BB, Taylor B, Liu J, Yoon TK, Macias M, Arterburn DE, Crawford CL, Drewnowksi A, Figueroa Gray MS, Hansell LD, Ji M, Lewis KH, Moore DD, Murali SB, Young DR. Cohort profile: The Bariatric Experience Long Term (BELONG): a long-term prospective study to understand the psychosocial, environmental, health and behavioural predictors of weight loss and regain in patients who have bariatric surgery. BMJ Open 2022; 12:e059611. [PMID: 35613770 PMCID: PMC9125764 DOI: 10.1136/bmjopen-2021-059611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Bariatric Experience Long Term (BELONG) prospective study cohort was created to address limitations in the literature regarding the relationship between surgical weight loss and psychosocial, health, behaviour and environmental factors. The BELONG cohort is unique because it contains 70% gastric sleeve and 64% patients with non-white race/ethnicity and was developed with strong stakeholder engagement including patients and providers. PARTICIPANTS The BELONG cohort study included 1975 patients preparing to have bariatric surgery who completed a baseline survey in a large integrated health system in Southern California. Patients were primarily women (84%), either black or Hispanic (59%), with a body mass index (BMI) of 45.1±7.4 kg/m2, age 43.3±11.5 years old, and 32% had at least one comorbidity. FINDINGS TO DATE A total of 5552 patients were approached before surgery between February 2016 and May 2017, and 1975 (42%) completed a baseline survey. A total of 1203 (73%) patients completed the year 1 and 1033 (74%) patients completed the year 3 postoperative survey. Of these survey respondents, 1341 at baseline, 999 at year 1, and 951 at year 3 were included in the analyses of all survey and weight outcome data. A total of 803 (60% of eligible patients) had survey data for all time points. Data collected were self-reported constructs to support the proposed theoretical model. Height, weight and BMI were abstracted from the electronic medical record to obtain the main outcomes of the study: weight loss and regain. FUTURE PLANS We will collect self-reported constructs and obtain height, weight and BMI from the electronic medical record 5 years after bariatric surgery between April 2022 and January 2023. We will also collect patient experiences using focus groups of 8-12 patients each throughout 2022.
Collapse
Affiliation(s)
- Karen J Coleman
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Silvia R Paz
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bhumi B Bhakta
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brianna Taylor
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jialuo Liu
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Tae K Yoon
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Mayra Macias
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Adam Drewnowksi
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | | | - Laurel D Hansell
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Kristina H Lewis
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Darren D Moore
- Marriage and Family Therapy Program, The Family Institute, Northwestern University, Evanston, Illinois, USA
| | - Sameer B Murali
- Center for Obesity Medicine & Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Deborah R Young
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| |
Collapse
|
16
|
Hany M, Elfiky S, Mansour N, Zidan A, Ibrahim M, Samir M, Allam HE, Yassin HAA, Torensma B. Dialectical Behavior Therapy for Emotional and Mindless Eating After Bariatric Surgery: a Prospective Exploratory Cohort Study. Obes Surg 2022; 32:1570-1577. [PMID: 35212910 DOI: 10.1007/s11695-022-05983-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effect of dialectical behavior therapy (DBT) on emotional and mindless eating and, consequently, body mass index (BMI) loss, in patients who have undergone bariatric surgery. MATERIALS AND METHODS A prospective exploratory cohort study was conducted with two groups of patients who had undergone bariatric surgery: the DBT group received DBT group skills training sessions, while the control group received no intervention. Outcome measurements included BMI and scores of the Emotional Eating Scale (EES) and Mindful Eating Questionnaire (MEQ). RESULTS The study included 36 women: 18 in each group. In the DBT group, the interval from surgery was 11.17 ± 7.12 months, and in the control group 10.89 ± 5.74. Laparoscopic sleeve gastrectomy was done in 88.9% and 83.3% of patients in the DBT and control groups respectively. The rest underwent Roux-en-Y gastric bypass. The DBT group showed significant changes in overall and subscale scores of the EES and MEQ and BMI in kg/m2 after 6 months of follow-up. BMI in kg/m2 changed from mean ± SD 35.45 ± 6.17 to 28.47 ± 4.28 in the DBT group, in control 35.88 ± 5.07 to 31.56 ± 3.71. The excess weight loss percentage (EWL%) in the DBT was mean ± SD 75.3 ± 17.9 and in the control was 63.6 ± 14.5. In the DBT group, the EES score and MEQ score changed from mean ± SD 45.06 ± 20.19 to 20.50 ± 13.40 and 11.52 ± 2.02 to 15.87 ± 1.92, respectively. The control group showed no significant change in scores. CONCLUSIONS DBT skills training can reduce emotional eating, increase mindful eating, and facilitate weight loss after bariatric surgery.
Collapse
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
| | - Samira Elfiky
- Psychiatry and Psychotherapy Clinic, Madina Women's Hospital, 290 St., Building Number 25 Smouha, Bariatric CentreAlexandria, Egypt
| | - Nesma Mansour
- Psychiatry and Psychotherapy Clinic, Madina Women's Hospital, 290 St., Building Number 25 Smouha, Bariatric CentreAlexandria, Egypt
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Mohamed Samir
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | | | | | - Bart Torensma
- Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| |
Collapse
|
17
|
Punt SE, Rhodes AC, Ilardi SS, Hamilton JL. Use of the Stanford Integrative Psychosocial Assessment for Transplant as a Pre-surgical Psychological Evaluation Tool for Bariatric Surgery. J Clin Psychol Med Settings 2022; 29:808-817. [DOI: 10.1007/s10880-022-09850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
|
18
|
Wiechert M, Holzapfel C. Nutrition Concepts for the Treatment of Obesity in Adults. Nutrients 2021; 14:169. [PMID: 35011045 PMCID: PMC8747374 DOI: 10.3390/nu14010169] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity caused by a positive energy balance is a serious health burden. Studies have shown that obesity is the major risk factor for many diseases like type 2 diabetes mellitus, coronary heart diseases, or various types of cancer. Therefore, the prevention and treatment of increased body weight are key. Different evidence-based treatment approaches considering weight history, body mass index (BMI) category, and co-morbidities are available: lifestyle intervention, formula diet, drugs, and bariatric surgery. For all treatment approaches, behaviour change techniques, reduction in energy intake, and increasing energy expenditure are required. Self-monitoring of diet and physical activity provides an effective behaviour change technique for weight management. Digital tools increase engagement rates for self-monitoring and have the potential to improve weight management. The objective of this narrative review is to summarize current available treatment approaches for obesity, to provide a selective overview of nutrition trends, and to give a scientific viewpoint for various nutrition concepts for weight loss.
Collapse
Affiliation(s)
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, 80992 Munich, Germany;
| |
Collapse
|
19
|
Yu Y, Ma Q, Johnson JA, O'Malley WE, Sabbota A, Groth SW. Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Surg Obes Relat Dis 2021; 18:384-393. [PMID: 34974998 DOI: 10.1016/j.soard.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.
Collapse
Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- School of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Joseph A Johnson
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - William E O'Malley
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Aaron Sabbota
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
| |
Collapse
|
20
|
Wright C, Mutsekwa RN, Hamilton K, Campbell KL, Kelly J. Are eHealth interventions for adults who are scheduled for or have undergone bariatric surgery as effective as usual care? A systematic review. Surg Obes Relat Dis 2021; 17:2065-2080. [PMID: 34474983 DOI: 10.1016/j.soard.2021.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022]
Abstract
This systematic review aimed to evaluate the effect of eHealth-delivered interventions for adults who undergo bariatric surgery on postoperative weight loss, weight loss maintenance, eating psychopathology, quality of life, depression screening, and self-efficacy. Six electronic databases were searched, with 14 studies (across 17 reports) included, involving 1633 participants. With substantial heterogeneity, qualitative descriptions have been provided. Interventions were delivered via an online program or internet modules (n = 2), telephone (n = 2), text messages (n = 2), videoconferencing (n = 3), mobile application (n = 1), and audiovisual media (n = 1). Three studies included a combination, including internet modules and telephone (n = 1), wireless fidelity scales, emails, and telephone (n = 1), and a combination of online treatment, weekly emails, and access to a private Facebook group (n = 1). All the eHealth interventions, except for one, implemented behavior change techniques, including self-monitoring, problem solving, social support, goal setting, and shaping knowledge. Both eHealth intervention and control groups lost weight across the included studies, and eHealth was found to be as effective as or more effective than the control for weight loss. Two studies measured weight loss maintenance; both eHealth and control groups regained weight in the longer term. The interventions showed significant improvement on assessment measures for eating psychopathology. In conclusion, when bariatric surgery patients have limited or no access to healthcare teams or require additional support, eHealth may be a suitable option. Future studies implementing eHealth interventions would benefit from reporting intervention components as per the behavior change techniques taxonomy and further consideration of delivering eHealth in a stepped care approach would be beneficial.
Collapse
Affiliation(s)
- Charlene Wright
- School of Medicine and Dentistry, Centre of Applied Health Economics and Menzies Health Institute Queensland, Griffith University, Southport, Australia.
| | - Rumbidzai N Mutsekwa
- School of Medicine and Dentistry, Centre of Applied Health Economics and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Queensland, Australia; School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Katrina L Campbell
- School of Medicine and Dentistry, Centre of Applied Health Economics and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Queensland, Australia
| | - Jaimon Kelly
- School of Medicine and Dentistry, Centre of Applied Health Economics and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Centre for Online Health, Faculty of Medicine, University of Queensland, Queensland, Australia
| |
Collapse
|
21
|
Romeijn MM, Bongers M, Holthuijsen DD, Janssen L, van Dielen FM, Anema HJ, Leclercq WK. Place Work on a Scale: What Do We Know About the Association Between Employment Status and Weight Loss Outcomes After Bariatric Surgery? Obes Surg 2021; 31:3822-3832. [PMID: 34018099 PMCID: PMC8270822 DOI: 10.1007/s11695-021-05388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022]
Abstract
Despite the initial successful weight loss after bariatric surgery, a significant amount of patients experience weight loss failure and weight regain. Several factors are known to contribute to this, though the impact of employment status is unknown. The objective of this systematic review was to examine the impact of employment status on post-surgical weight loss outcomes. Eight studies were included with a follow-up ranging between 2 and 10 years. Employed patients seemed to present more weight loss (9.0-11.0% EWL, 1.3-1.6% BMI loss) compared to unemployed patients, but none of these numbers were statistically significant. Moreover, there were contrasting findings in terms of weight regain. This review may highlight the importance of working status after bariatric surgery and warrants further investigation on this topic.
Collapse
Affiliation(s)
- Marleen M. Romeijn
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marlies Bongers
- SGBO, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- ArboNed Occupational Health Service, Utrecht, The Netherlands
| | | | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Han J.R. Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research, VU University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
22
|
Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients. Obes Surg 2021; 31:4045-4054. [PMID: 34212345 PMCID: PMC8397664 DOI: 10.1007/s11695-021-05485-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 11/04/2022]
Abstract
Background Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery. Methods The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations. Results Attitude to adherence was associated with alexithymia (β = ˗2.228; p < 0.001) and binge eating disorder (β = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (β = 0.113; p = 0.012) and alexithymia (β = −2.256; p < 0.001); with age (β = 0.161; p = 0.002) and psychiatric comorbidity (β =0.107; p = 0.021) manifesting in the barrier subscale. Conclusion We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done. Graphical Abstract ![]()
Collapse
|
23
|
Coleman KJ, Schlundt DG, Bonnet KR, Holmquist KJ, Dunne J, Crull E, Hanaoka BY, Lent MR, Nadglowski J, Sylvia L, Venkatachalam S, Xanthakos SA, Zeiger R, Arterburn D, Williams N, Courcoulas A, Anau J, McTigue KM, Blalock C, Malanga E, McClay J, McBride CL, Schlundt D, Emiliano A, Nemr R, McTigue K, Courcoulas A, Xanthakos SA, Michalsky M, Coleman KJ, Murali S, Tavakkoli A, Desai N, Apovian C, Clark J, Nauman E, Cirielli E, Nadglowski J, St Clair T, Tice J, Vitello J, Zeiger R, Arterburn D, Anau J, Janning C, Williams N. Understanding the Bariatric Patient Perspective in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study. Obes Surg 2021; 30:1837-1847. [PMID: 31965490 DOI: 10.1007/s11695-020-04404-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study. METHODS Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania, and Ohio and in a national advocacy conference for patients with obesity. Participants were identified and recruited in both clinical and community settings. Focus group transcripts were analyzed using an iterative inductive-deductive approach to identify global overarching themes. RESULTS There were 76 focus group participants. Participants were mostly women (81.4%), had primarily undergone gastric sleeve (47.0%), were non-Hispanic white (51.4%), had some college education (44.3%), and made $100,000 annual income or less (65.7%). Qualitative findings included negative reactions patients received from friends, family, and co-workers once they disclosed that they had bariatric surgery to lose weight; and barriers to follow-up care included insurance coverage, emotional and situational challenges, and physical pain limiting mobility. CONCLUSIONS These findings confirm the other qualitative findings in this area. The approach to bariatric surgery should be expanded to provide long-term comprehensive care that includes in-depth postoperative lifetime monitoring of emotional and physical health.
Collapse
Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Kimberly J Holmquist
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | - Michelle R Lent
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | - Louisa Sylvia
- Massachusetts General Hospital, Boston, MA and Harvard Medical School, Cambridge, MA, USA
| | | | | | | | - David Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | | | | | - Jane Anau
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | | | - Cynthia Blalock
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elisha Malanga
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - James McClay
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Corrigan L McBride
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Ana Emiliano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rabih Nemr
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | - Marc Michalsky
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sameer Murali
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ali Tavakkoli
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Nirav Desai
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Caroline Apovian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jeanne Clark
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elizabeth Nauman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Elizabeth Cirielli
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Tammy St Clair
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Julie Tice
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joseph Vitello
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - David Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Jane Anau
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Cheri Janning
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | |
Collapse
|
24
|
Sociodemographic Factors Associated with Loss to Follow-Up After Bariatric Surgery. Obes Surg 2021; 31:2701-2708. [PMID: 33796974 DOI: 10.1007/s11695-021-05326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE Despite the importance of follow-up and multidisciplinary care after bariatric surgery, many patients do not attend postoperative appointments, particularly those with the medical team. The present study aimed to identify factors associated with loss to follow-up after bariatric surgery. MATERIALS AND METHODS We recruited patients who underwent bariatric surgery between 01/01/2012 and 31/12/2013. Data were collected on demographic and socioeconomic information and comorbidities. Ten baseline psychological evaluations were blindly reviewed to evaluate the relationship between emotions and compliance with follow-up. During the 3-year postoperative period, we defined frequent attendees as those who attended at least two visits, whereas non-attendees were those who attended one visit or none. We evaluated baseline variables associated with non-adherence with follow-up schedules. RESULTS Among 92 patients, 41 patients (44.6%) attended at least two postoperative appointments, while 51 (55.4%) were classified as non-attendees. Among the non-attendees, significantly more were younger than 45 years compared with attendees. No other statistically significant differences were found in terms of socioeconomic variables. Multivariate logistic regression revealed male gender and psychological issued related to obesity to be independent predictors of poor compliance with follow-up. Blinded psychological evaluation of ten patients did not suggest that psychological factors are predictive of follow-up attendance. CONCLUSION Identifying factors associated with loss to follow-up after bariatric surgery is challenging. However, this is important in order to enable the design of personalized follow-up plans, especially for younger patients and those with psychological issues.
Collapse
|
25
|
Koball AM, Ames G, Goetze RE. Addiction Transfer and Other Behavioral Changes Following Bariatric Surgery. Surg Clin North Am 2021; 101:323-333. [PMID: 33743972 DOI: 10.1016/j.suc.2020.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite its important treatment implications for obesity and related comorbidities, bariatric surgery requires several behavioral changes that warrant comprehensive evaluation and support before and after surgery. This article outlines emerging scientific and anecdotal evidence for addiction transfer after bariatric surgery. Other common behavioral changes that impact adherence, weight loss, and psychiatric risk after surgery are also reviewed. Last, recommendations for presurgical psychological evaluation and postoperative support are provided.
Collapse
Affiliation(s)
- Afton M Koball
- Behavioral Medicine, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
| | - Gretchen Ames
- Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Rachel E Goetze
- VA Maine Healthcare System-Togus, 1 VA Center, Augusta, ME 04330, USA
| |
Collapse
|
26
|
Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic. Int J Obes (Lond) 2021; 45:1086-1094. [PMID: 33603129 DOI: 10.1038/s41366-021-00778-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents. METHODS A total of 280 adolescents (12-17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests. RESULTS CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X2 = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243-0.654); Food Avoidance scales were inconsistently correlated (r = 0.034-0.439). No AEBQ scales were correlated with BMI (r = -0.101-0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores. CONCLUSIONS The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ's potential for assessing eating behaviors in adolescents with obesity are discussed.
Collapse
|
27
|
Moore DD, Arterburn DE, Bai Y, Cornejo M, Crawford CL, Drewnowski A, Gray MF, Ji M, Lewis KH, Paz S, Taylor B, Yoon TK, Young DR, Coleman KJ. The Bariatric Experience Long Term (BELONG): Factors Related to Having Bariatric Surgery in a Large Integrated Healthcare System. Obes Surg 2021; 31:847-853. [PMID: 33125675 PMCID: PMC7855040 DOI: 10.1007/s11695-020-05045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Bariatric surgery is the most effective treatment for severe obesity, but currently, only 1-2% of all eligible patients undergo surgery each year. This study examined which factors were associated with a patient receiving bariatric surgery after referral in a real-world healthcare setting. MATERIALS AND METHODS The current study used the baseline survey and electronic medical record (EMR) data from the Bariatric Experience Long Term (BELONG) study (n = 1975). Predictors of who did (n = 1680) and who did not (n = 295) have surgery were analyzed using multivariate logistic regression. RESULTS Participants (n = 1975; 42.4% response rate) were primarily women (84%) and either non-Hispanic Black or Hispanic (60%). In the fully adjusted multivariate model, the strongest predictors of having surgery were being a woman (OR = 3.17; 95% CI = 2.15, 4.68; p < .001) and losing at least 5% of their body weight in the year before surgery (OR = 3.16; 95% CI = 2.28, 4.38; p < .001). The strongest predictors of not having surgery were a ≥ BMI 50 kg/m2 (OR = .39; 95% CI = .27, .56; p < .001) and having a higher physical comorbidity burden (OR = .84; 95% CI = .75, .94; p = .004). CONCLUSIONS Practices such as 5-10% total weight loss before surgery and selection of patients with safer operative risk profiles (younger with lower comorbidity burden) may inadvertently contribute to under-utilization of bariatric surgery among some demographic subpopulations who could most benefit from this intervention.
Collapse
Affiliation(s)
- Darren D Moore
- Marriage and Family Therapy Program, Touro University Worldwide, Los Alamitos, CA, USA
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Yun Bai
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Melissa Cornejo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, USA
| | | | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Kristina H Lewis
- SM Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Silvia Paz
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brianna Taylor
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Tae K Yoon
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Deborah Rohm Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
| |
Collapse
|
28
|
Heuser J, Maeda A, Yang L, Masino C, Duggal S, Jackson T, Okrainec A. Impact of a Mobile App to Support Home Recovery of Patients Undergoing Bariatric Surgery. J Surg Res 2021; 261:179-184. [PMID: 33444947 DOI: 10.1016/j.jss.2020.12.005] [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: 03/24/2020] [Revised: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Perioperative patient education and engagement are critical components of care in patients undergoing bariatric surgery, given the short length of stay and the requirements to adhere to various instructions. The use of patient engagement mobile technology may promote adherence to perioperative protocols and improve care by potentially identifying complications earlier and reducing associated health care costs. MATERIALS AND METHODS We introduced a mobile app that provides bariatric patients with access to educational materials and the ability to report on their symptoms. Using the data from the app and linking the data to patient outcomes collected in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, we examined the effects of the app on readmission, length of stay, visits to the emergency department (ED), and patient satisfaction. RESULTS A total of 505 patients were enrolled in the app between July 2017 and March 2019. Among them, 396 patients who met the inclusion criteria for the study were compared with 458 patients in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database who were not enrolled in the app for the same study period. While the use of the app was not associated with the rates of prolonged length of stay, ED visits, and readmission, patients who completed a survey at 30 d after discharge reported that the app helped them avoid phone calls to the hospital (48.5%) and ED visits (13.0%). Furthermore, 94.8% of these patients reported that they would recommend the app to other patients undergoing the same surgery. CONCLUSIONS Additional features, such as the ability for patients to directly communicate with the health care providers within the app, may be effective in decreasing unnecessary health care utilization.
Collapse
Affiliation(s)
- Jordan Heuser
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Azusa Maeda
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lynn Yang
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Caterina Masino
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Shikha Duggal
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Timothy Jackson
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
29
|
Where Are My Patients? Lost and Found in Bariatric Surgery. Obes Surg 2021; 31:1979-1985. [PMID: 33428161 DOI: 10.1007/s11695-020-05186-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Follow-up is a cornerstone of the success of bariatric surgery. However, adherence to monitoring decreases over time. The reasons for non-compliance with follow-up still remain unclear. MATERIALS AND METHODS This is a retrospective, single-center, cohort study, including all patients undergoing bariatric surgery between 2014 and 2017. Patients lost to follow-up were called back and questioned about the reasons of non-adherence. Patients followed and lost to follow-up were compared in terms of weight loss. RESULTS Overall, 29.7% of patients were lost to follow-up. After a callback, we obtained information on 89.9% of patients. The first reason of non-attendance was considering follow-up as unnecessary (29.5%). Almost a quarter of patients (24%) discontinued follow-up due to geographic distance, while 23.3%, 18.6%, and 14.0% of patients explained the lack of follow-up due to family, professional, or health problems. Only 7.0% declared to renounce to follow-up because of poor weight loss. Percentage of excess weight loss at 3 and 5 years after surgery was respectively 73.6% and 81.2% in attendant patients, and 70.7% and 68.4% in non-adherent patients (p = ns). Despite a greater weight loss in the group of patients regularly followed, the difference with patients lost to follow-up remained not significant in multivariate analysis. CONCLUSIONS Follow-up is of crucial importance in the management of bariatric patients. Follow-up disruption is associated to individual patient choice and external constraints. In order to improve the quality of long-term care, care providers will probably need to adapt to these constraints, diversifying the offer of care.
Collapse
|
30
|
Prochaska M, Worcester E. Risk Factors for Kidney Stone Formation following Bariatric Surgery. ACTA ACUST UNITED AC 2020; 1:1456-1461. [PMID: 34085046 DOI: 10.34067/kid.0004982020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
Collapse
Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago, Chicago, Illinois
| | | |
Collapse
|
31
|
Assakran BS, Widyan AM, Alhumaidan NA, Alharbi FA, Alhnaya MA, Aljabali AA, Aleid MA. Dietary assessment and patient-perspective reasons for poor adherence to diet and exercise post bariatric surgery. BMC Res Notes 2020; 13:526. [PMID: 33176857 PMCID: PMC7659172 DOI: 10.1186/s13104-020-05373-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/31/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Obesity prevalence is increasing, and as an outcome, bariatric procedures are on the rise. Previous articles about bariatric surgery disclosed tremendous results. This study aims to assess eating patterns and identify the reasons behind poor adherence to diet and exercise in postbariatric patients. RESULTS According to the questionnaire used, the majority (85.5%) of our patients scored "good", 12% scored "fair", and only 2% scored "excellent". None scored "needs improvement". Fruits had a mean consumption of 1.51 ± 0.79 and vegetables 1.78 ± 0.76. The main reasons for patient nonadherence to healthy eating were low self-discipline (48%), lack of motivation (28%), and availability of healthy food and being too busy to prepare healthy meals, both at 25%. Additionally, 55.9% of the study subjects engaged in physical activity. Lack of time (47%), low self-discipline (38%), and weather (32%) were the primary reasons for not exercising regularly.
Collapse
Affiliation(s)
- Bandar Saad Assakran
- Bariatric Division, General Surgery Department, King Fahd Specialist Hospital, Alnaziyah, P.O. Box 2290, Buraidah, Qassim 52366 Saudi Arabia
| | - Adel Mefleh Widyan
- Mathematics Department, College of Science, Qassim University, Buraidah, Qassim Saudi Arabia
| | | | | | | | | | | |
Collapse
|
32
|
Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery. Surg Endosc 2020; 35:5774-5786. [DOI: 10.1007/s00464-020-08066-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
|
33
|
Güven B, Akyolcu N. Effects of Nurse-Led Education on Quality of Life and Weight Loss in Patients Undergoing Bariatric Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Betül Güven
- School of Nursing, Koç University, İstanbul, Turkey
| | - Neriman Akyolcu
- Faculty of Health Science, Istinye University, İstanbul, Turkey
| |
Collapse
|
34
|
Abstract
PURPOSE Appointment scheduling systems traditionally book patients at fixed intervals, without taking into account the complexity factors of the health system. This paper analyzes several appointment scheduling policies of the literature and proposes the most suitable to a bariatric surgery clinic, considering the following complexity factors: (i) stochastic service times, (ii) patient unpunctuality, (iii) service interruptions, and (iv) patient no-shows. MATERIALS AND METHODS We conducted the study using data collected in a bariatric surgery clinic located in Rio de Janeiro, Brazil. The dataset presented 1468 appointments from June 29, 2015, to June 29, 2016. We comparatively evaluate the main literature policies through a discrete event simulation (DES). RESULTS The proposed policy (IICR) provides a 30% increase in attendance and allows a decrease in the total cost, maintaining the level of service in terms of average waiting time. CONCLUSION IICR was successfully implemented, and the practical results were very close to the simulated ones.
Collapse
|
35
|
David LA, Sijercic I, Cassin SE. Preoperative and post-operative psychosocial interventions for bariatric surgery patients: A systematic review. Obes Rev 2020; 21:e12926. [PMID: 31970925 DOI: 10.1111/obr.12926] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 12/12/2022]
Abstract
Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post-operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty-four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post-operative period before significant problematic eating behaviours and weight regain occur.
Collapse
Affiliation(s)
- Lauren A David
- Department of Psychology, Ryerson University, Toronto, Canada.,Eating Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Iris Sijercic
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Mental Health, University Health Network, Toronto, Canada
| |
Collapse
|
36
|
Adolescent Bariatric Surgery: Effects of Socioeconomic, Demographic, and Hospital Characteristics on Cost, Length of Stay, and Type of Procedure Performed. Obes Surg 2020; 29:757-764. [PMID: 30612326 DOI: 10.1007/s11695-018-03657-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the efficacy of bariatric surgery in adolescents and the increasing rates of adolescent obesity, the use of bariatric surgery remains low. Treatment cost and length of stay (LOS) could be influencing the utilization of bariatric surgery. METHODS We used the Kids' Inpatient Database (KID) from 2006, 2009, and 2012. Adolescents with a primary diagnosis of obesity who underwent bariatric surgery were included. Multinomial logistic and linear regression modeling was used to determine the association of the predictor variables with type of procedure and treatment cost and LOS, respectively. RESULTS We identified 1799 adolescents who underwent bariatric surgery. The majority of the subjects were female (77%) and White (60%). The most commonly performed procedure was Roux-en-Y gastric bypass (56%). Race, region, hospital teaching status, and hospital ownership affected the type of procedure performed. Self-pay patients were less likely to undergo Roux-en-Y gastric bypass (RYGB) than sleeve gastrectomy (SG) when compared to patients with private insurance. Teaching hospitals were less likely to perform RYGB or AGB than SG when compared to non-teaching hospitals. Treatment cost was significantly affected by income, teaching hospital status, hospital size, and surgery type. LOS was affected by income quartile, region, and surgery type. CONCLUSION Socioeconomic and demographic factors as well as hospital characteristics affect not only the LOS and treatment cost, but also the type of bariatric surgery performed in adolescents. Identifying and understanding the factors influencing procedure choice, treatment cost, and LOS can improve care and healthcare resource utilization.
Collapse
|
37
|
Murphy J, Uttamlal T, Schmidtke KA, Vlaev I, Taylor D, Ahmad M, Alsters S, Purkayastha P, Scholtz S, Ramezani R, Ahmed AR, Chahal H, Darzi A, Blakemore AIF. Tracking physical activity using smart phone apps: assessing the ability of a current app and systematically collecting patient recommendations for future development. BMC Med Inform Decis Mak 2020; 20:17. [PMID: 32013996 PMCID: PMC6998214 DOI: 10.1186/s12911-020-1025-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background Within the United Kingdom’s National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients’ physical activity and other health-related variables could provide healthworkers with a more ‘ecologically valid’ picture of these patients’ behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively. Methods Participants with a BMI > 35 kg/m2 being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The ‘Moves’ app automatically tracked participants’ physical activity and the ‘WLCompanion’ app prompted participants to set goals and input other health-related information. Then, to learn about participants’ facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics. Results Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18–65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants’ activity levels pre- and post-surgery did not differ. In addition, 54 participants’ survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain. Conclusions The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps. Trial registration ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.
Collapse
Affiliation(s)
- J Murphy
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - T Uttamlal
- Warwick Business School, University of Warwick, Coventry, UK
| | - K A Schmidtke
- Psychology Department, Manchester Metropolitan University, Manchester, UK
| | - I Vlaev
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, UK.
| | - D Taylor
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - M Ahmad
- Big Data Analytical Unit, Imperial College London, London, UK
| | - S Alsters
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Imperial College London, London, UK
| | - P Purkayastha
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - S Scholtz
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - R Ramezani
- Wireless Health Institute, University of California, Los Angeles, USA
| | - A R Ahmed
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - H Chahal
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - A Darzi
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - A I F Blakemore
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Imperial College London, London, UK.,Department of Life Sciences, Brunel University London, London, UK
| |
Collapse
|
38
|
Dantas LF, Hamacher S, Cyrino Oliveira FL, Barbosa SDJ, Viegas F. Predicting Patient No-show Behavior: a Study in a Bariatric Clinic. Obes Surg 2020; 29:40-47. [PMID: 30209668 DOI: 10.1007/s11695-018-3480-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE No-shows of patients to their scheduled appointments have a significant impact on healthcare systems, including lower clinical efficiency and higher costs. The purpose of this study was to investigate the factors associated with patient no-shows in a bariatric surgery clinic. MATERIALS AND METHODS We performed a retrospective study of 13,230 records for 2660 patients in a clinic located in Rio de Janeiro, Brazil, over a 17-month period (January 2015-May 2016). Logistic regression analyses were conducted to explore and model the influence of certain variables on no-show rates. This work also developed a predictive model stratified for each medical specialty. RESULTS The overall proportion of no-shows was 21.9%. According to multiple logistic regression, there is a significant association between the patient no-shows and eight variables examined. This association revealed a pattern in the increase of patient no-shows: appointment in the later hours of the day, appointments not in the summer months, post-surgery appointment, high lead time, higher no-show history, fewer numbers of previous appointments, home address 20 to 50 km away from the clinic, or scheduled for another specialty other than a bariatric surgeon. Age group, forms of payment, gender, and weekday were not significant predictors. Predictive models were developed with an accuracy of 71%. CONCLUSION Understanding the characteristics of patient no-shows allows making improvements in management practice, and the predictive models can be incorporated into the clinic dynamic scheduling system, allowing the use of a new appointment policy that takes into account each patient's no-show probability.
Collapse
Affiliation(s)
- Leila F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Fernando L Cyrino Oliveira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Simone D J Barbosa
- Department of Informatics, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil
| | - Fábio Viegas
- Institute of Gastro and Obesity Surgery, Rua Paulo Barreto, 73, Rio de Janeiro, RJ, 22280-010, Brazil.
| |
Collapse
|
39
|
Every-Palmer S, Romans SE, Stubbs R, Tomlinson A, Gandhi S, Huthwaite M. Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study. Front Psychiatry 2020; 11:419. [PMID: 32477191 PMCID: PMC7236816 DOI: 10.3389/fpsyt.2020.00419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated. OBJECTIVES A qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness. METHODS Nine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken. RESULTS Five broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery. CONCLUSIONS Participants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.
Collapse
Affiliation(s)
- Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- *Correspondence: Susanna Every-Palmer,
| | - Sarah E. Romans
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Richard Stubbs
- Wakefield Obesity Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Anneka Tomlinson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sophie Gandhi
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
40
|
Jackson HT, Anekwe C, Chang J, Haskins IN, Stanford FC. The Role of Bariatric Surgery on Diabetes and Diabetic Care Compliance. Curr Diab Rep 2019; 19:125. [PMID: 31728654 PMCID: PMC7205514 DOI: 10.1007/s11892-019-1236-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Bariatric surgery is a durable and long-term solution to treat both obesity and its associated comorbidities, specifically type 2 diabetes mellitus (T2DM). Many studies have demonstrated the benefits of bariatric surgery on T2DM, but weight recidivism along with recurrence of comorbidities can be seen following these procedures. Patient compliance post-bariatric surgery is linked to weight loss outcomes and comorbidity improvement/resolution. The role of compliance with respect to T2DM medication in bariatric patients specifically has not recently been examined. This article seeks to review the role of bariatric surgery on short- and long-term resolution of T2DM, recurrence, and compliance with T2DM medication following bariatric surgery. RECENT FINDINGS Seven randomized control trials have examined metabolic surgery versus medical therapy in glycemic control in patients meeting criteria for severe obesity. Six out of seven studies demonstrate a significant advantage in the surgical arms with regards to glycemic control, as well as secondary endpoints such as weight loss, serum lipid levels, blood pressure, renal function, and other parameters. While patient compliance with lifestyle modifications post-bariatric surgery is linked to weight loss outcomes, there are no studies to date that directly evaluate the role of lifestyle modifications and T2DM medication adherence in the management of T2DM post-bariatric surgery. Bariatric surgery is an effective treatment option to achieve long-term weight loss and resolution of obesity-related medical comorbidities, specifically T2DM. Patient compliance to lifestyle modifications post-bariatric surgery is linked to weight loss outcomes and comorbidity resolution. The role of diabetic care compliance in bariatric patient outcomes, however, is poorly understood. Further studies are needed to elucidate the predictors and associated risk factors for non-compliance in this patient population.
Collapse
Affiliation(s)
- Hope T Jackson
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
| | - Chika Anekwe
- Harvard Medical School, Boston, MA, USA
- Internal Medicine-Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
| | - Julietta Chang
- Weight Loss Surgical Institute of Central Coast, Marian Regional Medical Center, Santa Monica, CA, USA
| | - Ivy N Haskins
- Department of Surgery, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, USA
- Internal Medicine-Neuroendocrine Unit and Pediatrics Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
41
|
Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS. Food Addiction: Implications for the Diagnosis and Treatment of Overeating. Nutrients 2019; 11:E2086. [PMID: 31487791 PMCID: PMC6770567 DOI: 10.3390/nu11092086] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022] Open
Abstract
With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.
Collapse
Affiliation(s)
- Rachel C Adams
- CUBRIC, School of Psychology, Cardiff University, Maindy Road, Cardiff CF24 4HQ, UK.
| | - Jemma Sedgmond
- CUBRIC, School of Psychology, Cardiff University, Maindy Road, Cardiff CF24 4HQ, UK
| | - Leah Maizey
- CUBRIC, School of Psychology, Cardiff University, Maindy Road, Cardiff CF24 4HQ, UK
| | | | - Natalia S Lawrence
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, UK
| |
Collapse
|
42
|
Jalilvand A, Blaszczak A, Dewire J, Detty A, Needleman B, Noria S. Laparoscopic sleeve gastrectomy is an independent predictor of poor follow-up and reaching ≤ 40% excess body weight loss at 1, 2, and 3 years after bariatric surgery. Surg Endosc 2019; 34:2572-2584. [PMID: 31359199 DOI: 10.1007/s00464-019-07023-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Contrary to published literature, our institutional data demonstrated reduced weight loss following laparoscopic sleeve gastrectomy (LSG) compared to gastric bypass (LRYGB). The purpose of this study was to determine if known predictors of poor weight loss accounted for this discrepancy at a large volume center. METHODS All patients undergoing primary LSG (n = 322) and LRYGB (n = 249), from 2014 to 2016, at a single institution were retrospectively reviewed. Baseline medical, socioeconomic, and follow-up data (6, 12, 24, and 36 months) were obtained. The first aim characterized differences in LSG and LRYGB. The second objective determined predictors of experiencing the lowest or highest quartile of excess body weight loss [(EBWL), (%EBWL-25th, %EBWL-75th)] at 12, 24, and 36 months. Thirdly, predictors of poor weight loss within sleeve gastrectomy were characterized. RESULTS In comparison to patients undergoing LRYGB, LSG patients demonstrated lower baseline BMI (47.9 ± 8.2 vs. 51.5 ± 10.1, p < 0.0005), lower incidences of obesity-related comorbidities (p < 0.05), were more likely to have higher education (p = 0.02), and were associated with no-shows up to 2 years post-operatively. LSG remained a strong independent predictor of %EBWL-25th at 12 months (OR = 5.2, p < 0.005), 24 months (OR = 5.3, p < 0.005), and 36 months (OR = 7.3, p = 0.006), after adjusting for comorbidities, education, and no-shows. Predictors of poor weight loss after LSG included hypertension, African American race, major depression, no-shows at 6 and 12 months. Within patients associated with these characteristics, the relative risk of experiencing poor weight loss was significantly higher following LSG compared to LRYGB at 12 months (60% vs. 25.0%, p < 0.05), 24 months (43% vs. 18%, p < 0.05), and 36 months (70% vs. 21%, p < 0.05). CONCLUSIONS LSG remained an independent predictor of poor weight loss at all post-operative time points. Furthermore, the risk of experiencing poor weight loss was significantly higher following LSG compared to LRYGB for patients with high-risk characteristics.
Collapse
Affiliation(s)
- Anahita Jalilvand
- Department of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, USA
| | - Alecia Blaszczak
- College of Medicine, The Ohio State Wexner Medical Center, Columbus, USA
| | - Jane Dewire
- College of Medicine, The Ohio State Wexner Medical Center, Columbus, USA
| | - Andrew Detty
- College of Medicine, The Ohio State Wexner Medical Center, Columbus, USA
| | - Bradley Needleman
- Department of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, USA
| | - Sabrena Noria
- Department of General and Gastrointestinal Surgery, The Ohio State Wexner Medical Center, Columbus, USA.
| |
Collapse
|
43
|
Abstract
Bariatric surgery candidates often report problematic and/or eating disordered behaviors. For most patients, these eating behaviors improve after surgery. A subset, however, experience a recurrence or new onset of problematic eating behaviors as early as 2 months to 18 months after surgery, which can result in compromised weight loss/excessive weight regain. Those most at risk are individuals with comorbid psychopathology (ie, loss-of-control eating or depression) after surgery. For some, such problems are present before surgery. Therefore, it is critical to monitor patients closely after surgery so that appropriate psychiatric treatments can be provided if indicated.
Collapse
Affiliation(s)
- Cassie S Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA.
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| |
Collapse
|
44
|
Seip RL, Robey K, Stone A, Chin G, Staff I, McLaughlin T, Tishler D, Papasavas P. Comparison of Non-routine Healthcare Utilization in the 2 years Following Roux-En-Y Gastric Bypass and Sleeve Gastrectomy: A Cohort Study. Obes Surg 2019; 29:1922-1931. [DOI: 10.1007/s11695-019-03793-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
45
|
Müller M, Nett PC, Borbély YM, Buri C, Stirnimann G, Laederach K, Kröll D. Mental Illness Has a Negative Impact on Weight Loss in Bariatric Patients: a 4-Year Follow-up. J Gastrointest Surg 2019; 23:232-238. [PMID: 30091038 DOI: 10.1007/s11605-018-3903-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/24/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mental health disorders are highly prevalent among bariatric surgery patients. Bariatric surgery induces weight loss with continuous health improvements. However, long-term follow-up data on weight loss and quality of life data of patients who have a mental illness after bariatric surgery are scarce, and it is not clear whether mental illness is associated with more pronounced weight regain. The aim was to investigate the impact of preoperative mental illness on the course of long-term weight changes after bariatric surgery. METHODS Patients with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass surgery (RYGB) between 2005 and 2013 with a follow-up of at least 3 years were included. The study population was divided into two groups: patients with mental illness (MI) and patients without (No-MI). Weight loss outcomes over time were compared using mixed models up to 4 years after surgery. RESULTS In total, 254 patients (RYGB 61.0%, SG 39%) were included. The distribution of baseline characteristics was similar between the MI (n = 108) and No-MI groups (n = 146). The most prevalent mental illness was depressive disorder (63.9%). In the MI group, the percent of total weight loss (%TWL) was significantly smaller over the study period. After 36 months, the predicted mean group-difference of %TWL was 4.6% (95% CI 1.9, 7.2; p = 0.001), and the predicted odds ratio for weight regain was 4.9 (95% CI 1.6, 15.1) for patients in the MI group. CONCLUSION Preoperative mental illness leads to lower long-term weight loss and an increased risk of weight regain after bariatric surgery.
Collapse
Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Philipp C Nett
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Yves Michael Borbély
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Caroline Buri
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Guido Stirnimann
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Kurt Laederach
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland
| | - Dino Kröll
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
| |
Collapse
|
46
|
Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know? ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 63:344-369. [PMID: 29214946 DOI: 10.13109/zptm.2017.63.4.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUBJECT In view of the epidemic increase in severe obesity and the ineffectiveness of conservative weight-loss interventions, bariatric surgery delivers compelling results for patients with class II (BMI ≥ 35 kg/m²) and class III obesity (BMI ≥ 40 kg/m²), not only in reducing weight over the long term, but also in reducing obesity-related somatic comorbidity and improving psychosocial functioning and quality of life. Investigations into the psychosocial aspects of obesity surgery have proliferated over the last 15 years, providing a huge amount of essential research data. Yet the results are partly contradictory and highly dependent on the duration of follow-up. METHODS Based of a narrative review, this article provides an overview of the current status and recent developments of the reciprocal effects between bariatric surgery and psychosocial functioning. The review focused on eight domains representing important psychosomatic and psychosocial aspects of bariatric surgery. RESULTS Especially in cases of class II and III obesity, bariatric surgery is the only means to reduce bodyweight significantly and permanently, though they carry with them the associated risk factors of metabolic, cardiovascular, and oncological diseases.With regard to psychosocial and psychosomatic aspects, studies with a short-term catamnesis (approx. 3 years) speak in favor of an improvement in the quality of life including mental disorders. If we consider studies with longer follow-ups, however, the results are not as uniform. In particular, we observe an increase in harmful alcohol consumption, self-harm behavior, and suicide risk. CONCLUSIONS In light of mental well-being and thus also quality of life, bariatric surgery would appear to convey an elevated risk for a minority of patients.Yet identifying these patients before surgery has so far been insufficient.
Collapse
|
47
|
Taylor T, Dewes O, Taufa N, Wrapson W, Siegert R. Factors associated with preoperative attrition in bariatric surgery: a protocol for a systematic review. Syst Rev 2018; 7:212. [PMID: 30486899 PMCID: PMC6262965 DOI: 10.1186/s13643-018-0855-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bariatric surgery results in substantial medical and economic benefits; however, independent studies typically report high patient preoperative attrition rates. Studies have identified individual characteristics and sociodemographic variables of those who complete the surgery compared to those who do not. The aim of the present protocol is to outline a systematic review focussed on identifying the sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who were enrolled in bariatric surgery programmes. METHODS/DESIGN The databases Scopus, CINAHL, PsycINFO, Web of Science, and MEDLINE will be searched for retrospective, prospective, and cross-sectional observational studies that have identified any sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who are enrolled in a bariatric surgery programme. English-language articles published between 1997 to 2020, inclusive of adults 18 years or older, will be included in the review. This protocol has been registered in PROSPERO, registration number; CRD42017068557. DISCUSSION Presently, there are studies and reviews investigating population-based utilisation and access to bariatric surgery; however, there is a need to review the reasons behind preoperative bariatric surgery patient attrition once selected for bariatric surgery. The results of the review will highlight potential systematic disparities in patient attrition, where gaps in knowledge remain for further investigation, and suggest areas where countermeasures may be focussed for decreasing attrition rates. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017068557.
Collapse
Affiliation(s)
- Tamasin Taylor
- Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627 New Zealand
| | - Ofa Dewes
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Nalei Taufa
- University of Auckland, Auckland, New Zealand
| | - Wendy Wrapson
- Auckland University of Technology, Auckland, New Zealand
| | | |
Collapse
|
48
|
Bradley LE, Thomas JG, Hood MM, Corsica JA, Kelly MC, Sarwer DB. Remote assessments and behavioral interventions in post-bariatric surgery patients. Surg Obes Relat Dis 2018; 14:1632-1644. [DOI: 10.1016/j.soard.2018.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
|
49
|
Perna S, Spadaccini D, Riva A, Allegrini P, Edera C, Faliva MA, Peroni G, Naso M, Nichetti M, Gozzer C, Vigo B, Rondanelli M. A path model analysis on predictors of dropout (at 6 and 12 months) during the weight loss interventions in endocrinology outpatient division. Endocrine 2018; 61:447-461. [PMID: 29470776 DOI: 10.1007/s12020-018-1563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study aimed to identify the dropout rate at 6 and 12 months from the first outpatient visit, and to analyze dropout risk factors among the following areas: biochemical examinations, anthropometric measures, psychological tests, personal data, and life attitude such as smoking, physical activity, and pathologies. METHODS This is a retrospective longitudinal observational study. Patients undergo an outpatient endocrinology visit, which includes collecting biographical data, anthropometric measurements, physical and pathological history, psychological tests, and biochemical examinations. RESULTS The sample consists of 913 subjects (682 women and 231 men), with an average age of 50.88 years (±15.80) for the total sample, with a BMI of 33.11 ± 5.65 kg/m2. 51.9% of the patients abandoned therapy at 6 months after their first visit, and analyzing the dropout rate at 12 months, it appears that 69.5% of subjects abandon therapy. The main predictor of dropout risk factors at 6 and 12 months is the weight loss during the first 3 months (p < 0.05). As regards the hematological predictors, white blood cell and iron level stated dropout at 12 months. Patients who introduced physical activity had a reduction of - 17% (at 6 months) and -13% (at 12 months) of dropout risk (p < 0.05). As regards the "worker" status, patients classified as"retired" had a decrease risk of dropout vs. other categories of worker (i = 0.58; p < 0.05). Dropout risk at 12 months decrease in patients with a previous history of cancer, Endocrine and psychic and behavioral disorders (p < 0.001). CONCLUSIONS The main factor that predisposes patients to continue therapy or to abandon it is the success (or failure) of the diet in the initial period, based on weight lost (or not lost) in the early months of the initiation of therapy. Furthermore, considerable differences were found in different categories of "workers", and with previous "pathologies". The level of physical activity and previous diseases also seem to be predictors of dropout.
Collapse
Affiliation(s)
- Simone Perna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy.
| | - Daniele Spadaccini
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | | | | | - Chiara Edera
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Milena Anna Faliva
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Maurizio Naso
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mara Nichetti
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Carlotta Gozzer
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Beatrice Vigo
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| |
Collapse
|
50
|
Han S, Agostini G, Brewis AA, Wutich A. Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery. BMC OBESITY 2018; 5:18. [PMID: 29988619 PMCID: PMC6027738 DOI: 10.1186/s40608-018-0195-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022]
Abstract
Background People living with severe obesity report high levels of weight-related stigma. Theoretically, this stigma undermines weight loss efforts. The objective of this study is to test one proposed mechanism to explain why weight loss is so difficult once an individual becomes obese: that weight-related stigma inhibits physical activity via demotivation to exercise. Methods The study focused on individuals who had bariatric surgery within the past 5 years (N = 298) and who report a post-surgical body mass index (BMI) ranging from 16 to 70. Exercise avoidance motivation (EAM) and physical activity (PA) were modeled as latent variables using structural equation modeling. Two measures of weight stigma, the Stigmatizing Situations Inventory (SSI) and the Weight Bias Internalization Scale (WBIS) were modified for people with a long history of extreme obesity for use as observed predictors. Results Exercise avoidance motivation (EAM) significantly mediated the association between both experienced (SSI) and internalized (WBIS) weight stigma and physical activity (PA) in this population. Conclusion Exercise avoidance motivation, influenced by weight stigma, may be a significant factor explaining the positive relationship between higher body weights with lower levels of physical activity.
Collapse
Affiliation(s)
- SeungYong Han
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Gina Agostini
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA
| | - Alexandra A Brewis
- Mayo Clinic/Arizona State University Obesity Solutions, 1000 Cady Mall Suite 164, Tempe, AZ 85287 USA.,2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
| | - Amber Wutich
- 2School of Human Evolution and Social Change, Arizona State University, 900 Cady Mall, Tempe, AZ 85287 USA
| |
Collapse
|