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Burke E, Jenkins T, Boles RE, Mitchell JE, Inge T, Gunstad J. Cognitive function 10 years after adolescent bariatric surgery. Surg Obes Relat Dis 2024; 20:614-620. [PMID: 38413319 DOI: 10.1016/j.soard.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up. OBJECTIVE Examine cognitive function 10 years after adolescent bariatric surgery. SETTING University hospital. METHODS A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. RESULTS Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up. CONCLUSIONS The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.
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Affiliation(s)
- Erin Burke
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Todd Jenkins
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; University of North Dakota School of Medicine and Health Science, Fargo, North Dakota
| | - Thomas Inge
- Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
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Weldeslase TA, Akinyemi OA, Keeling DJ, Enchill KA, Cornwell EE, Fullum TM. Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States. Am Surg 2024; 90:1234-1239. [PMID: 38214232 DOI: 10.1177/00031348241227190] [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] [Indexed: 01/13/2024]
Abstract
BACKGROUND The passage of the Affordable Care Act (ACA) in 2010 marked a pivotal moment in American health care policy, significantly expanding access to health care services. This study aims to explore the relationship between the ACA and the utilization and outcomes of Roux-en-Y Gastric Bypass (RYGB) surgery. METHODS Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient's characteristics, comorbidities, and hospital type. RESULTS In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% (P < .05), while Black patients increased from 12.5% to 18.5% (P < .05). Medicaid-insured patients increased from 6.8% to 18.1% (P < .05), and patients in the poorest income quartile increased from 20% to 26% (P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period. DISCUSSION Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.
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Affiliation(s)
- Terhas A Weldeslase
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | | | - Darien J Keeling
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Kobina A Enchill
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Edward E Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
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Johnson-Mann C, Hassan M, Johnson S. Improving equity and access to bariatric surgery. Lancet Gastroenterol Hepatol 2023; 8:1068-1070. [PMID: 37951233 DOI: 10.1016/s2468-1253(23)00277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Crystal Johnson-Mann
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA.
| | - Monique Hassan
- Department of Surgery, Baylor Scott and White Memorial Hospital, Temple, TX, USA; Department of Surgery, Baylor College of Medicine, Temple, TX, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA; Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
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Chen G, Donahoo WT, Cardel MI, Holgerson A, Ayzengart A, Johnson-Mann CN, Gurka MJ. Variation by race/ethnicity in the utilization and weight loss following metabolic bariatric surgery. Surg Obes Relat Dis 2023; 19:1391-1404. [PMID: 37666726 DOI: 10.1016/j.soard.2023.06.007] [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: 11/18/2022] [Revised: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Understanding the disparities in utilization and weight loss outcomes of metabolic and bariatric surgery (MBS) by demographics will inform strategies targeting potential treatment gaps and enhance overall clinical obesity treatment. OBJECTIVE To identify factors associated with utilization and longitudinal weight loss after MBS. SETTING OneFlorida Clinical Research Consortium Database. METHODS We performed a retrospective study using data from the OneFlorida Clinical Research Consortium between 2012 and 2018. We used logistic regression with intersectional effects to identify factors associated with utilization of MBS. Mixed-effect models were used to estimate longitudinal percentage total weight loss among those who underwent MBS with up to 18 months of follow-up. RESULTS Among 429,821 patients eligible for MBS, 8290 (1.9%) underwent MBS between 2012 and 2018. Intersectional analysis revealed that non-Hispanic Black patients experienced an inferior utilization of MBS compared with non-Hispanic White and Hispanic counterparts, defined by the interaction between race/ethnicity and demographic factors, including male sex, older age, and insurance coverage. In the longitudinal weight loss assessment, 4016 patients (48.3% Roux-en-Y gastric bypass, 51.7% sleeve gastrectomy) were included. We found that non-Hispanic Black patients experienced significantly less weight loss than non-Hispanic White and Hispanic counterparts. Other factors associated with less weight loss over time included undergoing sleeve gastectomy, male sex, lower preoperative body mass index, and having type 2 diabetes at the time of surgery. CONCLUSIONS Our findings will help to design new strategies focusing on the intersection of race/ethnicity and sociodemographic factors to improve access and effectiveness of MBS.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - William T Donahoo
- Department of Endocrinology, University of Florida College of Medicine, Gainesville, Florida
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; WW International, Inc., New York, New York
| | - Allison Holgerson
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | | | | | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
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Sher T, Diab AR, Mhaskar R, Docimo S, Sujka J, DuCoin C. Evaluating the Spanish readability of American Society for Metabolic and Bariatric Surgery (ASMBS) Centers of Excellence (COE) websites. Surg Endosc 2023:10.1007/s00464-023-09978-9. [PMID: 36914781 PMCID: PMC10010650 DOI: 10.1007/s00464-023-09978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Healthcare disparities continue to be an ongoing struggle in Bariatrics. Limited availability of Spanish online material may be a correctible barrier for accessibility to Hispanic patients. We sought to evaluate accredited Bariatric Centers of Excellence (COE) for Spanish readability via their websites to determine accessibility for Spanish speakers. METHODS This was an internet research study. 103 COE accredited by American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) were evaluated and assigned one of five Spanish Visibility Categories. The United States was divided into 4 regions. Regional Spanish visibility was calculated by dividing each category count by the number of institutions in each region. County Spanish-speaking populations were obtained from the US Census Bureau's 2009-2013 American Community Survey. Differences in their distributions across the Spanish Visibility Categories were investigated using the Mann-Whitney U test. RESULTS 25% of websites were translatable to Spanish, and a regional discrepancy was found with 61% translatable in the West, 19% in Northeast, 19% in Midwest, and 15% in South. Median Spanish-speaking population was higher in counties where websites were translatable to Spanish than where websites were not translatable. CONCLUSION Healthcare disparities in Bariatrics continue to be an ongoing struggle. We suggest that Spanish readability for ASMBS ACS COE websites should be improved regardless of geographic differences in Spanish-speaking populations. We believe it would be valuable for these websites to have standards for readability of Spanish and other languages.
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Affiliation(s)
- Theo Sher
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Abdul-Rahman Diab
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Escobedo LE, Cervantes L, Havranek E. Barriers in Healthcare for Latinx Patients with Limited English Proficiency-a Narrative Review. J Gen Intern Med 2023; 38:1264-1271. [PMID: 36720766 PMCID: PMC9888733 DOI: 10.1007/s11606-022-07995-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.
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Affiliation(s)
- Luis E Escobedo
- University of Colorado Internal Medicine Residency Training Program, Aurora, CO, USA.
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Edward Havranek
- Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
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Wong WG, Perez Holguin RA, Butt M, Rigby A, Rogers AM, Shen C. Racial Differences in Bariatric Surgical Approach: a Cross-Sectional National Inpatient Sample Analysis. Obes Surg 2022; 32:3359-3367. [PMID: 35930116 DOI: 10.1007/s11695-022-06227-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Although racial inequalities in referral and access to bariatric surgical care have been well reported, racial difference in the selection of surgical techniques is understudied. This study examined factors associated with the utilization of the two main bariatric surgical techniques: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIALS AND METHODS The National Inpatient Sample database was queried for patients who underwent elective LSG or LRYGB for the treatment of severe obesity. Chi-square tests and multivariable logistic regression assessed associations of surgical approach with patient and facility characteristics. Sensitivity analyses examined the following body mass index (BMI) subgroups: < 40.0 kg/m2, 40.0-44.9 kg/m2, 45.0-49.9 kg/m2, and ≥ 50.0 kg/m2. RESULTS Within the final cohort (N = 86,053), 73.0% (N = 62,779) underwent LSG, and 27.0% (N = 23,274) underwent LRYGB. Patients with BMI 45.0-49.9 kg/m2 (OR = 0.85) and BMI ≥ 50.0 kg/m2 (OR = 0.80) were less likely to undergo LSG than patients with BMI 40.0-45.0 kg/m2 (all p < 0.001). However, Black (OR = 1.74) and White Hispanic patients (OR = 1.30) were more likely to undergo LSG than White non-Hispanic patients (all p < 0.005). In the BMI ≥ 50.0 kg/m2 group, Black patients were still more likely to undergo LSG compared to White non-Hispanic patients (OR = 1.69, p < 0.001), while Asians/Pacific Islanders were less likely to receive LSG than White non-Hispanic patients (OR = 0.41, p < 0.05). CONCLUSION In this observational study, we identified racial differences in the selection of common bariatric surgical approaches across various BMI categories. Future investigations are warranted to study and to promote awareness of the racial/ethnic influence in attitudes on obesity, weight loss, financial support, and surgical risks during bariatric discussions with minorities.
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Affiliation(s)
- William G Wong
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA
| | - Andrea Rigby
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Ann M Rogers
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA. .,Division of Outcomes Research and Quality, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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8
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Merriwether EN, Wittleder S, Cho G, Bogan E, Thomas R, Bostwick N, Wang B, Ravenell J, Jay M. Racial and weight discrimination associations with pain intensity and pain interference in an ethnically diverse sample of adults with obesity: a baseline analysis of the clustered randomized-controlled clinical trial the goals for eating and moving (GEM) study. BMC Public Health 2021; 21:2201. [PMID: 34856961 PMCID: PMC8638106 DOI: 10.1186/s12889-021-12199-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. However, the individual or combined effects of RD and WD on pain in adults with obesity is not well understood. There are gender differences and sexual dimorphisms in nociception and pain, but the effect of gender on relationships between RD, WD, and pain outcomes in ethnically diverse adults with obesity is unclear. Thus, the purposes of this study were to: 1) examine whether RD and WD are associated with pain intensity and interference, and 2) explore gender as a moderator of the associations between RD, WD, and pain. METHODS This is a baseline data analysis from a randomized, controlled clinical trial of a lifestyle weight-management intervention. Eligible participants were English or Spanish-speaking (ages 18-69 years) and had either a body mass index of ≥30 kg/m2 or ≥ 25 kg/m2 with weight-related comorbidity. RD and WD were measured using questions derived from the Experiences of Discrimination questionnaire (EOD). Pain interference and intensity were measured using the PROMIS 29 adult profile V2.1. Linear regression models were performed to determine the associations between WD, RD, gender, and pain outcomes. RESULTS Participants (n = 483) reported mild pain interference (T-score: 52.65 ± 10.29) and moderate pain intensity (4.23 ± 3.15). RD was more strongly associated with pain interference in women (b = .47, SE = .08, p < 001), compared to men (b = .14, SE = .07, p = .06). Also, there were no significant interaction effects between RD and gender on pain intensity, or between WD and gender on pain interference or pain intensity. CONCLUSIONS Pain is highly prevalent in adults with obesity, and is impacted by the frequencies of experiences with RD and WD. Further, discrimination against adults with obesity and chronic pain could exacerbate existing racial disparities in pain and weight management. Asking ethnically diverse adults with obesity about their pain and their experiences of RD and WD could help clinicians make culturally informed assessment and intervention decisions that address barriers to pain relief and weight loss. TRIAL REGISTRATION NCT03006328.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Melanie Jay
- NYU Grossman School of Medicine, New York, USA
- New York Harbor VA, New York, USA
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Daniel R, Jimenez J, Pall H. Health Equity and Social Determinants of Health in Pediatric Gastroenterology. Pediatr Clin North Am 2021; 68:1147-1155. [PMID: 34736581 DOI: 10.1016/j.pcl.2021.07.004] [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] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDH) as outlined by Healthy People 2020 encompasses 5 key domains: economic, education, social and community context, health and health care, and neighborhood and built environment. This article emphasizes pediatric populations and some of the existing SDH and health care disparities seen in pediatric gastroenterology. We specifically review inflammatory bowel disease, endoscopy, bariatric surgery, and liver transplantation. We also examine the burgeoning role of telehealth that has become commonplace since the coronavirus disease 2019 era.
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Affiliation(s)
- Rhea Daniel
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, McGovern Medical School, University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX 70007, USA
| | - Jennifer Jimenez
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Harpreet Pall
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, USA.
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Masrur M, Bustos R, Sanchez-Johnsen L, Gonzalez-Ciccarelli L, Mangano A, Gonzalez-Heredia R, Patel R, Danielson KK, Gangemi A, Elli EF. Factors Associated with Weight Loss After Metabolic Surgery in a Multiethnic Sample of 1012 Patients. Obes Surg 2021; 30:975-981. [PMID: 31848986 DOI: 10.1007/s11695-019-04338-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metabolic surgery is the most effective method for weight loss in the long-term treatment of morbid obesity and its comorbidities. The primary aim of this study was to examine factors associated with percent total weight loss (%TWL) after metabolic surgery among an ethnically diverse sample of patients. METHODS A retrospective review was performed on 1012 patients who underwent either a sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at our institution between January 2008 and June 2015. RESULTS African Americans had a lower %TWL than non-Hispanic/Latino Whites at 6, 9, 12, 18, and 48 months. At all timeframes, there was a negative association between pre-surgery TWL and %TWL after surgery. Female sex was negatively associated with %TWL at 3 months only. Higher initial BMI was also associated with greater post-operative %TWL at 18, 24 and 36 months. Older patients had lower %TWL at 6, 9, 12 and 24 months post-surgery. Patients who received RYGB had greater %TWL than those who received SG at 3, 6, 9, 12, 24 and 36 months. CONCLUSIONS African Americans had a lower %TWL than non-Hispanic/Latino Whites at most time points; there were no other significant race/ethnicity or sex differences. BMI (greater initial BMI), age (lower) and RYGB were associated with a greater post-operative %TWL at certain post-surgery follow-up time points. A limitation of this study is that there was missing data at a number of time points due to lack of attendance at certain follow-up visits.
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Affiliation(s)
- Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.
| | - Lisa Sanchez-Johnsen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Luis Gonzalez-Ciccarelli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | | | - Ronak Patel
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Enrique Fernando Elli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA
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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.
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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.
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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]
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