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Walter FA, Hoyt T, Michl TM. When insurance is not a barrier: psychological factors predicting whether bariatric candidates undergo surgery. Surg Obes Relat Dis 2024; 20:953-961. [PMID: 38777643 DOI: 10.1016/j.soard.2024.04.012] [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: 09/05/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the effectiveness of bariatric surgery, utilization rates have increased only marginally over the last 2 decades; candidates who are eligible for bariatric surgery regularly fail to undergo surgery. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has previously been used to assist in identification of those who will not move forward with surgery after being identified as eligible. However, medical insurance has been identified as a significant barrier to surgery; research in those who have universal healthcare may yield different results. OBJECTIVES Determine if MMPI-RF scales are associated with failure to undergo bariatric surgery in patients eligible to have the procedure. SETTING Large military hospital in the Northwestern U.S. METHODS This study used archival data for 279 patients psychologically screened for eligibility for bariatric surgery. All assessments took place between January 2017 and December 2019. T-tests and chi-square tests were used to compare groups of patients who did and did not have surgery on relevant medical and demographic variables. Profile analyses of patient MMPI-2-RF scores were conducted to examine scale associations with undergoing surgery. RESULTS A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complaints, cynicism, and helplessness/hopelessness. CONCLUSIONS MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs. Findings indicate psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery.
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Affiliation(s)
| | - Tim Hoyt
- Madigan Army Medical Center, Tacoma, Washington.
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2
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Hawkins LK, Burns L, Swancutt D, Moghadam S, Pinkney J, Tarrant M. Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews. Obes Rev 2024; 25:e13798. [PMID: 38952041 DOI: 10.1111/obr.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/10/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.
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Affiliation(s)
- Lily K Hawkins
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Lorna Burns
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Dawn Swancutt
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Shokraneh Moghadam
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Jonathan Pinkney
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
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3
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Benamran D, Chierici A, Bulsei J, Fontas E, Iannelli A. A Comprehensive Insight into the Economic Profile of People Receiving Metabolic and Bariatric Surgery Use in France. Obes Surg 2024; 34:3315-3323. [PMID: 39129041 DOI: 10.1007/s11695-024-07377-0] [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: 01/16/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The use of metabolic and bariatric surgery (MBS) is not uniformly distributed within the population, even if it is governed by established guidelines. This disparity seems to be associated, among other factors, with the economic profile of people receiving this surgery. OBJECTIVES We investigated the disparities in the use of MBS with respect to the socio-economic level in France based on socio-economic status (SES). MATERIALS AND METHODS A descriptive observational study was conducted to compare the population of individuals with obesity who underwent MBS (MBS group) with individuals with obesity with no history of MBS (obese group). Data were extracted from the French National Hospital discharge database ("Programme De Médicalisation des Systèmes d'Information," PMSI). Socio-economic status (SES) was assessed through the French Deprivation Index (FDep). RESULTS The use of MBS was significantly lower in patients having a higher SES compared to those having a lower one. There was no statistically significant difference in the use of MBS between individuals within the 4th and 5th SES quintiles compared to those in the 2nd and 3rd quintiles. No difference was found in the specific MBS procedures used depending on the SES. The obesity level was significantly lower in patients from the 1st and 3rd SES quintiles compared to the patients having a lower SES. CONCLUSION Our study provides valuable insights into the complex interrelationships between the use of MBS, patients' SES, and obesity levels according to the FDep. These findings underscore the importance of developing targeted interventions to address disparities in the use of bariatric care.
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Affiliation(s)
- Dorith Benamran
- University of Côte d'Azur, Nice, France
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France
| | - Andrea Chierici
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France
| | - Julie Bulsei
- Department of Clinical Research, University Hospital of Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research, University Hospital of Nice, Nice, France
| | - Antonio Iannelli
- University of Côte d'Azur, Nice, France.
- Department of Digestive Surgery, Hopital Archet, University Hospital of Nice, Nice, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France.
- Adipocible Research Consortium (Université Nice Côte d'Azur and Idex), Nice, France.
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Archet 2 HospitalNice, 151 Route Saint Antoine de Ginestière, BP 3079, Cedex 3, Nice, France.
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Matteo MV, Gualtieri L, Bove V, Palumbo G, Pontecorvi V, De Siena M, Barbaro F, Spada C, Boškoski I. Endoscopic sleeve gastroplasty for metabolic dysfunction-associated steatotic liver disease. Expert Rev Gastroenterol Hepatol 2024; 18:397-405. [PMID: 39234763 DOI: 10.1080/17474124.2024.2387231] [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: 02/07/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly nonalcoholic fatty liver disease - NAFLD) is a chronic liver condition linked to obesity and metabolic syndrome. It affects one-third of people globally and, in some cases, can lead to metabolic dysfunction-associated steatohepatitis (MASH, formerly nonalcoholic steatohepatitis, NASH) and fibrosis. Weight loss is crucial for the treatment of MASLD, but diet and lifestyle modifications often fail. AREAS COVERED In recent years, endoscopic sleeve gastroplasty (ESG) has gained popularity as an effective and minimally invasive option for obesity treatment, with widespread use worldwide. We present a current overview of the most significant studies conducted on ESG for the management of obesity and MASLD. Our report includes data from published studies that have evaluated the impact of ESG on noninvasive hepatic parameters used to estimate steatosis and fibrosis. However, at present, there are no data available on liver histology. EXPERT OPINION ESG has shown promising results in treating MASLD evaluated by noninvasive tests, but current data is limited to small, nonrandomized studies. More research is needed, particularly on the effects of ESG on histologically proven MASH. If future research confirms its efficacy, ESG may be incorporated into treatment guidelines in the future.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulia Palumbo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Gudzune KA, Kaplan LM, Kahan S, Kumar RB, Dunn JP, Ahmad NN, Poon JL, Sims TJ, Mackie DS, Jauregui AK, Balkaran BL, Kan H, Ard J. Weight-Reduction Preferences Among OBSERVE Study Participants With Obesity or Overweight: Opportunities for Shared Decision-Making. Endocr Pract 2024:S1530-891X(24)00564-0. [PMID: 38901731 DOI: 10.1016/j.eprac.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Limited recent evidence exists regarding weight-reduction preferences among people with obesity in the United States (US). We assessed preferred magnitudes of weight reduction among adults with obesity and how these preferences differ by participant characteristics. METHODS The Perceptions, Barriers, and Opportunities for Anti-obesity Medications in Obesity Care: A Survey of Patients, Providers and Employers was a cross-sectional study assessing perceptions of obesity and anti-obesity medications among people with obesity, healthcare providers, and employers in the US. Adults with obesity and overweight with obesity-related complications self-reported current weight and weight they associated with 5 preferences ("dream," "goal," "happy," "acceptable," and "disappointed.") Preferred percent weight reductions for each preference were calculated. Multivariable regression analyses were performed identifying associations between weight-reduction preferences and participant characteristics. RESULTS The study included 1007 participants (women: 63.6%; White: 41.0%; Black or African American: 28.9%; Asian: 6.5%; Hispanic: 15.3%; and median body mass index (BMI): 34.2 kg/m2). Median preferred percent weight reductions were dream = 23.5%; goal = 16.7%; happy = 14.6%; acceptable = 10.3%; and disappointed = 4.8%. Women reported higher preferred weight reductions than men. Preferred weight reductions among Black/African American participants were lower than White participants. Regression analyses indicated significant associations, with higher preferred magnitudes of weight reduction within females, higher weight self-stigma, and BMI class in Hispanic participants compared to White. CONCLUSION In this large, real-world study, preferred magnitudes of weight reduction exceeded outcomes typically achieved with established nonsurgical obesity treatments but may be attained with bariatric procedures and newer and emerging anti-obesity medications. Respecting patients' preferences for treatment goals with obesity management could help support shared decision-making. Evaluating for an individual's contributors to weight preferences, such as weight self-stigma, can further benefit holistic obesity care.
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Affiliation(s)
- Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lee M Kaplan
- The Obesity and Metabolism Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Scott Kahan
- National Center for Weight and Wellness, George Washington University School of Medicine, Washington, District of Columbia
| | - Rekha B Kumar
- Comprehensive Weight Control Center, Weill Cornell Medical College, New York, New York
| | - Julia P Dunn
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, Indiana
| | - Nadia N Ahmad
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, Indiana
| | - Jiat Ling Poon
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, Indiana
| | - Tracy J Sims
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, Indiana
| | | | - Adam K Jauregui
- Cerner Enviza, Real-World Evidence, North Kansas City, Missouri
| | | | - Hong Kan
- Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, Indiana.
| | - Jamy Ard
- Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Garcia FK, Mulder BC, Hazebroek EJ, Koelen MA, Veen EJ, Verkooijen KT. Bariatric surgery stigma from the perspective of patients: A scoping review. J Adv Nurs 2024; 80:2252-2272. [PMID: 38018285 DOI: 10.1111/jan.15994] [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: 05/28/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
AIMS To explore the experiences and consequences of bariatric surgery stigma from the perspective of bariatric surgery patients and to identify knowledge gaps in the literature. DESIGN A scoping review. DATA SOURCES Studies published between December 2002 and January 2022 were identified from the following databases: PubMed, Web of Science, PsycINFO and MEDLINE. REVIEW METHODS We screened 3092 records and included 28 studies. Findings were grouped thematically using the health stigma discrimination framework. RESULTS Patients experienced several types of stigmas, including perceived, experienced, anticipated and internalized stigma, related to undergoing bariatric surgery. Patients were confronted with negative comments and judgement from others when they disclosed their decision to have surgery or when they revealed that they had undergone surgery. These experiences led to conflicts in the decision-making process, such as delaying the choice for surgery, seeking surgery abroad or opting out. Patients who internalized stigma often reported feelings of shame and embarrassment for choosing surgery and felt the need for secrecy or selective disclosure. Stigma experiences were influenced by gender and differed between different subgroups of patients. CONCLUSION The stigma surrounding bariatric surgery has detrimental consequences for eligible individuals and bariatric surgery patients. However, the evidence from patients' perspective remains limited. More research into patient's experiences is needed to improve patient care and further educate healthcare professionals. In addition, to better understand the nature and implications of bariatric surgery stigma, future research should be founded on stigma theories and distinguish between the different types of stigmas. IMPACT This scoping review contributes to a better understanding of the implications the stigma surrounding bariatric surgery has for bariatric surgery patients before and after surgery. The knowledge generated by this review can inform improvements in the education and management of people living with obesity and bariatric surgery patients. REPORTING METHOD The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. PROTOCOL REGISTRATION A protocol was not registered for this scoping review.
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Affiliation(s)
- Franshelis K Garcia
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Bob C Mulder
- Strategic Communication, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Eric J Hazebroek
- Human Nutrition and Health, Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, The Netherlands
- Department of Bariatric Surgery, Vitalys, Rijnstate Hospital, Arnhem, The Netherlands
| | - Maria A Koelen
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Esther J Veen
- Rural Sociology, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
- Aeres University of Applied Science, Almere, The Netherlands
| | - Kirsten T Verkooijen
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
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7
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Matteo MV, Bove V, Ciasca G, Carlino G, Di Santo R, Vinti L, Polidori G, Pontecorvi V, Papi M, Spada C, Boškoski I. Success Predictors of Endoscopic Sleeve Gastroplasty. Obes Surg 2024; 34:1496-1504. [PMID: 38451369 PMCID: PMC11031450 DOI: 10.1007/s11695-024-07109-4] [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: 09/20/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that proved to be safe and effective in obesity treatment. However, not all subjects respond to treatment in the same way, and, with a view to personalized care, it is essential to identify predictors of success or failure. METHODS A retrospective 2-year followed-up cohort of ESG subjects was analyzed to investigate the presence of any baseline or early indicators of long-term optimal or suboptimal ESG outcomes. RESULTS A total of 315 subjects (73% women) were included, with 73% of patients exhibiting an Excess weight loss percentage (%EWL) >25% at the 24 months. Neither demographic parameters (age and sex), smoking habits, and menopause in women nor the presence of comorbidities proved potential predictive value. Interestingly, the %EWL at 1 month after ESG was the strongest predictor of 24-month therapeutic success. Subsequently, we estimated an "early threshold for success" for 1 month-%EWL by employing Youden's index method. CONCLUSIONS ESG is a safe and effective bariatric treatment that can be offered to a wide range of subjects. Early weight loss seems to impact long-term ESG results significantly and may allow proper early post-operative care optimization.
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Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Giorgio Carlino
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Riccardo Di Santo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Laila Vinti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Giulia Polidori
- Department of Translational and Precision Medicine, Sapienza University of Rome, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Massimiliano Papi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Roma, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, 00168, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, 00168, Roma, Italy
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Maselli DB, Donnangelo LL, Coan B, McGowan CE. How to establish an endoscopic bariatric practice. World J Gastrointest Endosc 2024; 16:178-186. [PMID: 38680199 PMCID: PMC11045351 DOI: 10.4253/wjge.v16.i4.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/28/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Obesity is a chronic, progressive, and relapsing disease of excess adiposity that contributes to more than two hundred medical conditions and is projected to affect more than half the adult population of the United States by the year 2030. Given the limited penetrance of traditional bariatric surgery, as well as the cost and adherence barriers to anti-obesity medications, there is growing interest in the rapidly evolving field of endoscopic bariatric therapies (EBTs). EBTs are minimally invasive, same-day, per-oral endoscopic procedures and include endoscopic sleeve gastroplasty, intragastric balloons, and endoscopic bariatric revisional procedures. This field represents an exciting and innovative subspecialty within gastroenterology. However, building a successful endoscopic bariatric practice requires intentional, coordinated, and sustained efforts to overcome the numerous obstacles to entry. Common barriers include acquisition of the technical and cognitive skillset, practice limitations including the availability of nutrition counseling, facility capabilities, direct-to-consumer marketing, and financial pressures such as facility and anesthesia fees. As the highest-volume center for metabolic and bariatric endoscopy in the United States, we provide insights into successfully establishing an endoscopic bariatric program.
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Affiliation(s)
- Daniel B Maselli
- Clinical Research, True You Weight Loss, Atlanta, GA 30342, United States
| | | | - Brian Coan
- Clinical Research, True You Weight Loss, Cary, NC 27513, United States
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Evans LL, Lee WG, Karimzada M, Patel VH, Aribindi VK, Kwiat D, Graham JL, Cummings DE, Havel PJ, Harrison MR. Evaluation of a Magnetic Compression Anastomosis for Jejunoileal Partial Diversion in Rhesus Macaques. Obes Surg 2024; 34:515-523. [PMID: 38135738 PMCID: PMC10810932 DOI: 10.1007/s11695-023-07012-4] [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: 08/09/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Metabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model. MATERIALS AND METHODS Using an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight). RESULTS Device mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p < 0.05). Total weight also decreased in a linear fashion (R2 = 0.97) with total weight loss at 6 weeks post-device placement of 14.4% (p < 0.05). CONCLUSION The use of this novel magnetic compression device to create a limited caliber side-to-side jejunoileal anastomosis is safe and likely feasible in a nonhuman primate model. The observed glucoregulatory and metabolic effects of a partial jejunoileal bypass with this device warrant further investigation to validate the long-term glucometabolic impact of this approach.
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Affiliation(s)
- Lauren L Evans
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - William G Lee
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Mohammad Karimzada
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Veeshal H Patel
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Vamsi K Aribindi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Dillon Kwiat
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - James L Graham
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - David E Cummings
- Division of Metabolism, Endocrinology and Nutrition, University of Washington and VA Puget Sound Health Care System, Seattle, USA
| | - Peter J Havel
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California Davis, Davis, USA
| | - Michael R Harrison
- Department of Surgery, University of California San Francisco, San Francisco, USA.
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10
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Alanazi RH, Hussain MA, Alanazi RH, Alanazi SR, Alanazi RMK, Fawzy MS. Prevalence and Awareness of Obesity and Bariatric Surgeries in the Northern Borders Region, Saudi Arabia. Cureus 2023; 15:e50261. [PMID: 38196425 PMCID: PMC10775188 DOI: 10.7759/cureus.50261] [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: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Obesity is a complex health issue affecting millions worldwide, characterized by excessive body fat accumulation, often leading to various health complications. Bariatric surgeries are effective interventions for severe obesity, assisting patients in attaining substantial weight reduction and enhancing their overall well-being. This study aimed to assess obesity patterns and bariatric surgery prevalence in the Northern Borders region of Saudi Arabia to increase community knowledge and awareness about obesity and bariatric surgery. Methods This cross-sectional study included 386 residents in the Northern Borders region, Saudi Arabia. The participants completed a previously validated self-administered electronic questionnaire, and the confidentiality of the collected data was ensured. Results Nearly 58.3% of the participants (31-40 years), with a predominance of females, had a body mass index (BMI) >30, and 33.7% had undergone bariatric surgery. Most participants (92.5%) were aware that obesity is associated with significant medical issues, 98.2% appreciated that there is a surgical method to reduce weight, and 58.8% indicated that the procedure was not safe. Additionally, the majority of the respondents (57.0%) were not sure about the complications of weight-loss surgeries, and only 28.0% knew that surgeries for obesity and their complications may lead to death. Significant associations were found between age, education level, and BMI concerning the knowledge of obesity/bariatric surgery (p=0.003, 0.001, 0.002), respectively. However, gender and work status did not show such associations (p> 0.05). Conclusion Our study highlighted a lack of knowledge among the community regarding the safety, potential complications, and survival outcomes associated with obesity and bariatric surgery that could be due to ignorance and reluctance to pursue bariatric surgery to overcome morbid obesity. Significantly, the study found a relationship between age, education level, BMI, and knowledge of obesity and bariatric surgery.
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Affiliation(s)
| | - Malik A Hussain
- Department of Surgery, Northern Border University, Arar, SAU
| | | | - Saja R Alanazi
- College of Medicine, Northern Border University, Arar, SAU
| | | | - Manal S Fawzy
- Department of Biochemistry, Northern Border University, Arar, SAU
- Unit of Medical Research and Graduate Studies, Northern Border University, Arar, SAU
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11
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Piester TL, Jagtap N, Kalapala R. Review of paediatric obesity and non-alcoholic fatty liver disease-A focus on emerging non-pharmacologic treatment strategies. Pediatr Obes 2023; 18:e13067. [PMID: 37602954 DOI: 10.1111/ijpo.13067] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non-pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy-based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric-focused clinical trials, is essential for these emerging modalities.
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Affiliation(s)
- Travis L Piester
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nitin Jagtap
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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12
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Lee S, Supparamaniam S, Varghese C, Mahawar K. Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:2884-2897. [PMID: 37526816 DOI: 10.1007/s11695-023-06762-5] [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: 04/11/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Marginal ulcer (MU) is an uncommon but significant complication following one-anastomosis gastric bypass (OAGB). Our study aims to understand the incidence rates, risk factors, and management of MU following OAGB. METHODS MEDLINE, Scopus, and Cochrane Library databases were examined to identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition. RESULTS Thirty-two studies involving 8868 patients were analysed. The mean age and body mass index (BMI) of patients in these studies were 40.9 ± 4.5 years and 47.6 ± 5.6 kg/m2, respectively. Among the patient cohort, approximately 72% were female, and 20.6% had preoperative gastroesophageal reflux disease (GERD). The authors described prescribing proton-pump inhibitors (PPI) prophylaxis to 14.1% of patients after surgery. Two hundred twenty-eight patients were reported to have MU. The incidence of MU was 2.59% (95% CI 1.89-3.52), of which 53 patients presented within 12 months, 24 patients presented after 31 months, and five patients after 6 years. One hundred forty-six patients did not have presentation time documented. Sixty-five patients were described to have MU diagnosed on endoscopy, of which 54 were symptomatic and 11 were asymptomatic. The authors were, however, not specific on the choice of investigation for the remaining 163 patients. Of patients, 89.7% were treated conservatively with PPIs, whilst 10.3% had surgery to treat MU. CONCLUSIONS Marginal ulcer is an uncommon complication following OAGB. The majority of patients are treated conservatively with PPIs. Larger, well-designed studies reporting on risk factors, investigation, and management of MU following OAGB are warranted.
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Affiliation(s)
- Shiela Lee
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK.
| | | | - Chris Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
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13
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Ngenge S, Xie L, McAdams C, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Marroquin E, Francis J, Kukreja S, Schneider BE, Messiah SE. Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients. Obes Surg 2023; 33:2166-2175. [PMID: 37217806 PMCID: PMC10202355 DOI: 10.1007/s11695-023-06652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. METHODS This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. RESULTS The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men. CONCLUSIONS Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.
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Affiliation(s)
- Sophia Ngenge
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, TX, USA.
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14
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Kadkhodayan K, Viana A, Singh S, Cosgrove N, Jain D, Yang D, Arain MA, Irani S, Hasan MK. Ultrasound Assisted Endoscopic Gastric Bypass (USA-EGB): a potential endoscopic alternative to surgical bypass, a pre-clinical proof of concept study. Endosc Int Open 2023; 11:E581-E587. [PMID: 37564728 PMCID: PMC10410691 DOI: 10.1055/a-2085-3866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/27/2023] [Indexed: 08/12/2023] Open
Abstract
Background and study aims Endoscopic weight loss procedures have gained traction as minimally invasive options for the primary treatment of obesity. Thus far, we have developed endoscopic procedures that reliably address gastric restriction but result in significantly less weight loss than surgical gastrointestinal bypass. The goal of this nonsurvival study was to assess the technical feasibility of an endoscopic procedure, that incorporates both gastric restriction and potentially reversible gastrointestinal bypass. Methods Ultrasound-assisted endoscopic gastric bypass (USA-EGB) was performed in three consecutive live swine, followed by euthanasia and necropsy. Procedure steps were: 1) balloon-assisted enteroscopy that determines the length of the bypassed limb; 2) endoscopic ultrasound-guided gastroenterostomy that creates a gastrointestinal anastomosis using a lumen apposing metal stent; 3) endoscopic pyloric exclusion that disrupts transpyloric continuity resulting in complete gastrointestinal bypass; and 4) gastric restriction that reduces gastric volume. Results Complete gastrointestinal bypass and gastric restriction was achieved in all three swine. The mean total procedure time was 131 minutes (range 113-143), mean length of the bypassed limb was 92.5 cm and 180 cm, using short and long overtubes, respectively. There were no significant complications. Conclusions We successfully described USA-EGB in three consecutive live swine. Further studies are needed to access the procedures safety, efficacy, and clinical use.
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Affiliation(s)
- Kambiz Kadkhodayan
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Artur Viana
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Sanmeet Singh
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Natalie Cosgrove
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Deepanshu Jain
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Dennis Yang
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Mustafa A Arain
- Center For Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Shayan Irani
- Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
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15
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Zareen M, Bashir M, Khan S, Maroof A. Apprehensions of Morbidly Obese People Regarding Bariatric Surgery. Cureus 2023; 15:e37098. [PMID: 37153320 PMCID: PMC10158567 DOI: 10.7759/cureus.37098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Obesity has emerged as a major public health issue in both developed and developing countries. The prevalence of obesity is on the rise. Bariatric surgery is acknowledged as the most effective and safe solution for this problem. It has been shown to be effective in sustained weight loss and improving quality of life. The aim of this study was to identify the causes of reluctance to have surgery among patients who were potential candidates for weight loss procedures. Method Morbidly obese people who were enrolled at Khyber Teaching Hospital, Peshawar, from December 2021 to August 2022 were included in the study. It included hospitalized as well as outpatient appointments. A questionnaire was adopted as the data collection tool. Result A total of 107 patients (58 men and 49 women) were enrolled in the study. The median age was 42. Of the 107 patients, 5% (n=5) of the patients were super morbidly obese (BMI >50kg/m2). Seventy-two percent (n=77) of the population considered themselves morbidly obese. Only 22% (n=24) were physically active. Twenty percent (n=21) of the patients reported that they have or are currently trying dietary modifications for weight loss. Young females were most likely to be on dieting programs. Importantly, 56% (n=60) had never heard of bariatric surgery. Exploring the reasons for reluctance among patients revealed that the concern for surgical mortality was the major hindrance. This was followed by being not interested in committing to surgery and recovery. Concerns regarding cost and financing were also the reasons candidates didn't opt for surgical procedures to treat obesity. Conclusion The study concluded that there is a serious lack of knowledge and awareness among physicians and the general public regarding bariatric surgery. Most of the patients who were potential candidates for the procedure weren't aware that obesity had a surgical and definitive treatment. Patients who were aware of the surgical procedure were hesitant to undergo surgery for the management of their weight as they harbored misconceptions, particularly regarding the safety and efficacy of the procedure.
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Affiliation(s)
- Muhammad Zareen
- Department of General Surgery, Khyber Medical College, Khyber Teaching Hospital, Peshawar, PAK
| | - Mutahar Bashir
- Department of Health and Nutrition, Helping Hand for Relief and Development, Islamabad, PAK
- Department of General Surgery, Khyber Medical College, Khyber Teaching Hospital, Peshawar, PAK
| | - Shahzeb Khan
- Department of General Surgery, Khyber Medical College, Khyber Teaching Hospital, Peshawar, PAK
| | - Asad Maroof
- Department of General Surgery, Khyber Medical College, Khyber Teaching Hospital, Peshawar, PAK
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16
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Rajeev ND, Samaan JS, Premkumar A, Srinivasan N, Yu E, Samakar K. Patient and the Public's Perceptions of Bariatric Surgery: A Systematic Review. J Surg Res 2023; 283:385-406. [PMID: 36434835 DOI: 10.1016/j.jss.2022.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bariatric surgery is an effective therapeutic modality for obesity and related comorbidities, yet it remains significantly underutilized. Patient perceptions and expectations may influence the decisions of eligible patients in pursuing surgery. METHODS PubMed, SCOPUS, and OVID databases were searched in July 2022 to identify published studies discussing patient and the public's perceptions of bariatric surgery. RESULTS The literature shows participants often reported bariatric surgery to be a life-changing intervention known to induce weight loss, improve obesity-related comorbidities, and improve quality of life. However, a significant proportion of survey respondents perceived bariatric surgery as unsafe or risky. Patients belonging to racial minority groups cited higher concern with mortality risk, lower weight loss expectations, and different motivations to pursue bariatric surgery. Female patients were significantly more likely to have more positive perceptions of, and higher expectations of weight loss from, bariatric surgery. CONCLUSIONS The literature highlighted discordance between patient perceptions and the demonstrated clinical safety and efficacy profile of bariatric surgery. Overestimations of the risks, unrealistic expectations, and unfamiliarity with bariatric surgery outcomes were common findings. These perceptions of bariatric surgery may contribute to its underutilization among eligible patients. Perceptions and motivations often varied by race, region, sex, and age, which demonstrates the necessity of patient-centered education in the prereferral stage. The literature also demonstrated misconceptions of bariatric surgery among the public. Further research should explore the impact of education on the perceptions of patients and the public.
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Affiliation(s)
- Nithya D Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Agnes Premkumar
- Department of General Surgery, Creighton University of Phoenix, Phoenix, Arizona
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Erin Yu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California.
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17
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Currie A, Bolckmans R, Askari A, Byrne J, Ahmed AR, Batterham RL, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R. Bariatric-metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry. Diabet Med 2023; 40:e15041. [PMID: 36648127 DOI: 10.1111/dme.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023]
Abstract
AIM Bariatric-metabolic surgery is approved by the National Institute of Health and Care Excellence (NICE) for people with severe obesity and type 2 diabetes (T2DM) (including class 1 obesity after 2014). This study analysed baseline characteristics, disease severity and operations undertaken in people with obesity and T2DM undergoing bariatric-metabolic surgery in the UK National Health Service (NHS) compared to those without T2DM. METHODS Baseline characteristics, trends over time and operations undertaken were analysed for people undergoing primary bariatric-metabolic surgery in the NHS using the National Bariatric Surgical Registry (NBSR) for 11 years from 2009 to 2019. Clinical practice before and after the publication of the NICE guidance (2014) was examined. Multivariate logistic regression was used to determine associations with T2DM status and the procedure undertaken. RESULTS 14,948/51,715 (28.9%) participants had T2DM, with 10,626 (71.1%) on oral hypoglycaemics, 4322 (28.9%) on insulin/other injectables, and with T2DM diagnosed 10+ years before surgery in 3876 (25.9%). Participants with T2DM, compared to those without T2DM, were associated with older age (p < 0.001), male sex (p < 0.001), poorer functional status (p < 0.001), dyslipidaemia (OR: 3.58 (CI: 3.39-3.79); p < 0.001), hypertension (OR: 2.32 (2.19-2.45); p < 0.001) and liver disease (OR: 1.73 (1.58-1.90); p < 0.001), but no difference in body mass index was noted. Fewer people receiving bariatric-metabolic surgery after 2015 had T2DM (p < 0.001), although a very small percentage increase of those with class I obesity and T2DM was noted. Gastric bypass was the commonest operation overall. T2DM status was associated with selection for gastric bypass compared to sleeve gastrectomy (p < 0.001). CONCLUSION NHS bariatric-metabolic surgery is used for people with T2DM much later in the disease process when it is less effective. National guidance on bariatric-metabolic surgery and data from multiple RCTs have had little impact on clinical practice.
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Affiliation(s)
- Andrew Currie
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Roel Bolckmans
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Alan Askari
- Department of Bariatric Surgery, Bedfordshire Hospitals NHS Trust, Luton, UK
| | - James Byrne
- Department of Upper GI and Bariatric Surgery, University Hospital Southampton, Southampton, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Alexander Dimitri Miras
- School of Medicine, Ulster University, Ulster, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chris M Pring
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Sussex (St Richard's Hospital), Chichester, UK
| | - Peter K Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
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Maselli DB, Hoff AC, Kucera A, Waseem A, Wooley C, Donnangelo LL, Coan B, McGowan CE. Endoscopic revision of one-anastomosis gastric bypass (ER-OAGB) for weight recurrence: a case series of 17 adults. Ther Adv Gastrointest Endosc 2023; 16:26317745231210120. [PMID: 38026683 PMCID: PMC10666552 DOI: 10.1177/26317745231210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Weight recurrence after one-anastomosis gastric bypass (OAGB), the third most common metabolic and bariatric surgery performed worldwide, is observed in a subset of patients due to the chronic, progressive nature of obesity. Endoscopic revision of the OAGB (ER-OAGB) through full-thickness suturing to reduce the gastrojejunal anastomosis and gastric pouch is a potential alternative to surgical revision. Here, we present a case series of ER-OAGB and long-term nutritional support at two international centers with expertise in bariatric endoscopy. Data were retrospectively evaluated from a prospectively maintained database. The primary outcome was total body weight loss (TBWL) at 12 months. Secondary outcomes included TBWL at 3, 6, and 15 months; excess weight loss (EWL) at 3, 6, 12, and 15 months; frequency of new/worsening symptoms of gastroesophageal reflux disease (GERD); and the frequency of serious adverse events. In this series, 17 adults (70.6% female, mean age 46.8 years, mean BMI 39.1 kg/m2) successfully underwent ER-OAGB an average of 8 years (range 2-21 years) after OAGB for a mean weight recurrence of 43.2% (range 10.9-86.9%). TBWL from ER-OAGB was 9.7 ± 1.8% at 3 months, 13.4 ± 3.5% at 6 months, 18.5 ± 2.1% at 12 months, and 18.1 ± 2.2% at 15 months. EWL from ER-OAGB was 30.5 ± 14.7% at 3 months, 42.6 ± 16.2% at 6 months, 54.2 ± 11.3% at 12 months, and 54.2 ± 11.7% at 15 months. There were no instances of new/worsening GERD symptoms or serious adverse events. In this small series of adults who experienced weight recurrence after OAGB, ER-OAGB facilitated safe and clinically meaningful weight loss, without new or worsening GERD symptoms, when performed by experienced bariatric endoscopists in concert with longitudinal nutritional support.
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Affiliation(s)
| | | | | | | | | | | | | | - Christopher E. McGowan
- Medical Director and Research Director, True You Weight Loss, 2001 Weston Parkway, Cary, NC 27513, USA
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19
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Xie L, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Ngenge S, Marroquin EM, McAdams C, Kukreja S, Schneider B, Messiah SE. Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults. JAMA Netw Open 2022; 5:e2247431. [PMID: 36534399 PMCID: PMC9856898 DOI: 10.1001/jamanetworkopen.2022.47431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Metabolic and bariatric surgery (MBS) is an effective and safe treatment for obesity and its comorbidities, but less than 50% of those who are eligible and referred for MBS complete the procedure. The patient-physician relationship could be a decisive factor in the decision to complete MBS; however, this relationship has not been explored, particularly among racially and ethnically diverse populations. OBJECTIVE To examine the association between patient-reported satisfaction with their patient-physician relationship and MBS completion by self-reported racial and ethnic group. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 408 patients who were referred to a bariatric surgeon or obesity medicine program between July 24, 2019, and May 19, 2022. EXPOSURE Patient satisfaction with their physician was measured by 7 dimensions (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physician, and accessibility and convenience) using the Patient Satisfaction Questionnaire Short Form. MAIN OUTCOMES AND MEASURES Completion status for MBS (yes or no). RESULTS A total of 408 patients (mean [SD] age, 47.3 [11.6] years; among 366 with data available, 317 [86.6%] women and 49 [13.4%] men) were included in the study. Of 363 patients with data available on race and ethnicity, 66 were Hispanic/Latinx (18.2%), 136 (37.5%) were non-Hispanic Black, 146 (40.2%) were non-Hispanic White, and 15 (4.1%) were other race or ethnicity. A total of 124 patients (30.4%) completed MBS. Overall, the mean (SD) patient satisfaction score was significantly greater in MBS completers vs noncompleters (3.86 [0.56] vs 3.61 [0.64]; P < .001). Multivariable logistic regression analysis showed technical quality was the most significant factor for MBS completion (adjusted odds ratio [aOR], 1.99 [95% CI, 1.24-3.19]), followed by communication (aOR, 1.78 [95% CI, 1.16-2.72]) and accessibility and convenience (aOR, 1.61 [95% CI, 1.03-2.53]). The interaction between racial and ethnic groups and patient satisfaction was not significant (eg, mean [SD] score for Hispanic/Latinx completers, 3.95 [0.55] vs 3.77 [0.60] for non-Hispanic White completers; P = .46 for interaction). CONCLUSIONS AND RELEVANCE These findings suggest that there is an association between patient satisfaction with the patient-physician relationship and the decision to complete MBS regardless of race and ethnicity. These findings have important implications for strategies to improve the proportion of qualified patients who complete MBS to achieve improved health outcomes.
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Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Jaime P. Almandoz
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - M. Sunil Mathew
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Jeffrey N. Schellinger
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Olivia Kapera
- School of Public Health, University of Texas Health Science Center, Dallas
- School of Public Health, University of Texas Health Science Center, Austin
| | - Sophia Ngenge
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Elisa Morales Marroquin
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | | | - Benjamin Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Sarah E. Messiah
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
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20
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Chao GF, Diaz A, Ghaferi AA, Dimick JB, Byrnes ME. Questioning the legitimacy of bariatric surgery: a qualitative analysis of individuals from the community who qualify for bariatric surgery. Surg Endosc 2022; 36:6733-6741. [PMID: 34981224 PMCID: PMC8722749 DOI: 10.1007/s00464-021-08949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how individuals in the community who qualify for bariatric surgery perceive it and how this affects their likelihood to consider it for themselves. This study is the first qualitative study of a racially and ethnically diverse cohort to understand perceptions of bariatric surgery. METHODS We designed a descriptive study to understand attitudes about bariatric surgery. We interviewed 32 individuals who met NIH criteria for bariatric surgery but have never considered bariatric surgery. We purposively sampled to ensure the majority of participants were non-white. Using an Interpretive Description framework, an exploratory, iterative method was used to code interviews and arrive at final themes. RESULTS Participants self-identified as 88% female, 75% Black, 3% Hispanic, 3% Pacific Islander, and 19% white. Three major themes emerged from our data regarding legitimacy of bariatric surgery. First, participants perceived bariatric surgery to be something commercialized rather than needed treatment. They equated bariatric surgery with "botulism of the lips" or "cool sculpting." Second, an important contributor to the lack of legitimacy as a medical treatment was that many had not heard about bariatric surgery before from their doctors. Doctors were trusted sources for legitimate information about health. Lastly, conflicting information over bariatric surgery-related diet and weight loss further diminished the legitimacy of bariatric surgery. As one participant reflected about pre-operative weight loss requirements, "[If] I'm going to do that, I might as well just keep losing the weight. Why even go do the surgery?". CONCLUSION Though bariatric surgery is a safe, effective, and durable therapy for patients with obesity, the majority of individuals we interviewed had concerns over the legitimacy of bariatric surgery as a medical treatment. Moving forward in reaching out to communities about bariatric surgery, healthcare providers and systems should consider the presentation of information to attenuate these concerns.
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Affiliation(s)
- Grace F Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Building 14, Suite G100, Ann Arbor, MI, 48109, USA.
- Veterans Affairs Ann Arbor, Ann Arbor, MI, USA.
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Adrian Diaz
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Building 14, Suite G100, Ann Arbor, MI, 48109, USA
- Veterans Affairs Ann Arbor, Ann Arbor, MI, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amir A Ghaferi
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mary E Byrnes
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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21
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Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry. Int J Obes (Lond) 2022; 46:2163-2167. [PMID: 36008680 DOI: 10.1038/s41366-022-01217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
Despite its cardiometabolic benefits, bariatric surgery has historically been underused in patients with obesity and diabetes, but contemporary data are lacking. Among 1,520,182 patients evaluated from 2013 to 2019 within a multicenter, longitudinal, US registry of outpatients with diabetes, we found that 462,033 (30%) met eligibility for bariatric surgery. After a median follow-up of 854 days, 6310/384,859 patients (1.6%) underwent primary bariatric surgery, with a slight increase over time (0.38% per year [2013] to 0.68% per year [2018]). Patients who underwent bariatric surgery were more likely to be female (63% vs. 56%), white (87% vs. 82%), have higher body mass indices (42.1 ± 6.9 vs. 40.6 ± 5.9 kg/m2), and depression (23% vs. 14%; p < 0.001 for all). Over a median (IQR) follow-up after surgery of 722 days (364-993), patients who underwent bariatric surgery had lost an average of 11.8 ± 18.5 kg (23% of excess body weight), 10.2% were on fewer glucose-lowering medications, and 8.4% were on fewer antihypertensives. Despite bariatric surgery being safer and more accessible over the past two decades, less than one in fifty eligible patients with diabetes receive this therapy.
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22
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Abu Dayyeh BK, Bazerbachi F, Vargas EJ, Sharaiha RZ, Thompson CC, Thaemert BC, Teixeira AF, Chapman CG, Kumbhari V, Ujiki MB, Ahrens J, Day C, Galvao Neto M, Zundel N, Wilson EB. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet 2022; 400:441-451. [PMID: 35908555 DOI: 10.1016/s0140-6736(22)01280-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an endolumenal, organ-sparing therapy for obesity, with wide global adoption. We aimed to explore the efficacy and safety of ESG with lifestyle modifications compared with lifestyle modifications alone. METHODS We conducted a randomised clinical trial at nine US centres, enrolling individuals aged 21-65 years with class 1 or class 2 obesity and who agreed to comply with lifelong dietary restrictions. Participants were randomly assigned (1:1·5; with stratified permuted blocks) to ESG with lifestyle modifications (ESG group) or lifestyle modifications alone (control group), with potential retightening or crossover to ESG, respectively, at 52 weeks. Lifestyle modifications included a low-calorie diet and physical activity. Participants in the primary ESG group were followed up for 104 weeks. The primary endpoint at 52 weeks was the percentage of excess weight loss (EWL), with excess weight being that over the ideal weight for a BMI of 25 kg/m2. Secondary endpoints included change in metabolic comorbidities between the groups. We used multiple imputed intention-to-treat analyses with mixed-effects models. Our analyses were done on a per-protocol basis and a modified intention-to-treat basis. The safety population was defined as all participants who underwent ESG (both primary and crossover ESG) up to 52 weeks. FINDINGS Between Dec 20, 2017, and June 14, 2019, 209 participants were randomly assigned to ESG (n=85) or to control (n=124). At 52 weeks, the primary endpoint of mean percentage of EWL was 49·2% (SD 32·0) for the ESG group and 3·2% (18·6) for the control group (p<0·0001). Mean percentage of total bodyweight loss was 13·6% (8·0) for the ESG group and 0·8% (5·0) for the control group (p<0·0001), and 59 (77%) of 77 participants in the ESG group reached 25% or more of EWL at 52 weeks compared with 13 (12%) of 110 in the control group (p<0·0001). At 52 weeks, 41 (80%) of 51 participants in the ESG group had an improvement in one or more metabolic comorbidities, whereas six (12%) worsened, compared with the control group in which 28 (45%) of 62 participants had similar improvement, whereas 31 (50%) worsened. At 104 weeks, 41 (68%) of 60 participants in the ESG group maintained 25% or more of EWL. ESG-related serious adverse events occurred in three (2%) of 131 participants, without mortality or need for intensive care or surgery. INTERPRETATION ESG is a safe intervention that resulted in significant weight loss, maintained at 104 weeks, with important improvements in metabolic comorbidities. ESG should be considered as a synergistic weight loss intervention for patients with class 1 or class 2 obesity. This trial is registered with ClinicalTrials.gov, NCT03406975. FUNDING Apollo Endosurgery, Mayo Clinic.
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Affiliation(s)
- Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham & Women's Hospital, Boston, MA, USA
| | | | - Andre F Teixeira
- Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA
| | - Christopher G Chapman
- Center for Endoscopic Research and Therapeutics, University of Chicago, Chicago, IL, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Chicago, IL, USA
| | | | - Courtney Day
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | - Natan Zundel
- Department of Surgery, State University of New York, Buffalo, NY, USA
| | - Erik B Wilson
- Department of Surgery, The University of Texas Health Science Center, Houston, TX, USA
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23
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Tettero OM, Monpellier VM, Janssen IMC, Steenhuis IHM, van Stralen MM. Early Postoperative Weight Loss Predicts Weight Loss up to 5 Years After Roux-En-Y Gastric Bypass, Banded Roux-En-Y Gastric Bypass, and Sleeve Gastrectomy. Obes Surg 2022; 32:2891-2902. [PMID: 35842505 PMCID: PMC9392686 DOI: 10.1007/s11695-022-06166-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose Previous studies showed that patients with lower weight loss after bariatric surgery could be identified based on early postoperative weight loss. However, these studies had only 12–36-month follow-up. This study aimed to explore whether patients in the lowest weight loss quartile at 3 months had lower weight loss trajectories up to 5 years after Roux-en-Y gastric bypass (RYGB), banded Roux-en-Y gastric bypass (BRYGB), and sleeve gastrectomy (SG) surgery. Methods Weight was assessed preoperatively, and 3, 6, 9, 12, 24, 36, 48, and 60 months postoperatively. Patients were grouped into four categories based on quartiles of percentage total weight loss (%TWL) at 3-month follow-up. Results were compared between the lowest %TWL quartile group and other quartile groups. Results Patients underwent either RYGB (n=13,106; 72%), SG (n=3585; 20%), or BRYGB (n=1391, 8%) surgery. Weight loss trajectories of patients in the lowest %TWL quartile group remained lower than that of other quartile groups throughout a 5-year follow-up, for all three types of surgery. Patients in the lowest %TWL quartile group had higher age at surgery, higher baseline BMI, and were more likely to be male (in the SG group), and to suffer from diabetes, hypertension, dyslipidemia, and osteoarthritis. Conclusion This study showed a positive association between weight loss at 3 and 12 to 60 months after bariatric surgery. Weight loss at 3 months after surgery could be used to identify patients whose anticipated weight loss trajectories are below average, to potentially improve their outcomes through early behavioral or medical interventions. Graphical Abstract ![]()
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Affiliation(s)
- Onno M Tettero
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit (VU University) Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands. .,Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, Zeist, the Netherlands.
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, Zeist, the Netherlands
| | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, Zeist, the Netherlands
| | - Ingrid H M Steenhuis
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit (VU University) Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit (VU University) Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands
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24
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Diao X, Gao L, Yang Y, Chen X, Gong J, Qian Y, Yang W. Knowledge and Attitudes Towards Obesity and Bariatric Surgery in University Students: a National Survey. Obes Surg 2022; 32:2869-2879. [PMID: 35729447 DOI: 10.1007/s11695-022-06157-y] [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: 02/13/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity has become a noticeable public health problem, especially in the young population. Bariatric surgery is growing in China but it is still new to the general public. Knowledge and attitudes towards obesity and bariatric surgery in university students are important to national health decision-making. OBJECTIVES To study the knowledge and attitudes towards obesity and bariatric surgery among Chinese university students. METHODS A self-designed questionnaire was distributed to university students to fill in online from June to July 2021. RESULTS A total of 3199 questionnaires were received, with an effective rate of 98.58% (3154 questionnaires). 65.44% of whom had normal BMI and 12.14% of whom were overweight or in obesity. More than 80% of them had a high knowledge of the common causes and complications of obesity but lacked knowledge of the relationship between obesity and bone and joint, tumor or cancer, and reproductive diseases. 51.55% of them thought they needed to lose weight, especially female students (P < 0.01). Only 39% had regular physical exercise habits, 58.62% of them could reasonably control their diet, and more than 2/3 of them (67.82%) often stayed up late. Safety (29.77%) and effectiveness (29.3%) of bariatric surgery were not well accepted. Among medical students, education positively affected knowledge and attitudes towards bariatric surgery (P < 0.05). Mass media and social platforms were the main sources for obtaining obesity and weight-loss information. CONCLUSIONS Chinese university students have insufficient knowledge of obesity and related complications, lack of scientific management of their own weight, and poor acceptance of bariatric surgery. More education is needed on this issue.
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Affiliation(s)
- Xingling Diao
- School of Nursing, Jinan University, Guangzhou, China
| | - Lilian Gao
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Avenue West, Guangzhou, China
| | - Yurou Yang
- School of Nursing, Jinan University, Guangzhou, China
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Avenue West, Guangzhou, China
| | - Jiayu Gong
- School of Nursing, Jinan University, Guangzhou, China
| | - Yuxiu Qian
- Operating Room, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, China.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Avenue West, Guangzhou, China.
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China.
- Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China.
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25
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Widmer J, Gero D, Sommerhalder B, Alceste D, Raguz I, Serra M, Vonlanthen R, Bueter M, Thalheimer A. Online survey on factors influencing patients' motivation to undergo bariatric surgery. Clin Obes 2022; 12:e12500. [PMID: 34878217 PMCID: PMC9285963 DOI: 10.1111/cob.12500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
Given the worldwide increasing prevalence of severe obesity and considering the amount of scientific evidence demonstrating the beneficial effects of bariatric surgery (BS), it is surprising that only a fraction of patients with obesity undergo BS. We therefore conducted an anonymized online survey among individuals with a history of BS to understand factors influencing the deciding process leading to BS. Respondents were recruited on a voluntary basis from obesity-related social media groups between April and June 2020. The self-designed, non-validated questionnaire consisted of 20 questions and was open to any participants with a history of BS. Of 851 participants who started the survey, 665 completed the questionnaire (completion rate of 78.1%). Five years after BS, still 70% of the survey-participants were very satisfied or satisfied with the surgical result. However, the majority (73.3%) would have undergone BS earlier. The main motivation to choose BS was related to health status or quality of life. Important characteristics for a bariatric surgeon to obtain patients' trust are "taking time and listen" (74.7%), empathy (64%) and sympathy (56%). Post-operative satisfaction with the surgical outcome was high and long-lasting in this large cohort of BS patients. However, most participants would retrospectively have undergone BS earlier. The main reason to choose BS as treatment for their obesity were impaired physical health or reduced quality of life. Nearby location to patients' residence and availability of surgeons with empathy were decisive motives for bariatric centre selection.
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Affiliation(s)
- Jeannette Widmer
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Daniel Gero
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | | | - Daniela Alceste
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Ivana Raguz
- Department of SurgerySpital MännedorfMännedorf
| | - Michele Serra
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - René Vonlanthen
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Marco Bueter
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
- Department of SurgerySpital MännedorfMännedorf
| | - Andreas Thalheimer
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
- Department of SurgerySpital MännedorfMännedorf
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26
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Murtha JA, Alagoz E, Breuer CR, Finn A, Raffa SD, Voils CI, Funk LM. Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study. Am J Surg 2021; 224:429-436. [PMID: 34963509 DOI: 10.1016/j.amjsurg.2021.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. METHODS Adults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. RESULTS Of the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its "tipping point," concerns about dietary changes, lack of social support, and patient characteristics influencing referral. CONCLUSIONS Patient and provider education should address patient fears of surgery and the belief that surgery is a "last resort." Bariatric surgery programs should strengthen social support networks for patients.
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Affiliation(s)
- Jacqueline A Murtha
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Catherine R Breuer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Alex Finn
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Susan D Raffa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 905 W Main St, Durham, NC, 27701, USA; Veterans Health Administration National Center for Health Promotion and Disease Prevention, 3022 Croasdaile Dr, Durham, NC, 27705, USA
| | - Corrine I Voils
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Administration, 2500 Overlook Terrace, Madison, WI, 53705, USA.
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27
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The Effects of the Affordable Care Act on Utilization of Bariatric Surgery. Obes Surg 2021; 31:4919-4925. [PMID: 34415519 DOI: 10.1007/s11695-021-05669-3] [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: 06/23/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Affordable Care Act (ACA) expanded Medicaid (ME) and instituted Essential Health Benefits (EHB) that included bariatric surgery coverage on a state-by-state opt-in basis, increasing insurance coverage of bariatric surgery. MATERIALS AND METHODS Using a difference-in-differences framework, changes in bariatric surgery rates, defined as utilization in the population of people with obesity, before and after the ACA were evaluated in four states. Bariatric surgery procedure data were taken from the Healthcare Cost and Utilization Project's State In-patient Database 2012-2015. Adjusted multivariable regressions were run in the Medicaid and commercially insured populations. RESULTS We identified 36,456 bariatric surgeries across the 286 Health Service Areas and time periods, with 31,732 covered by commercial insurers and 4724 covered by Medicaid. An unadjusted increase in utilization rates was seen in the Medicaid and Commercial populations in both ME- and EHB-covered states as well as non-expansion and EHB opt-out states over time. In the Medicaid population, after adjusting for confounders, there was a significant increase of 24.77 cases per 100,000 people with obesity (95% confidence interval: 12.41, 37.13) in the expansion states relative to the control and pre-period. The commercial population experienced a nonsignificant change in the rates of bariatric surgery, decreasing by 2.89 cases per 100,000 people with obesity (95% confidence interval: - 21.59, 15.81). CONCLUSIONS There was a significant increase in bariatric surgery rates among Medicaid beneficiaries associated with Medicaid expansion, but there was no change among the commercially insured.
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Staudenmann DA, Sui Z, Saxena P, Kaffes AJ, Marinos G, Kumbhari V, Aepli P, Sartoretto A. Endoscopic bariatric therapies for obesity: a review. Med J Aust 2021; 215:183-188. [PMID: 34333788 DOI: 10.5694/mja2.51179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
▪ Obesity is reaching pandemic proportions globally, with overweight or obesity affecting at least two-thirds of Australian adults. ▪ Bariatric surgery is an effective weight loss strategy but is constrained by high resource requirements and low patient acceptance. ▪ Multiple endoscopic bariatric therapies have matured, with well established and favourable safety and efficacy profiles in multiple randomised controlled trials (RCTs), and are best used within a multidisciplinary setting as an adjuvant to lifestyle intervention. ▪ Three types of intragastric balloon are currently in use in Australia offering average total weight loss ranging from 10% to 18%, with others available internationally. ▪ Endoscopic sleeve gastroplasty produces average total weight loss of 15-20% with low rates of severe complications, with RCT data anticipated in December 2021. ▪Bariatric and metabolic endoscopy is rapidly evolving, with many novel, promising therapies currently under investigation.
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Affiliation(s)
- Dominic A Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Praxis Balsiger Seibold und Partner, Bern, Switzerland.,Université de Fribourg, Fribourg, Switzerland
| | | | | | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
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29
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Primary Endoscopic Treatments for Obesity. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Thakur A, Sharma D, Gupta B, Kramadhari N, Rajagopal R, Simmons D, Piya MK. Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study. BMC Endocr Disord 2021; 21:55. [PMID: 33757476 PMCID: PMC7988916 DOI: 10.1186/s12902-021-00722-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. METHODS Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017-2019. RESULTS Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the "BMI ≥ 35 group") and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). CONCLUSIONS In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.
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Affiliation(s)
- Arunav Thakur
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Dharmesh Sharma
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Bhavya Gupta
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Nikitha Kramadhari
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
| | - Rohit Rajagopal
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia
| | - Milan Kumar Piya
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, 2560, Australia.
- Macarthur Diabetes Service, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, 2560, Australia.
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Rodgers M, Migdal AL, Rodríguez TG, Chen ZZ, Nath AK, Gerszten RE, Kasid N, Toschi E, Tripaldi J, Heineman B, Phan M, Ngo L, Maratos-Flier E, Dushay J. Weight Loss Outcomes Among Early High Responders to Exenatide Treatment: A Randomized, Placebo Controlled Study in Overweight and Obese Women. Front Endocrinol (Lausanne) 2021; 12:742873. [PMID: 34867786 PMCID: PMC8635796 DOI: 10.3389/fendo.2021.742873] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE As there is significant heterogeneity in the weight loss response to pharmacotherapy, one of the most important clinical questions in obesity medicine is how to predict an individual's response to pharmacotherapy. The present study examines patterns of weight loss among overweight and obese women who demonstrated early robust response to twice daily exenatide treatment compared to those treated with hypocaloric diet and matched placebo injections. METHODS We randomized 182 women (BMI 25-48 kg/m2) to treatment with exenatide alone or matched placebo injections plus hypocaloric diet. In both treatment groups, women who demonstrated ≥ 5% weight loss at 12 weeks were characterized as high responders and those who lost ≥10% of body weight were classified as super responders. Our primary outcome was long-term change in body weight among early high responders to either treatment. An exploratory metabolomic analysis was also performed. RESULTS We observed individual variability in weight loss with both exenatide and hypocaloric diet plus placebo injections. There was a trend toward a higher percentage of subjects who achieved ≥ 5% weight loss with exenatide compared to diet (56% of those treated with exenatide, 76% of those treated with diet, p = 0.05) but no significant difference in those who achieved ≥ 10% weight loss (23% of individuals treated with exenatide and 36% of those treated with diet, p = 0.55). In both treatment groups, higher weight loss at 3 months of treatment predicted super responder status (diet p=0.0098, exenatide p=0.0080). Both treatment groups also demonstrated similar peak weight loss during the study period. We observed lower cysteine concentrations in the exenatide responder group (0.81 vs 0.48 p < 0.0001) and a trend toward higher levels of serotonin, aminoisobutyric acid, anandamide, and sarcosine in the exenatide super responder group. CONCLUSION In a population of early high responders, longer term weight loss with exenatide treatment is similar to that achieved with a hypocaloric diet. CLINICAL TRIAL REGISTRATION www.clinicaltrialsgov, identifier NCT01590433.
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Rees M, Collins CE, De Vlieger N, McDonald VM. Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review. Diabetes Metab Syndr Obes 2021; 14:417-429. [PMID: 33564249 PMCID: PMC7866939 DOI: 10.2147/dmso.s280735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Adult inpatients with Class II or III obesity and comorbidities have a high health burden with frequent hospitalizations. Surgical risk and patient choice can be contraindications to bariatric surgery, which is considered the gold standard treatment. The best approach to non-surgical management for this adult inpatient group is currently unknown. The aim of this scoping review was to summarize current research in the inpatient setting. The unpublished literature and six electronic database searches identified 4,582 articles, with 12 articles (reporting on 10 studies) eligible and included. The literature on the interventions and their key components in the non-surgical care of the adult inpatient with Class II or III obesity were mapped identifying service provision successes and gaps. The articles reported on intensive lifestyle interventions, comparison of oxygen administration regimes, total parenteral nutrition regimens, and pre-surgical rapid weight loss. Study designs included evaluation (n=1), before-after intervention studies (n=3), and randomized/non-randomized controlled trials (n=6). The classification of obesity as a chronic disease is not universal resulting in reduced inpatient treatment options. Recommendations for consumers, practitioner practice, health policy-makers and future research priorities are reported. Further research in the development of cost-effective inpatient models of care is indicated.
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Affiliation(s)
- Merridie Rees
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Priority Research Centre for Healthy Lungs and the School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition and the School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Nienke De Vlieger
- Priority Research Centre for Physical Activity and Nutrition and the School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
- Priority Research Centre for Healthy Lungs and the School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Correspondence: Vanessa M McDonald School of Nursing and Midwifery, The University of Newcastle, Locked Bag 1000, New Lambton, NSW, 2305, AustraliaTel +61 2 40420146Fax +61 2 40420046 Email
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Holt G, Hughes D. A study using semi-structured interview and Delphi survey to explore the barriers and enabling factors that influence access and utilisation of weight management services for people living with morbid obesity: A patient and professional perspective. J Hum Nutr Diet 2020; 34:215-223. [PMID: 33170550 DOI: 10.1111/jhn.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A quarter of the United Kingdom's population are living with obesity, a disease that causes an estimated 30 000 deaths each year. This coincides with an under-utilisation of weight management services across the country with the majority of patients with morbid obesity having no record of any weight loss intervention at all. This study explores the factors that influence patient access to weight management services. METHODOLOGY Expert opinion was obtained using semi-structured interviews and the Delphi methodology. Participants were selected from primary and secondary healthcare settings. Healthcare professionals (HCPs) had experience working in weight management services or in services dealing with obesity-related comorbidities. Patients had experience in attending a variety weight management services. RESULTS Nineteen participants completed all aspects of the study. The main barriers included negative perceptions, low mood/depression, obesity not being considered as a serious disease, lack of access to services for housebound patients and disproportionate commissioning. Suggested facilitating factors to improve access included the education of all HCPs about obesity, improving HCP communication with patients, and broadening the number of HCP's that are able to refer to weight management services. CONCLUSIONS Future services must prioritise the education of all HCPs and the public to combat the stigma of obesity and its impact on health. National commissioning guidelines in partnership with advocates of obesity should seek to streamline referral pathways, broaden referral sources and increase the availability of specialist services. Awareness of these factors when designing future weight management services will help to improve their utilisation.
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Affiliation(s)
- Guy Holt
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital (University Hospitals of Derby and Burton), Derby, UK
| | - David Hughes
- East Midlands Bariatric & Metabolic Institute, Royal Derby Hospital (University Hospitals of Derby and Burton), Derby, UK
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Elliott AF, B C D, Stolberg CR, Hepp N, Juhl AJA, Adhikari K, Juhl CB. Attitudes and knowledge regarding referrals for bariatric surgery among Danish secondary healthcare providers: A national survey. Clin Obes 2020; 10:e12369. [PMID: 32458582 DOI: 10.1111/cob.12369] [Citation(s) in RCA: 3] [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: 12/04/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
Bariatric surgery induces significant and sustained weight loss and subsequently reduces obesity-related comorbidities. However, only a small percentage of patients with severe obesity undergo bariatric surgery in Denmark. There is limited knowledge about the experiences with and possible reservations to bariatric surgery among secondary healthcare providers. The aim of this cross-sectional study was to investigate referral patterns and knowledge regarding the criteria for bariatric surgery among Danish secondary healthcare providers, treating obesity-related diseases. A questionnaire regarding experiences with and reservations to referring patients for consideration for bariatric surgery, along with thoughts to specific patient cases were sent to several specialists: endocrinologists, obstetricians and gynaecologists, orthopaedic surgeons and otorhinolaryngologists. Most questions required responses on a 5-point Likert scale and frequency distributions were calculated. A total of 345 (44%) specialists responded to the questionnaires. Good knowledge of the criteria for referral to bariatric surgery varied among the specialist from 6% to 68%. One of the main issues was a concern about the medical and surgical postoperative complications, which was a barrier to and influenced referral decisions. Furthermore, specialists were more likely to refer patients to bariatric surgery when patients requested this. Except for endocrinologists, the Danish secondary healthcare specialists interviewed have limited knowledge about bariatric surgery, which results in a reluctance in referring patients. Our results indicate that there is a need to improve knowledge among specialists, regarding the indications, criteria and outcomes for bariatric surgery to establish a more pro-active, specialist led approach to referrals.
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Affiliation(s)
- Anja F Elliott
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - Deepti B C
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte R Stolberg
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - Nicola Hepp
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anna J A Juhl
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kalyan Adhikari
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus B Juhl
- Department of Medicine, Section of Endocrinology, Southwest Jutland Hospital, Esbjerg, Denmark
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Conz CA, Jesus MCPD, Kortchmar E, Braga VAS, Machado RET, Merighi MAB. Path taken by morbidly obese people in search of bariatric surgery in the public health system. Rev Lat Am Enfermagem 2020; 28:e3294. [PMID: 32696927 PMCID: PMC7365606 DOI: 10.1590/1518-8345.3579.3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to understand the path taken in the public health system by people with
morbid obesity in the search for bariatric surgery. Method: qualitative research based on the social phenomenology of Alfred Schütz, with
17 hospitalized morbidly obese people, with a scheduled date for bariatric
surgery. The phenomenological interview with open questions was used and the
statements were analyzed in the light of the theoretical-methodological
framework and literature related to the theme. Results: the participants were able to schedule bariatric surgery by referring
friends, family and public people. The waiting list for the procedure
generated anguish and anxiety due to fear of surgery, weight gain, risk of
worsening health and physical limitations, but it helped prepare for its
performance. The experience lived in the search for bariatric surgery led
these people to want continuity of care in the Basic Health Unit, after the
surgery, by professionals trained to meet their needs. Conclusion: the aspects inscribed in the path of people in search of bariatric surgery
signal the need to strengthen the assistance-related flows of the public
health system and to invest in professional training to reduce the social
inequalities in access to bariatric surgery and increased quality of
services.
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Affiliation(s)
| | | | - Estela Kortchmar
- Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Brunaldi VO, Galvao Neto M. Gastric space-occupying devices for management of obesity and metabolic disease. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.tige.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Davis JA, Saunders R. Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada. JAMA Netw Open 2020; 3:e1919545. [PMID: 31951277 PMCID: PMC6991282 DOI: 10.1001/jamanetworkopen.2019.19545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Information on the associations between barriers to delivery of bariatric surgery and poor weight trajectory afterward is lacking. Estimates are needed to inform decisions by administrators and clinicians to improve care. OBJECTIVE To estimate the difference in patient-years of treatment for diabetes, hypertension, and dyslipidemia and public-payer cost between the Canadian standard and an improved bariatric surgery care pathway. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation of a decision analytic model comparing the outcomes of the standard care in Canada with an improved bariatric care pathway with earlier sleeve gastrectomy delivery and better postsurgical weight trajectory. The model was informed by published clinical data (101 studies) and meta-analyses (11 studies) between January and May 2019. Participants were a hypothetical 100-patient cohort with demographic characteristics derived from a Canadian study. INTERVENTIONS Reduction of Canadian mean bariatric surgery wait time by 2.5 years following referral and improvement of patient postsurgery weight trajectory to levels observed in other countries. MAIN OUTCOMES AND MEASURES Modeling weight trajectory after sleeve gastrectomy and resolution rates for comorbidities in Canada in comparison with an improved care pathway to estimate differences in patient-years of comorbidity treatment over 10 years following referral and the associated costs. RESULTS For the 100-patient cohort (mean [SD] 88.2% [1.4%] female; mean [SD] age, 43.6 [9.2] years; mean [SD] body mass index, 49.4 [8.2]; and mean [SD] comorbidity prevalence of 50.0% [4.1%], 66.0% [3.9%], and 59.3% [4.0%] for diabetes, hypertension, and dyslipidemia, respectively) over 10 years following referral, the improved vs standard care pathway was associated with median reduction in patient-years of treatment of 324 (95% credibility interval [CrI], 249-396) for diabetes, 245 (95% CrI, 163-356) for hypertension, and 255 (95% CrI, 169-352) for dyslipidemia, corresponding to total savings of $900 000 (95% CrI, $630 000 to $1.2 million) for public payers in the base case. Relative to standard of care, the associated reduction in costs was approximately 29% (95% CrI, 20%-42%) in the improved pathway. Sensitivity analyses demonstrated independent associations of earlier surgical delivery and various levels of postsurgical weight trajectory improvements with overall savings. CONCLUSIONS AND RELEVANCE This study suggests that health care burden may be decreased through improvements to delivery and management of patients undergoing sleeve gastrectomy. More data are needed on long-term patient experience with bariatric surgery in Canada to inform better estimates.
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Sartoretto A, Sui Z, Hill C, Dunlap M, Rivera AR, Khashab MA, Kalloo AN, Fayad L, Cheskin LJ, Marinos G, Wilson E, Kumbhari V. Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study. Obes Surg 2019; 28:1812-1821. [PMID: 29450845 DOI: 10.1007/s11695-018-3135-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success. DESIGN Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events. RESULTS In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed. CONCLUSIONS ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.
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Affiliation(s)
| | - Zhixian Sui
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Christine Hill
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Margo Dunlap
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Angielyn R Rivera
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - Lawrence J Cheskin
- Johns Hopkins Weight Management Center, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA
| | - George Marinos
- Bariatric and Metabolic Institute, Double Bay, NSW, Australia
| | - Erik Wilson
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 4940 Eastern Avenue, AA Building, 3rd floor, Baltimore, MD, 21224, USA.
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Abstract
PURPOSE OF REVIEW The endoscopic armamentarium against obesity and metabolic syndrome is rapidly growing and improving. Novel devices have been tested and recent data either support or reject their use. We aim to discuss current data on new endoscopic procedures addressing overweight, diabetes, and metabolic syndrome. RECENT FINDINGS Four-year follow-up of the aspiration therapy have shown efficacy and safety at long term. A recent consensus on intragastric balloon gathered experience from more than 40 000 procedures and standardized most steps of the treatment. The TransPyloric Shuttle has been proven effective at short term but carries high rates of adverse events. The endoscopic sleeve gastroplasty promotes similar weight loss to laparoscopic sleeve gastrectomy in mildly obese patien. The endoluminal magnetic partial jejunal diversion promoted good weight loss and a significant reduction in glycated hemoglobin (HbA1c) but most cases required laparoscopic assistance to couple the magnets. One-year follow-up demonstrated that the duodenal mucosal resurfacing carried a 1.0% reduction in HbA1c. SUMMARY Innovative endoscopic procedures focused on the treatment of overweight and related diseases are available and there is growing evidence supporting their use. Nonetheless, a multidisciplinary approach is mandatory. VIDEO ABSTRACT: http://links.lww.com/COG/A25.
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Turner M, Johnson AC, Lantz P. Impact of self-efficacy on risk aversion in the context of surgical weight loss decision scenarios. Clin Obes 2019; 9:e12311. [PMID: 31050137 DOI: 10.1111/cob.12311] [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: 12/05/2018] [Revised: 02/28/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
Obesity is prevalent among a third of US adults and a leading indicator for many chronic diseases. Self-efficacy is important for non-surgical weight loss interventions, but there is less information about the role of self-efficacy in the candidacy phase when there are discussions of side effects and decisions for uptake. This study conducted an experiment set within an online survey assessing risk aversion towards bariatric surgery as a weight loss intervention. The survey asked about hypothetical weight loss scenarios for bariatric surgery among a national probability-based sample of US adults aged 18 years and older. Participants answered their willingness to achieve different weight loss amounts within the context of bariatric surgery in varying risk scenarios. The analysis utilized a repeated-measures linear mixed model. A three-way interaction demonstrated that participants were more willing to take risks under ideal weight loss conditions even with the risk of death, particularly when considering self-efficacy (𝛽 = 1.20, P = .05). Margin projections showed that those with lower self-efficacy were more likely to take risks overall. This trend was significant for those with a body mass index of 30 and above in scenarios presenting one's ideal weight as the outcome of bariatric surgery. Adding a measure of self-efficacy within patient assessments could identify those eligible patients who are most likely to adopt bariatric surgery, particularly among those who may have negative post-surgical outcomes due to low self-efficacy levels. Addressing self-efficacy by way of providing support resources in tandem with candidacy consultations may enhance quality of life and post-surgical outcomes.
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Affiliation(s)
- Monique Turner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Andrea C Johnson
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Paula Lantz
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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Xin Y, Davies A, McCombie L, Briggs A, Messow CM, Grieve E, Leslie WS, Taylor R, Lean MEJ. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight-Plus weight management programme within a primary care randomized controlled trial. Diabet Med 2019; 36:1003-1012. [PMID: 31026353 DOI: 10.1111/dme.13981] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/21/2022]
Abstract
AIM The Counterweight-Plus weight management programme achieved 46% remission of Type 2 diabetes at 1 year in the DiRECT trial. We estimated the implementation costs of the Counterweight-Plus programme and its 1-year cost-effectiveness in terms of diabetes remission, compared with usual care, from the UK National Health Service (NHS) perspective. METHODS Within-trial total costs included programme set-up and running costs (practitioner appointment visits, low-energy formula diet sachets and training), oral anti-diabetes and anti-hypertensive medications, and healthcare contacts. Total costs were calculated for aggregated resource use for each participant and 95% confidence intervals (CI) were based on 1000 non-parametric bootstrap iterations. RESULTS One-year programme costs under trial conditions were estimated at £1137 per participant (95% CI £1071, £1205). The intervention led to a significant cost-saving of £120 (95% CI £78, £163) for the oral anti-diabetes drugs and £14 (95% CI £7.9, £22) for anti-hypertensive medications compared with the control. Deducting the cost-savings of all healthcare contacts from the intervention cost resulted an incremental cost of £982 (95% CI £732, £1258). Cost per 1 year of diabetes remission was £2359 (95% CI £1668, £3250). CONCLUSIONS Remission of Type 2 diabetes within 1-year can be achieved at a cost below the annual cost of diabetes (including complications). Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission. (Clinical Trial Registry No.: ISRCTN03267836).
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Affiliation(s)
- Y Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A Davies
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L McCombie
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - A Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C-M Messow
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - E Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - W S Leslie
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - R Taylor
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - M E J Lean
- Human Nutrition, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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43
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Jolles SA, Alagoz E, Liu N, Voils CI, Shea G, Funk LM. Motivations of Males with Severe Obesity, Who Pursue Medical Weight Management or Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2019; 29:730-740. [PMID: 31017517 PMCID: PMC6940588 DOI: 10.1089/lap.2019.0219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Both medical weight management (MWM) and bariatric surgery are significantly underutilized by patients with severe obesity, particularly males. Less than 30% of participants in MWM programs are male, and only 20% of patients undergoing bariatric surgery are men. Objectives: To identify motivations of males who pursue either MWM or bariatric surgery. Setting: Interviews with males with severe obesity (body mass index ≥35 kg/m2), who participated in a Veteran Affairs weight loss program in the Midwest. Materials and Methods: Participants were asked to describe their experiences with MWM and bariatric surgery. Interviews were audio-recorded, transcribed, and uploaded to NVivo for data management and analysis. Five coders iteratively developed a codebook using inductive content analysis to identify relevant themes. We utilized theme matrices organized by type of motivation and treatment pathway to generate higher-level analysis and generate themes. Results: Twenty-five males participated. Participants were 58.7 (standard deviation 8.6) years old on average, and 24% were non-white. Motivations for pursuing MWM or surgery included a desire to improve physical or psychological health and to enhance quality of life. Patients seeking bariatric surgery were motivated by the fear of death and felt that they had exhausted all other weight loss options. MWM patients believed they had more time to pursue other weight loss options. Conclusion: The opportunity to improve health, optimize quality of life, and lengthen lifespan motivates males with severe obesity to pursue weight loss treatments. These factors should be considered when providers educate patients about obesity treatment options and outcomes.
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Affiliation(s)
- Sally A. Jolles
- Department of Surgery, William S. Middleton Memorial VA, Madison, Wisconsin
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Esra Alagoz
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Natalie Liu
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Corrine I. Voils
- Research Service, William S. Middleton Memorial VA, Madison, Wisconsin
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Grace Shea
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
| | - Luke M. Funk
- Department of Surgery, William S. Middleton Memorial VA, Madison, Wisconsin
- Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin
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Chablaney S, Kumta NA. Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity. J Diabetes 2019; 11:351-358. [PMID: 30447101 DOI: 10.1111/1753-0407.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/25/2018] [Accepted: 11/13/2018] [Indexed: 01/25/2023] Open
Abstract
Endoscopic bariatric and metabolic therapies (EBMTs) have sparked significant interest as minimally invasive therapeutic options for weight loss. Although bariatric surgery remains an effective option for sustained weight loss and improvement in the metabolic syndrome, access and utilization are limited. Various EBMTs have been designed to emulate the physiologic effects of established surgical interventions, including space-occupying and non-space-occupying gastric therapies, gastric remodeling procedures, and small bowel therapies. This review discusses the safety and efficacy of available US Food and Drug Administration-approved minimally invasive endoscopic bariatric interventions, as well as those currently under investigation. In addition, the role of endoscopic revision after failed surgical intervention is discussed.
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Affiliation(s)
- Shreya Chablaney
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nikhil A Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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45
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McCombie L, Brosnahan N, Ross H, Bell‐Higgs A, Govan L, Lean MEJ. Filling the intervention gap: service evaluation of an intensive nonsurgical weight management programme for severe and complex obesity. J Hum Nutr Diet 2018; 32:329-337. [DOI: 10.1111/jhn.12611] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- L. McCombie
- College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - N. Brosnahan
- College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | | | | | - L. Govan
- Phastar Statistical Consultancy Chiswick, London UK
| | - M. E. J. Lean
- College of Medical, Veterinary and Life Sciences University of Glasgow Glasgow UK
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46
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Kallies KJ, Ramirez LD, Grover BT, Kothari SN. Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference? Surg Obes Relat Dis 2018; 14:1843-1849. [PMID: 30290991 DOI: 10.1016/j.soard.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE To evaluate preferences for RYGB versus SG. SETTING Survey of U.S. adults. METHODS An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.
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Affiliation(s)
- Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Luis D Ramirez
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
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Lean M, Hankey C. Keeping it off: the challenge of weight-loss maintenance. Lancet Diabetes Endocrinol 2018; 6:681-683. [PMID: 29371077 DOI: 10.1016/s2213-8587(17)30405-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Michael Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G31 2ER, UK.
| | - Catherine Hankey
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G31 2ER, UK
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48
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Johnson LP, Asigbee FM, Crowell R, Negrini A. Pre-surgical, surgical and post-surgical experiences of weight loss surgery patients: a closer look at social determinants of health. Clin Obes 2018; 8:265-274. [PMID: 29766655 PMCID: PMC6039235 DOI: 10.1111/cob.12251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 01/05/2023]
Abstract
Using a novel qualitative approach, Photovoice, researchers assessed social, psychological, physical and economic barriers encountered by patients of weight loss surgery. Applying the Photovoice approach and Williams' theory of narrative reconstruction for qualitative interviewing, the research team set out to investigate the bariatric patient experience from pre-surgery to hospitalization to post-surgery. Fifteen participants were given digital cameras and asked to take photographs that represented their weight loss journeys. Photographs and qualitative interviews were used to theorize the role played by comorbidities, social determinants of health, provider communication experiences and understanding of insurance coverage in patient outcomes. Several themes emerged from the interviews and photographs including themes centred around: (i) racial/ethnic standards of beauty; (ii) gender expectations; (iii) comorbidities, depression/disordered eating and obesity discrimination and (iv) financial hardship impacting adherence. Photographs also illuminated the impact of hospital and state-wide policies on patient lives. Results suggest that Photovoice may be a useful adjunct to standard-of-care to help patients identify barriers, and to identify shortcomings in health services. Additional screening tools for gender- and income-related barriers (and concomitant referrals to support services) provide an opportunity to improve patient care and reduce post-operative readmissions.
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Affiliation(s)
- L P Johnson
- Master of Public Health Program, Creighton University, Omaha, NE, USA
| | - F M Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - R Crowell
- Department of Medical Education, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - A Negrini
- Department of Medical Education, Saint Francis Hospital and Medical Center, Hartford, CT, USA
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49
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Juo YY, Freeby MJ, Arguello V, Liu L, Huang E, Dutson E, Chen Y. Efficacy of video-based education program in improving metabolic surgery perception among patients with obesity and diabetes. Surg Obes Relat Dis 2018; 14:1246-1253. [PMID: 29980463 DOI: 10.1016/j.soard.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metabolic surgery remains underutilized despite its efficacy and safety. Poor perception of surgery has been cited as one of the major reasons. OBJECTIVES Evaluate current patient perceptions about metabolic surgery and measure the impact a video-based education program has on changing the perceptions of patients diagnosed with obesity and type 2 diabetes. SETTING A university hospital in the United States. METHODS A prospective interventional study was performed at an endocrinology clinic. Patients were asked to complete surveys evaluating their perception of metabolic surgery before and after watching a short educational video. RESULTS A total of 51 patients were recruited; almost all patients (98%) attempted weight loss in the past, and approximately 90.1% voiced dissatisfaction with their current weight. The video-based education program was effective in improving the patient's perception of the efficacy and safety with regard to surgery. In addition, the proportion of patients with overall positive impression toward metabolic surgery increased from 22.5% to 53.1% (P < .01) and those willing to undergo surgical consultation increased from 41.7% to 51.0% (P < .01). Among those that remained unwilling, fear of surgery in general was the most commonly voiced reason (31.4%), with safety (27.5%) and cost of metabolic surgery (27.5%) being equally concerning. CONCLUSIONS Most patients with obesity and type 2 diabetes held negative impressions of metabolic surgery due to its perceived risk profile. A video-based educational intervention may improve patients' perception and increase their willingness for surgical referral. Future trials with a broader sample and longer follow-up could provide answers to its efficacy in increasing metabolic surgery accessibility.
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Affiliation(s)
- Yen-Yi Juo
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California, Los Angeles, California; Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Matthew J Freeby
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Vanessa Arguello
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Linda Liu
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Emily Huang
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Erik Dutson
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California, Los Angeles, California; Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Yijun Chen
- Center for Advanced Surgical and Interventional Technology (CASIT), University of California, Los Angeles, California; Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, California.
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50
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Blanchet MC, Gignoux B, Matussière Y, Vulliez A, Lanz T, Monier F, Frering V. Experience with an Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery: Comparison of MGB and LSG in 374 Patients. Obes Surg 2018; 27:1896-1900. [PMID: 28455803 DOI: 10.1007/s11695-017-2694-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Strategic multidisciplinary protocols for "enhanced recovery after surgery" (ERAS) have demonstrated reductions in length of hospital stay (LOS), morbidity, and costs in conjunction with bariatric procedures. METHODS We prospectively investigated the effectiveness and safety of an ERAS protocol with laparoscopic omega loop gastric bypass ("mini" gastric bypass, MGB) and LSG in morbidly obese patients. RESULTS Average LOS was 1.24 days (range 1-14); 86.1% discharged on day 1; 96.9% by day 2, a value comparable or better than that of other ERAS studies vs standard care according to meta-analysis. Complications 2.9%; readmission 2.1%; reintervention 1.3%. CONCLUSION The program was equally safe with both procedures. Postoperative antithrombotic heparin does not appear necessary in low-risk patients. Bariatric surgical ERAS programs are evolving and not yet standardized.
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Affiliation(s)
- Marie-Cécile Blanchet
- Clinique de la Sauvegarde, Lyon, France. .,Espace Médico-Chirurgical, Immeuble ''Trait d'Union'', Entrée A29 Av des Sources, 69009, Lyon, France.
| | | | - Yann Matussière
- Clinique de la Sauvegarde, Lyon, France.,Department of Nutrition 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Alexandre Vulliez
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Thomas Lanz
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Fabienne Monier
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
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