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Geerts MM, van den Berg EM, van Riel L, Peen J, Goudriaan AE, Dekker JJM. Behavioral and psychological factors associated with suboptimal weight loss in post-bariatric surgery patients. Eat Weight Disord 2021; 26:963-972. [PMID: 32472495 DOI: 10.1007/s40519-020-00930-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Bariatric surgery is the most effective long-term treatment for sustained weight loss in obesity. Studies have shown that not all patients lose the expected amount of weight. The aim of this study was to develop a better understanding of which behavioral and psychological factors are associated with suboptimal weight loss. METHODS The present paper describes a cross-sectional study that included 140 participants. The mean follow-up period after bariatric surgery was 3.16 years. Eating disorder pathology (Eating Disorder Examination-Questionnaire), impulsivity (Barratt Impulsiveness scale-II) and depressive symptoms (Beck Depression Inventory) were compared with successful and suboptimal participants. A weight loss of more than or equal to 50% of excess weight, was considered to be successful. RESULTS More than 81% of the participants met the criterion for successful weight loss. The suboptimal weight loss group reported more symptoms of eating disorder pathology (p = .001), more loss of control over eating (p = .001), and more avoidant behavior due to poor body image (p < .001). The suboptimal weight loss group scored higher on impulsivity (p = .007) and on depression (p < .001). More early weight loss was associated with better weight outcome later on (r = .491). Reporting more eating disorder pathology, a longer follow-up period and pre-operative super-obesity (body mass index ≥ 50 kg/m2) at the time of surgery were associated with poorer weight loss (p < .001). CONCLUSION Eating disorder pathology, loss of control over eating and avoidant behavior due to poor body image, as well as depressive symptoms and impulsivity, (as reported postoperatively) are associated with suboptimal weight loss. Level III: Case-control analytic study.
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Affiliation(s)
- Marjolein M Geerts
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands.
| | - Elske M van den Berg
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands
| | - Laura van Riel
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
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2
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Nandrino JL, Grynberg D, Gandolphe MC, Willem C, Benaisa K, Van de Maele J, Taccoen A, Verkindt H, Pattou F. Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding. Appetite 2020; 149:104620. [PMID: 32070712 DOI: 10.1016/j.appet.2020.104620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023]
Abstract
While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.
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Affiliation(s)
- Jean-Louis Nandrino
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France; Fondation Santé des étudiants de France, Clinique des 4 Cantons, Villeneuve d'Ascq, France.
| | - Delphine Grynberg
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Marie-Charlotte Gandolphe
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Clémence Willem
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Karima Benaisa
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Justine Van de Maele
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Aurore Taccoen
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Hélène Verkindt
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - François Pattou
- UMR INSERM 1190, Recherche Translationnelle sur le Diabète, Université de Lille, France; Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
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3
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Monteleone AM, Cascino G, Solmi M, Pirozzi R, Tolone S, Terracciano G, Parisi S, Cimino M, Monteleone P, Maj M, Docimo L. A network analysis of psychological, personality and eating characteristics of people seeking bariatric surgery: Identification of key variables and their prognostic value. J Psychosom Res 2019; 120:81-89. [PMID: 30929713 DOI: 10.1016/j.jpsychores.2019.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The interplay among personality traits, anxiety and eating symptoms in candidates for bariatric surgery has never been investigated through the network analysis approach. Thus, we aimed to use this method to identify the key psychological traits that characterize these individuals and to assess their role as predictors of surgical outcomes. METHODS One-hundred-eighty-five candidates for bariatric surgery filled in the State Trait Anxiety Inventory (STAI), the Revised Restraint Scale, the Power of Food Scale and the Temperament and Character Inventory-Revised (TCI-R) questionnaires. All these variables were included in a network analysis. Then, the most central network nodes were entered as independent variables in a regression model that included 9-month follow-up weight outcomes as the dependent variable. RESULTS The network has showed a good stability. TCI-self directedness and harm avoidance scores and STAI state and trait anxiety scores were the nodes with the highest centrality in the network. Weight outcomes were assessed in 64 patients at follow-up. Among central nodes, low TCI-self directedness was found to be the only significant independent predictor of worse weight outcome. CONCLUSIONS Our findings show for the first time the interplay between personality traits and symptoms in candidates for bariatric surgery combining the network approach with a follow-up evaluation. Low self-directedness has been proved to be the node with highest centrality and the only predictor of short-term weight outcome. These data suggest the importance to take into consideration personality and psychological variables either in the pre-surgery assessment or as possible targets for pre or post-surgery psychotherapeutic interventions. ORCID 0000-0002-6786-4458.
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Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Raffaele Pirozzi
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Gianmattia Terracciano
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Parisi
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Monica Cimino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy.
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy.
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4
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Azagury D, Mokhtari TE, Garcia L, Rosas US, Garg T, Rivas H, Morton J. Heterogeneity of weight loss after gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Surgery 2018; 165:565-570. [PMID: 30316577 DOI: 10.1016/j.surg.2018.08.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding all lead to substantial weight loss in obese patients. Long-term weight loss can be highly variable beyond 1-year postsurgery. This study examines and compares the frequency distribution of weight loss and lack of treatment effect rates after laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding. METHODS A total of 1,331 consecutive patients at a single academic institution were reviewed from a prospectively collected database. Preoperative data collected included demographics, body mass index, and percent excess weight loss. Postoperative BMI and %EWL were collected at 12, 24, and 36 months. Percent excess weight loss was analyzed by the percentiles of excess weight lost, and the distribution of percent excess weight loss was evaluated in 10% increments. Lack of a successful treatment effect was defined as <25% excess weight loss. RESULTS Of the 1,331 patients, 72.4% (963) underwent laparoscopic Roux-en-Y gastric bypass, 18.3% (243) laparoscopic sleeve gastrectomy, and 9.4%(125) laparoscopic adjustable gastric banding. Mean percent excess weight loss was greatest for laparoscopic Roux-en-Y gastric bypass, followed by laparoscopic sleeve gastrectomy, and then by laparoscopic adjustable gastric banding at every time point: at 2 years mean percent excess weight loss was 77.9± 24.4 for laparoscopic Roux-en-Y gastric bypass, 50.8 ± 25.8 for laparoscopic sleeve gastrectomy, and 40.8± 25.9 for laparoscopic adjustable gastric banding (P < .0001). The rates of a successful treatment effect s for laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic adjustable gastric banding were 0.9%, 5.2%, and 24.3% at 1 year; 0.3%, 11.1%, and 26.0% at 2 years; and 1.0%, 25.3%, and 30.2% at 3 years. At 1 year, the odds ratio of lack of a successful treatment effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass was 6.305 (2.125-19.08; P = .0004), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass was 36.552 (15.64-95.71; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy was 5.791 (2.519-14.599; P < .0001). At 2 years, the odds ratio for laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass increased to 70.7 (9.4-531.7; P < .0001), the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass increased to 128.1 (16.8-974.3; P < .0001), and the odds ratio for laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy decreased to 1.8 (0.9-3.6; P = .09). CONCLUSION This study emphasizes the existing variability in weight loss across bariatric procedures as well as in the lack of a treatment effect for each procedure. Although laparoscopic adjustable gastric banding has the greatest rate of a lack of a successful treatment effect, the rate remained stable over 3 years postoperatively. Laparoscopic sleeve gastrectomy showed a doubling in the rate of a lack of a successful treatment effect every year reaching 25% at year 3. The rates for lack of a successful treatment effect for laparoscopic Roux-en-Y gastric bypass remained stable at about 1% for the first 3 years postoperatively.
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Affiliation(s)
- Dan Azagury
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - Tara E Mokhtari
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - Luis Garcia
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - Ulysses S Rosas
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - Trit Garg
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - Homero Rivas
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA
| | - John Morton
- Section of Bariatric and Minimally Invasive Surgery Stanford University School of Medicine, Stanford, CA.
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5
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Hindle A, de la Piedad Garcia X, Brennan L. Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 2017; 18:317-334. [PMID: 28170168 DOI: 10.1111/obr.12496] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
This is the first systematic review to synthesize the evidence concerning early post-operative variables predictive of later weight and psychosocial outcomes in bariatric surgery. Eight electronic databases for empirical studies were searched (1954 to 2016). Most of the 39 included studies reported solely on weight outcomes; eating and psychosocial outcomes were less common. A better early weight loss trajectory was the most consistent predictor of more successful medium-term weight outcome (≤24 months); however, its relationship to longer term weight loss maintenance is less certain. Early eating adaptation may be associated with later weight loss, but further research is needed. Evidence is lacking for associations between early adherence or early psychosocial variables and later outcome. In particular, the relationship between early post-operative depression and later weight remains unclear. Little research has considered early prediction of later eating or psychosocial outcomes. Consideration of mediating or moderating relationships is lacking. The body of evidence is limited, and synthesis is hampered by heterogeneity in the type and time at which predictors and outcomes are measured and quality of statistical reporting. Further research on prospective prediction of bariatric surgery outcome is needed to guide early post-operative intervention for those at greatest risk of poor outcomes.
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Affiliation(s)
- A Hindle
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - X de la Piedad Garcia
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - L Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
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6
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Wise ES, Ahmad S, Ladner TR, Hocking KM, Kavic SM. Impaired weight loss in laparoscopic adjustable gastric banding patients over 50 years of age: diabetes mellitus as an independent risk factor. Surg Endosc 2016; 30:663-669. [PMID: 26091994 PMCID: PMC4685024 DOI: 10.1007/s00464-015-4257-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/01/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic adjustable gastric banding (LAGB) represents a safe and effective bariatric procedure, particularly for patients over 50. Preoperative risk factors for impaired post-LAGB excess weight loss are not well characterized for this population. This study aimed to identify demographics, characteristics or comorbidities associated with excess weight loss at 6 and 12 months postoperatively (EWL180 and EWL365, respectively) for these patients. METHODS One hundred and seventeen LAGB patients >50 years of age from 2005 to 2014 were retrospectively reviewed for factors potentially associated with EWL180 and EWL365. Rationally selected variables chosen for analysis included age, race, gender, initial body mass index and preoperative weight loss; comorbidities assessed included hypertension, psychiatric disorders and diabetes mellitus (DM). Variables correlated with EWL180 or EWL365 on bivariate linear regression analysis (P ≤ .05) were input into multivariate linear regression analysis to confirm independent association. RESULTS Preoperative DM (B = -9.1% EWL; 95% CI -13.6, -4.5%; P < .001) and African-American race (B = -8.8% EWL; 95% CI -17.3, -0.3%; P = .05) were independent risk factors for impaired EWL180. Only DM was a risk factor for impaired EWL365 (B = -9.7% EWL; 95% CI -17.7, -1.8%; P = .02). CONCLUSIONS LAGB is a successful operation in patients >50 years of age. Preoperative DM is an independent risk factor for impaired EWL in this cohort.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA.
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
| | - Sarwat Ahmad
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Travis R Ladner
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Stephen M Kavic
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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7
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Agüera Z, García-Ruiz-de-Gordejuela A, Vilarrasa N, Sanchez I, Baño M, Camacho L, Granero R, Jiménez-Murcia S, Virgili N, Lopez-Urdiales R, de Bernabe MMG, Garrido P, Monasterio C, Steward T, Pujol-Gebelli J, Fernández-Aranda F, Menchón JM. Psychological and Personality Predictors of Weight Loss and Comorbid Metabolic Changes After Bariatric Surgery. EUROPEAN EATING DISORDERS REVIEW 2015; 23:509-16. [PMID: 26377595 DOI: 10.1002/erv.2404] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
Bariatric surgery (BS) has proven to be the most effective treatment for weight loss and for improving comorbidities in severe obesity. A comprehensive psychological assessment prior to surgery is proposed to prepare patients for a successful post-surgical outcome. Therefore, the main aim of the present study was to assess psychological and personality predictors of BS outcome. The sample comprised 139 severely obese patients who underwent BS. Assessment measures included the Eating Disorders Inventory-2, the Symptom Checklist-Revised and the Temperament and Character Inventory-Revised. Our results show that favourable BS outcome, after 2 years follow up, was associated with younger age, less depression, moderate anxiety symptoms and high cooperativeness levels. Likewise, metabolic improvements were found to be linked to younger age and certain psychopathological factors. In conclusion, our findings suggest that age, baseline body mass index, psychopathological indexes and personality traits predict successful BS outcome.
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Affiliation(s)
- Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Amador García-Ruiz-de-Gordejuela
- Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Sanchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Lucía Camacho
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Rafael Lopez-Urdiales
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Pilar Garrido
- Dietetics and Nutrition Unit, University Hospital of Bellvitge, Barcelona, Spain
| | - Carmen Monasterio
- Department of Pneumology, University Hospital of Bellvitge, Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jordi Pujol-Gebelli
- Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain.,CIBER de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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8
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Kindel T, Martin E, Hungness E, Nagle A. High failure rate of the laparoscopic-adjustable gastric band as a primary bariatric procedure. Surg Obes Relat Dis 2013; 10:1070-5. [PMID: 24630503 DOI: 10.1016/j.soard.2013.11.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/19/2013] [Accepted: 11/24/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Determinants of success of a bariatric procedure are many but paramount is the ability to durably produce significant and reliable weight loss. We sought to determine the primary success of the laparoscopic adjustable gastric band (LAGB) by defining failure as clinical weight loss failure with an intact band (excess weight loss [EWL]<20%) or band removal (terminal removal or conversion to a secondary bariatric procedure). METHODS A retrospective chart review was performed on patients who underwent an LAGB as a primary bariatric procedure between January 2003 and December 2007. Data collected included body mass index (BMI), weight, postoperative follow-up length, EWL, and adjustment number, as well as complications of the LAGB. RESULTS Sixteen of 120 patients had the band removed. Nine were terminally removed for unmanageable symptoms, and 7 were converted to an alternative bariatric procedure. The average follow-up for the 104 patients with an intact band was 4.8 years. The average EWL for successful intact bands was 44.9±19.4%; however, an additional 35.6% of patients had an EWL<20%. Patients with an EWL<20% had a significantly higher preoperative BMI and fewer band adjustments. In total, 44% of patients had band failure because of clinical weight loss failure (31%) or eventual band removal (13%). CONCLUSION This study finds that the LAGB failed as a primary bariatric procedure for 44% of patients because of either inadequate weight loss or adequate weight loss with unmanageable symptoms. This suggests that the LAGB should be abandoned as a primary bariatric procedure for the majority of morbidly obese patients because of its high failure rate.
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Affiliation(s)
- Tammy Kindel
- University of Nebraska Medical Center, Division of General Surgery, Omaha, Nebraska.
| | - Emily Martin
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Department of Surgery, Chicago, Illinois
| | - Eric Hungness
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Department of Surgery, Chicago, Illinois
| | - Alex Nagle
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Department of Surgery, Chicago, Illinois
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9
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Delko T, Köstler T, Peev M, Esterman A, Oertli D, Zingg U. Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis. Surg Endosc 2013; 28:552-8. [PMID: 24196539 DOI: 10.1007/s00464-013-3204-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/23/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB. METHODS In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity. RESULTS Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12 months of follow-up evaluation and 45.1% after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12 months and 57.2% after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1%/57.2% versus 70.4% (p < 0.001 and <0.002) after 24 months. CONCLUSIONS Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.
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Affiliation(s)
- Tarik Delko
- Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland,
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10
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Chiu CJ, Birch DW, Shi X, Karmali S. Outcomes of the adjustable gastric band in a publicly funded obesity program. Can J Surg 2013; 56:233-6. [PMID: 23883492 DOI: 10.1503/cjs.002712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is considered a safe and effective treatment for severe obesity and obesity-related comorbidities. We sought to examine the outcome of LAGB delivered through a Canadian publicly funded obesity program. METHODS We retrospectively analysed the cases of patients who underwent LAGB within a comprehensive, multidisciplinary, publically funded obesity program. RESULTS A total of 178 patients underwent LAGB. Mean percentage total body weight loss at 1, 2 and 3 years was 15.8%, 20.7% and 20.3%, respectively. The most common short-term complication was postoperative nausea (19%). The medium-term complications included band migration (5.6%) and port site complications, band leakage and incisional hernia at 1% each. The reoperation rate was 4.5%. The mean surgery duration was 56 minutes and the mean length of stay was 1.4 days. The average numbers of clinic visits and band adjustments were highest in the first year. The most common investigation for postoperative symptoms was fluoroscopy (86%). An outcome comparison between the 2 generations of the REALIZE gastric band was inconclusive, requiring further data collection. CONCLUSION Publicly funded LAGB results in effective weight loss and acceptable safety over the short term. Our patients may represent a distinct population that differs from that in the private system. Long-term data are necessary to determine the cost-effectiveness of this important surgical option for severe obesity.
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Affiliation(s)
- Chieh Jack Chiu
- Department of Surgery, University of Alberta, Edmonton, Alta
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Pulcini ME, Saules KK, Schuh LM. Roux-en-Y gastric bypass patients hospitalized for substance use disorders achieve successful weight loss despite poor psychosocial outcomes. Clin Obes 2013; 3:95-102. [PMID: 25586531 DOI: 10.1111/cob.12018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 03/26/2013] [Accepted: 04/14/2013] [Indexed: 11/30/2022]
Abstract
An emerging body of literature indicates that Roux-en-Y gastric bypass (RYGB) patients may be at a heightened risk for substance use disorders (SUDs) after surgery. Little is known about how weight loss and psychosocial outcomes of RYGB patients who develop SUD differ from those who do not. The present study compared weight loss and psychosocial outcomes of 26 post-RYGB patients in inpatient SUD treatment with those of 26 RYGB patients who did not evidence problematic substance use in the post-operative period. SUD and control cases were matched on age, sex and time lapse since surgery. No significant differences in % total weight loss or % excess weight loss (EWL) were found between groups. Those in SUD treatment were significantly less likely to meet the surgical failure criteria of <50% EWL but evidenced greater symptoms of depression, higher rates of probable major depressive disorder and poorer quality of life. Our findings indicate that RYGB patients hospitalized for SUDs achieve successful weight loss despite having poor psychosocial outcomes.
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Affiliation(s)
- M E Pulcini
- Psychology Department, Eastern Michigan University, Ypsilanti, MI, USA
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Weismann D, Pelka T, Bender G, Jurowich C, Fassnacht M, Thalheimer A, Allolio B. Bariatric surgery for morbid obesity in craniopharyngioma. Clin Endocrinol (Oxf) 2013; 78:385-90. [PMID: 22506774 DOI: 10.1111/j.1365-2265.2012.04409.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/05/2012] [Accepted: 04/04/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To retrospectively analyse the effectiveness of bariatric surgery for hypothalamic obesity in patients with craniopharyngioma (CP). PATIENTS Patients who developed morbid obesity after surgery for CP and who underwent laparoscopic gastric banding (LAGB), laparoscopic sleeve gastrectomy or gastric bypass were included (n = 9). Patients with common obesity who underwent bariatric surgery served as controls (LAGB n = 40, sleeve gastrectomy n = 49 and gastric bypass n = 54). RESULTS CP was diagnosed during childhood or adolescence [median (range) 10 (1-21) years] and age at bariatric surgery was 17 [12-30] years. Six patients underwent gastric banding [median follow-up 5.5 years (range 1-9)], 4 had a sleeve gastrectomy [median follow-up 2 (0.4-4) years] and two patients had gastric bypass surgery (median follow-up 3 years). Three patients had more than one type of bariatric surgery. Different from controls, no weight loss was observed after LAGB or sleeve gastrectomy. The two patients who had gastric bypass surgery lost body weight comparable with controls. CONCLUSION With LAGB and sleeve gastrectomy, no significant loss of body weight was achieved in young adult patients with craniopharyngioma-associated morbid obesity.
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Affiliation(s)
- Dirk Weismann
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University of Wuerzburg, Wuerzburg, Germany.
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Aerobic Exercise is Associated with Improved Weight Loss after Laparoscopic Adjustable Gastric Banding. Obes Surg 2012. [DOI: 10.1007/s11695-012-0826-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
BACKGROUND Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. METHODS We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. RESULTS Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]). CONCLUSIONS Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.
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