1
|
Johnston L, Jackson K, Hilton C, N H Graham Y. Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required. Clin Obes 2024; 14:e12626. [PMID: 38058253 DOI: 10.1111/cob.12626] [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: 08/17/2022] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 12/08/2023]
Abstract
In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m2 ) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (M = 43.20, SD = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (N = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.
Collapse
Affiliation(s)
- Lynne Johnston
- Clinical Health Psychology, Golden Jubilee University National Hospital, Clydebank, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Halley Johnston Associates Ltd, Whitley Bay, UK
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, UK
| | - Kacey Jackson
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Charlotte Hilton
- Hilton Health Consultancy, Derbyshire, UK
- Division of Clinical Research in the College of Medicine, University of Florida, Gainsville, Florida, USA
- College of Health Psychology and Social Care, University of Derby, Derby, UK
| | - Yitka N H Graham
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, UK
- Faculty of Psychology, University of Anahuac Mexico, Ciudad de Mexico, Mexico
- Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina
| |
Collapse
|
2
|
Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
3
|
Low resilience in severe obesity: marker of adverse childhood experiences and current psychological disorders. Eat Weight Disord 2022; 27:3507-3519. [PMID: 36209466 DOI: 10.1007/s40519-022-01488-2] [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: 04/10/2022] [Accepted: 09/25/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Psychological disorders, early-age psychological traumas and eating disorders may contribute to the development of severe obesity in vulnerable individuals. Resilience may serve a protective role against binge eating disorder or depression. The current study aimed to investigate the relationship between adverse childhood experiences (ACE), resilience, and current psychological disorders. It also examined whether resilience plays a protective role in this pathway in a cohort of patients seeking bariatric surgery. METHODS Two hundred patients (153 women, 47 men) with severe obesity scheduled for bariatric surgery at the CHRU Nancy were included between September 2016 and April 2017. Participants completed the Resilience Scale for Adults (RSA) questionnaire and underwent a structured interview on ACE and current psychological disorders. RESULTS Mean total RSA score was 5.16 ± 0.87. The most frequent ACE were emotional neglect (90.5%) and emotional abuse (61%); 96% reported at least one ACE; 67% presented at least one current psychological disorder, the most frequent being anxiety (36%) and BED (35%). The number of psychological disorders, cumulative ACE and age explained 19.5% of the variance in total RSA score (p < 0.0001; adjusted R2 = 0.19). The association of cumulative ACE and number of psychological disorders was mediated by resilience. CONCLUSION Our findings suggest that resilience is a relevant component of the psychosocial phenotype of severe obesity in bariatric surgery candidates. Resilience seems to play a partly mediation role in the relationship between ACE and psychological disorders. Low resilience becomes a marker that underscores the necessity to examine in greater depth ACE and psychological disorders. LEVEL OF EVIDENCE Level III, cohort analytic study.
Collapse
|
4
|
New Insights on the Association Between Socioeconomic Status and Weight Loss After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3752-3770. [DOI: 10.1007/s11695-022-06269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
|
5
|
Svarts A, Anders T, Engwall M. Volume creates value: The volume-outcome relationship in Scandinavian obesity surgery. Health Serv Manage Res 2022; 35:229-239. [PMID: 35125029 PMCID: PMC9574905 DOI: 10.1177/09514848211048598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study establishes the relationship between surgical volume and cost and
quality outcomes, using patient-level clinical data from a national quality
registry for bariatric surgery in Sweden. Data include patient characteristics
with comorbidities, surgical and follow-up data for patients that underwent
gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703
patients in 51 hospitals). The relationships between surgical volume (annual
number of bariatric procedures) and several patient-level outcomes were assessed
using multilevel, mixed-effect regression models, controlling for patient
characteristics and comorbidities. We found that hospitals with higher volumes
had lower risk of intraoperative complications as well as complications within
30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87,
respectively, p<0.01). In addition, higher-volume hospitals
had substantially shorter procedure time (17 min per 100 procedures,
p<0.01) and length of stay (0.88 incidence-rate ratio
per 100 procedures p<0.01). Our results support the claim
that increased surgical volume significantly improves quality. Further, the
results strongly suggest that increased volume leads to lower cost per surgery,
by reducing cost drivers such as procedure time and length of stay.
Collapse
Affiliation(s)
- Anna Svarts
- 225274Department of Industrial Economics and Management, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Thorell Anders
- 27106Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Mats Engwall
- 225274Department of Industrial Economics and Management, KTH Royal Institute of Technology, Stockholm, Sweden
| |
Collapse
|
6
|
Nilsson PM, Sundquist J, Sundquist K, Li X. Sibling rank and sibling number in relation to cardiovascular disease and mortality risk: a nationwide cohort study. BMJ Open 2021; 11:e042881. [PMID: 34035122 PMCID: PMC8162087 DOI: 10.1136/bmjopen-2020-042881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The number and rank order of siblings could be of importance for risk of cardiovascular disease and mortality. Previous studies have used only fatal events for risk prediction. We, therefore, aimed to use also non-fatal coronary and cardiovascular events in fully adjusted models. METHODS From the Multiple-Generation Register in Sweden, data were used from 1.36 million men and 1.32 million women (born 1932-1960), aged 30-58 years at baseline and with follow-up from 1990 to 2015. Mean age at follow-up was 67 years (range 55-83 years). Fatal and non-fatal events were retrieved from national registers. RESULTS Compared with men with no siblings, those with 1-2 siblings had a lower, and those with four or more siblings had a higher adjusted risk of cardiovascular events. Again, compared with men with no siblings, those with more than one sibling had a lower total mortality risk, and those with three or more siblings had an increased risk of coronary events.Correspondingly, compared with women with no siblings those women with three siblings or more had an increased risk of cardiovascular events, and those with two siblings or more had an increased risk of coronary events. Women with one sibling or more were at lower total mortality risk, following full adjustment. CONCLUSION Being first born is associated with a favourable effect on non-fatal cardiovascular and coronary events for both men and women. The underlying biological mechanisms for this should be studied in a sociocultural context.
Collapse
Affiliation(s)
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| |
Collapse
|
7
|
Jansåker F, Li X, Sundquist K. Sociodemographic factors and uncomplicated cystitis in women aged 15-50 years: a nationwide Swedish cohort registry study (1997-2018). LANCET REGIONAL HEALTH-EUROPE 2021; 4:100108. [PMID: 34557816 PMCID: PMC8454719 DOI: 10.1016/j.lanepe.2021.100108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Symptoms suggestive of uncomplicated cystitis constitutes one of the most common reasons to seek health care in otherwise healthy women. Previous studies regarding the relationship between sociodemographic factors and uncomplicated cystitis are limited, mainly because of the lack of nationwide population-based data from primary healthcare settings, where most uncomplicated cystitis are diagnosed. Methods A Swedish nation-wide open cohort study consisting of 2 044 065 females who were 15–50 years of age during the study period (1997–2018) was conducted. The outcome was first event uncomplicated cystitis diagnosed in primary health care rather than an assessment of the "true" incidence, which is not feasible in nationwide datasets. Cox regression models were used in the statistical analyses. Findings The study identified 546 076 first events of uncomplicated cystitis (26•7% of the study population), corresponding to an incidence rate per 100 person-years of 2•91 (95% CI 2•90–2•91). In fully adjusted models, rural living was associated with lower risks of uncomplicated cystitis (Hazard ratio, HR, 0•67; 95% CI, 0•66–0•68) compared to urban living, while both Middle Eastern/North African (HR, 1•15; 95% CI, 1•14–1•16) and Latin American/Caribbean (HR, 1•24; 95% CI, 1•22–1•27) women had higher risks compared to Swedish women. Low education and low income were also associated with higher risks compared to high education and high income. Interpretation This study presents novel risk factors associated with uncomplicated cystitis in women. The findings may help health care workers in the treatment of women with symptoms of uncomplicated cystitis. Funding The Primary Healthcare Management and ALF funding (Region Skåne, Sweden) and the Swedish Research Council.
Collapse
Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | |
Collapse
|
8
|
Variation in publicly funded bariatric surgery in New Zealand by ethnicity: cohort study of 328,739 patients. Surg Obes Relat Dis 2021; 17:1286-1293. [PMID: 33941480 DOI: 10.1016/j.soard.2021.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/27/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND New Zealand health services are responsible for equitable health service delivery, particularly for Māori, the Indigenous peoples of New Zealand. Recent research has indicated the presence of inequities in publicly funded bariatric surgery in New Zealand by ethnicity, but it is unclear whether these inequities persist after adjustment for co-morbidities. OBJECTIVES To determine whether receipt of publicly funded bariatric surgery varies by ethnicity, after adjustment for co-morbidities. SETTING New Zealand primary care. METHODS A cohort study of New Zealanders aged 30-79 years who had cardiovascular risk assessment in primary care between January 1, 2010 and June 30, 2018. Data were collated and analyzed using an encrypted unique identifier with regional and national datasets. Cox proportional hazard modeling was performed to determine the likelihood of receipt of a primary publicly funded bariatric procedure up to December 31, 2018, after adjustment for sex, age, ethnicity, locality, socioeconomic deprivation, body mass index, diabetes status, smoking status, and co-morbidities. RESULTS A total of 328,739 participants (44% female, median age 54 yr [interquartile range, IQR, 46-62], 54% European, 13% Māori, 13% Pacific, 20% Asian) were included in the study and followed up for a median of 5.6 years (IQR 4.1-6.9). The likelihood of receipt of bariatric surgery was lower for Māori and Pacific compared with Europeans (adjusted hazard ratio .82 [95% CI .69-.96] and .24 [.20-.29], respectively). The likelihood of receiving bariatric surgery was also inversely related with increasing socioeconomic deprivation and rurality. CONCLUSIONS Consistent with data worldwide, there is evidence of unequal access to publicly funded bariatric surgery by ethnicity, locality as well as socioeconomic deprivation among New Zealanders who were cardiovascular risk assessed in primary care.
Collapse
|
9
|
Memarian E, Carrasco D, Thulesius H, Calling S. Primary care physicians' knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study. BMC Endocr Disord 2021; 21:62. [PMID: 33832469 PMCID: PMC8030650 DOI: 10.1186/s12902-021-00723-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery. METHODS A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman's correlations and regression analyses. RESULTS Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery. We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = - 0.355, p < 0.001) and between positive attitudes and concerns (r = - 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1-0.7). CONCLUSION According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.
Collapse
Affiliation(s)
- Ensieh Memarian
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine Research Group, Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502, Malmö, Sweden.
| | - Daniel Carrasco
- Department of Clinical Sciences in Malmö, Lund University, Internal Medicine Research Group, Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502, Malmö, Sweden
| | - Hans Thulesius
- Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
- Linnaeus University, Kalmar, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| |
Collapse
|
10
|
High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity. Surg Obes Relat Dis 2020; 17:398-405. [PMID: 33097449 DOI: 10.1016/j.soard.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the modest effects of behavioral treatment on obesity in adolescence, bariatric surgery is rarely performed. Obesity often persists from childhood to adulthood, but it is not known how many individuals proceed with bariatric surgery in young adulthood. OBJECTIVE The aim of this study was to determine what proportion of individuals who received pediatric behavioral obesity treatment subsequently underwent bariatric surgery in early adulthood, and to identify predictors thereof. SETTING National registries, Sweden. METHODS In this prospective cohort study, the Swedish Childhood Obesity Treatment Register was linked to several national registers. RESULTS The childhood obesity cohort included 6502 (45% females) with a median age at follow-up of 21.7 years (interquartile range [IQR] 5.2). Of these, 8.2% underwent bariatric surgery at a median age of 20.9 years (IQR 4.2). The estimated cumulative incidence of bariatric surgery at age 30 was 21.5%. Obesity-related co-morbidities were identified in 31.7% before bariatric surgery in the childhood obesity cohort. Predictors of bariatric surgery were female sex, high body mass index standard deviation score (BMI SDS) at the start and end of treatment, poor treatment response, as well as own or parental cardiometabolic disease. CONCLUSIONS More than a fifth are estimated to undergo bariatric surgery in early adulthood, despite having received pediatric behavioral obesity treatment. Our results indicate that for many children, behavioral treatment is insufficient in reducing obesity and preventing obesity-related co-morbidity. Therefore, it is reasonable to assume that more effective treatment of adolescents with severe obesity, including more rigorous behavioral support and pharmacologic treatment, but also more frequent use of bariatric surgery, would benefit this group of patients.
Collapse
|
11
|
Shared Decision Making and Choice for Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244966. [PMID: 31817804 PMCID: PMC6950179 DOI: 10.3390/ijerph16244966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 01/14/2023]
Abstract
: The number of people undergoing bariatric surgery is increasing every year, and their expectations for surgery often differ greatly. The purpose of this study was to develop a patient-centered decision-making aid to help people define their weight loss goals and assist them in discussing their surgical treatment with surgeons. Before the operation, the patients were asked to read the shared decision-making text and conduct a self-assessment. After the operation, we evaluated the program using survey questionnaires. A total of 103 patients were formally included in this study. The results show that patients were very satisfied with the use of patient decision aids (PDAs), with a score of 4.3 points (±0.6), and the postoperative decision-making satisfaction was also very high, at 4.4 points (±0.5), while the postoperative regret score was low, at 1.6 points (±0.6). Their satisfaction with surgical decision making and decision regret were statistically significantly negatively correlated (r = -0.711, p < 0.001). The experience of using PDAs was statistically significantly negatively correlated with decision regret (r = -0.451, p < 0.001); the experience of PDA use was statistically positively correlated with decision satisfaction (r = 0.522, p < 0.001). Patient decision aids are a means of helping patients make informed choices before they seek to undergo bariatric surgery.
Collapse
|