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Haghighat N, Kamran H, Moaddeli MN, Hosseini B, Karimi A, Hesameddini I, Amini M, Hosseini SV, Vahidi A, Moeinvaziri N. The impact of gastric pouch size, based on the number of staplers, on the short-term weight outcomes of Roux-en-Y gastric bypass. Ann Med Surg (Lond) 2022; 84:104914. [DOI: 10.1016/j.amsu.2022.104914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
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Is Adherence to Follow-Up After Bariatric Surgery Necessary? A Systematic Review and Meta-Analysis. Obes Surg 2022; 32:904-911. [PMID: 35020125 PMCID: PMC8866276 DOI: 10.1007/s11695-021-05857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022]
Abstract
The association of adherence to follow-up (FU) after laparoscopic gastric bypass — and gastric sleeve with weight loss (WL) is unclear. The aim of this study was to evaluate this association. Fourteen full text articles were included in the systematic review. Eight studies were included in the meta-analysis concerning FU up to 3 years postoperatively and 3 for the FU between 3 and 10 years postoperatively. Results showed a significant association between adherence to FU 0.5 to 3 years postoperatively and percentage excess WL (%EWL) but did not demonstrate a significant association between FU > 3 years postoperatively and total WL (%TWL). In conclusion, adherence to FU may not be associated with WL and therefore stringent lifelong FU in its current form should be evaluated.
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An Z, Wang H, Mokadem M. Role of the Autonomic Nervous System in Mechanism of Energy and Glucose Regulation Post Bariatric Surgery. Front Neurosci 2021; 15:770690. [PMID: 34887725 PMCID: PMC8649921 DOI: 10.3389/fnins.2021.770690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023] Open
Abstract
Even though lifestyle changes are the mainstay approach to address obesity, Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most effective and durable treatments facing this pandemic and its associated metabolic conditions. The traditional classifications of bariatric surgeries labeled them as “restrictive,” “malabsorptive,” or “mixed” types of procedures depending on the anatomical rearrangement of each one of them. This conventional categorization of bariatric surgeries assumed that the “restrictive” procedures induce their weight loss and metabolic effects by reducing gastric content and therefore having a smaller reservoir. Similarly, the “malabsorptive” procedures were thought to induce their main energy homeostatic effects from fecal calorie loss due to intestinal malabsorption. Observational data from human subjects and several studies from rodent models of bariatric surgery showed that neither of those concepts is completely true, at least in explaining the multiple metabolic changes and the alteration in energy balance that those two surgeries induce. Rather, neuro-hormonal mechanisms have been postulated to underly the physiologic effects of those two most performed bariatric procedures. In this review, we go over the role the autonomic nervous system plays- through its parasympathetic and sympathetic branches- in regulating weight balance and glucose homeostasis after SG and RYGB.
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Affiliation(s)
- Zhibo An
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States
| | - Haiying Wang
- Department of Physiology, Basic Medical School of Jining Medical University, Jining, China
| | - Mohamad Mokadem
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, United States.,Fraternal Order of Eagles Diabetes Research Center, The University of Iowa, Iowa City, IA, United States.,Obesity Research and Education Initiative, The University of Iowa, Iowa City, IA, United States.,Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
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Reiber BMM, Leemeyer AMR, Bremer MJM, de Brauw M, Bruin SC. Weight Loss Results and Compliance with Follow-up after Bariatric Surgery. Obes Surg 2021; 31:3606-3614. [PMID: 33963975 PMCID: PMC8270808 DOI: 10.1007/s11695-021-05450-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE The importance of follow-up (FU) for midterm weight loss (WL) after bariatric surgery is controversial. Compliance to this FU remains challenging. Several risk factors for loss to FU (LtFU) have been mentioned. The aim was therefore to evaluate the association between WL and LtFU 3 to 5 years postoperatively and to identify risk factors for LtFU. MATERIALS AND METHODS A single-center cross-sectional study in the Netherlands. Between June and October 2018, patients scheduled for a 3-, 4-, or 5-year FU appointment were included into two groups: compliant (to their scheduled appointment and overall maximally 1 missed appointment) and non-compliant (missed the scheduled appointment and at least 1 overall). Baseline, surgical, and FU characteristics were collected and a questionnaire concerning socio-economic factors. RESULTS In total, 217 patients in the compliant group and 181 in the non-compliant group were included with a median body mass index at baseline of 42.0 and 42.9 respectively. Eighty-eight percent underwent a laparoscopic Roux-en-Y gastric bypass. The median percentage total weight loss for the compliant and non-compliant groups was 30.7% versus 28.9% at 3, 29.3% versus 30.2% at 4, and 29.6% versus 29.9% at 5 years respectively, all p>0.05. Age, persistent comorbidities and vitamin deficiencies, a yearly salary <20,000 euro, no health insurance coverage, and not understanding the importance of FU were risk factors for LtFU. CONCLUSION Three to 5 years postoperatively, there is no association between LtFU and WL. The compliant group demonstrated more comorbidities and vitamin deficiencies. Younger age, not understanding the importance of FU, and financial challenges were risk factors for LtFU.
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Affiliation(s)
- Beata M M Reiber
- Department of Gastro-Intestinal Surgery, Amsterdam University Medical Center, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Anna-Marie R Leemeyer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Maurits de Brauw
- Department of Bariatric Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Sjoerd C Bruin
- Department of Bariatric Surgery, Spaarne Gasthuis, Haarlem, the Netherlands
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Uittenbogaart M, de Witte E, Romeijn MM, Luijten AAPM, van Dielen FMH, Leclercq WKG. Primary and Secondary Nonresponse Following Bariatric Surgery: a Survey Study in Current Bariatric Practice in the Netherlands and Belgium. Obes Surg 2021; 30:3394-3401. [PMID: 32236909 DOI: 10.1007/s11695-020-04574-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Primary nonresponse (1NR) - inability to achieve adequate weight loss after surgery - and secondary nonresponse (2NR) - excessive weight regain after initial adequate weight loss after surgery - can occur in up to 25-35% of patients after bariatric surgery. The aim of this study was to explore the variations in both definition as well as management of 1NR and 2NR amongst bariatric surgeons. MATERIALS AND METHODS An online survey was distributed to all members of the national bariatric societies in the Netherlands and Belgium regarding questions about definition, work-up and treatment of 1NR and 2NR after bariatric surgery. RESULTS A total of 45 responses from bariatric surgeons were obtained, representing 32 medical centers that perform bariatric procedures. When assessing 1NR, excess weight loss(EWL) was reported to be used by most respondents(30/45), total body weight loss(TBWL) by 18/45 and body mass index(BMI) by 25/45. A great variation in cut off values was observed. When assessing 2NR, percentage weight gain from the lowest (nadir) weight was preferred most by 22/45 respondents with cut off values varying from 5 to 20%. Most respondents deemed 18 months after initial surgery the most appropriate timeframe to determine 1NR or 2NR. CONCLUSIONS The current practice regarding primary and secondary nonresponse after bariatric surgery has a wide variety in definitions, work-up and treatment options. Consensus on the definition of 1NR and 2NR is needed to optimize the treatment of bariatric patients.
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Affiliation(s)
- Martine Uittenbogaart
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands.
| | - Evelien de Witte
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands
| | - Marleen M Romeijn
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands
| | - Arijan A P M Luijten
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands
| | - Francois M H van Dielen
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands
| | - Wouter K G Leclercq
- Máxima Obesity Centre, Department of Surgery, Máxima Medical Centre, Veldhoven, /Eindhoven, the Netherlands
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
OBJECTIVE This article presents an argument for the rethinking of concerns around bariatric/metabolic surgery in people with disordered eating. CONCLUSION Practice has usually been cautious but disordered eating and eating disorders should not be a contraindication other than exceptional cases. Further research directions are suggested.
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Affiliation(s)
- Lois J Surgenor
- Professor, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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CHALLENGES AND NEW DIRECTIONS IN OBESITY MANAGEMENT: LIFESTYLE MODIFICATION PROGRAMMES, PHARMACOTHERAPY AND BARIATRIC SURGERY. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e1-e4. [PMID: 31577079 DOI: 10.15586/jptcp.v26i2.599] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/18/2019] [Indexed: 11/18/2022]
Abstract
Obesity is a growing health problem worldwide, and it is associated with serious medical and psychosocial comorbidities, impairment of health-related quality of life (HRQoL) and an increased risk of mortality. This article aims to discuss challenges faced by health-care providers when managing patients with obesity and to highlight sustainable policies in clinical practice and future research. All health professionals dealing with obesity should consider lifestyle-modification programmes within a multidisciplinary setting as the key element of weight management. However, standardisation is needed in terms of nature, content and duration of these programmes in order to facilitate their implementation in clinical practice at different levels. Moreover, health professionals should be aware that these programmes, for patients indicating "non-response," can be combined with recently approved anti-obesity drugs such as liraglutide, naltrexone/bupropion, lorcaserin and phentermine/topiramate, as well as with relatively less invasive bariatric surgery techniques such as Lap Band, endoscopic sleeve gastroplasty and gastric bypass. In any case, neither anti-obesity medication nor bariatric surgery should be considered as a miracle treatment in itself. At the same time, the field of obesity is still lacking in literature on some hot topics that need further investigation, including (i) a new phenotype termed sarcopenic obesity, to clarify its definition, potential health consequences and eventual treatment if necessary; (ii) issues that go beyond body weight, for instance, HRQoL that has been poorly studied in some populations affected by obesity; and (iii) the long-term effect of sleeve gastrectomy technique, which is becoming the most commonly used bariatric surgical procedure, perhaps to be studied using long-term randomised controlled trials that guarantee completeness of follow-up, in order to avoid misunderstanding and bias in interpretation of results.
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9
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Reiber BMM, Tenhagen M, Hunfeld MAJM, Cense HA, Demirkiran A. Calibration of the Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass: Does It Matter? The Influence on Weight Loss. Obes Surg 2018; 28:3400-3404. [DOI: 10.1007/s11695-018-3352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Conversional Weight Loss Surgery: an Australian Experience of Converting Laparoscopic Adjustable Gastric Bands to Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:1902-1909. [PMID: 29455406 DOI: 10.1007/s11695-018-3128-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for severe obesity, capable of producing more than 50% excess weight loss at 10-year follow-up (James Clin Dermatol 1; 22:276-80; O'Brien Br J Surg 2; 102:611-17; Buchwald et al. Metab Syndr 3; 347-56). The success of bariatric surgery extends far beyond weight loss, with up to 80-90% of patients having improvement or resolution of many of their weight-related co-morbidities including type II diabetes mellitus and hypertension (Puzziferri et al. JAMA 4; 312:934-42; Buchwald et al. Am J Med 5; 122:248-56). However, there is a paucity of data regarding conversional bariatric surgery. OBJECTIVE This study aims to explore the efficacy, safety and feasibility of conversional surgery. SETTING This study represents the largest Australasian series focusing on conversional bariatric surgery. The study was conducted in the Norwest Private Hospital and Hospital for Specialist Surgery (HSS), both private Hospitals in Sydney, Australia. METHODS Data was collected prospectively at regular intervals for more than 12 months from 1 January 2012 to 1st November 2015 for all patients requiring a laparoscopic sleeve gastrectomy (LSG) as secondary procedure after prior laparoscopic adjustable gastric band (LAGB). Excess weight loss (EWL), percentage total body weight loss (TWL) and excess BMI loss (EBMIL) as well as any complications were recorded. RESULTS There were low rates of morbidity (1.1%) and no mortality at 12-month follow-up. Satisfactory EWL of 60% (95% CI: 56.6-63.4%), EBMIL of 60.1% (95% CI: 48.8-71.4%) and 16% TWL was achieved at 12-month follow-up. CONCLUSION We therefore conclude that sleeve gastrectomy is a safe and valid option for conversional bariatric surgery following LAGB.
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11
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Fuchs T, Loureiro M, Both GH, Skraba HH, Costa-Casagrande TA. THE ROLE OF THE SLEEVE GASTRECTOMY AND THE MANAGEMENT OF TYPE 2 DIABETES. ACTA ACUST UNITED AC 2018; 30:283-286. [PMID: 29340555 PMCID: PMC5793149 DOI: 10.1590/0102-6720201700040013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/21/2017] [Indexed: 01/13/2023]
Abstract
Background: Currently, bariatric surgery has promoted weight loss and improved glycemic
control in obese patients through different techniques, including vertical
sleeve gastrectomy. Aim: Present and update the different vertical sleeve gastrectomy ways of action,
both in the treatment of obesity and diabetes, approaching its potential
effect on gastrointestinal physiology, as well as the benefits achieved by
this manipulation. Methods: Pubmed database search was used crossing the headings: obesity, type 2
diabetes and sleeve gastrectomy. Results: Published data have shown that short-term weight loss tends to be higher in
patients undergoing vertical sleeve gastrectomy compared to Roux-en-Y
gastric bypass. In relation to glycemic control, the procedure demonstrated
remission of diabetes in up to 60% after one year of surgery. After three
years, however, differences in remission rate between surgical and clinical
group was not observed, questioning the durability of the technical in a
long-term. Conclusion: Despite showing good results, both in the weight loss and co-morbidities,
conflicting results reinforce the need for more studies to prove the
efficiency of the vertical sleeve gastrectomy as well as to understand its
action about the molecular mechanisms involved in the disease.
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Affiliation(s)
- Taíse Fuchs
- Departament of Postgraduate in Industrial Biotechnology
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12
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Zhang L, Scott J, Shi L, Truong K, Hu Q, Ewing JA, Chen L. Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014. PLoS One 2017; 12:e0186306. [PMID: 29053709 PMCID: PMC5650154 DOI: 10.1371/journal.pone.0186306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/28/2017] [Indexed: 11/22/2022] Open
Abstract
Background With the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity. Objective To investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States. Setting This is a secondary data analysis of the Premier Perspective database. Methods ICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used. Results A total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001) and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001) decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001) increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001). The majority of patients undergoing surgery were female (78.5%), white (65.6%), younger than 65 years (93.8%), and insured with managed care (53.6%). In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8%) and urban (91.6%) hospitals. Conclusions Results based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - John Scott
- Department of Surgery, Greenville Health System, Greenville, South Carolina, United States of America
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Qingwei Hu
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
| | - Joseph A. Ewing
- Department of Surgery, Greenville Health System, Greenville, South Carolina, United States of America
| | - Liwei Chen
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, United States of America
- * E-mail:
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13
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Jung FUCE, Luck-Sikorski C, König HH, Riedel-Heller SG. Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists. Obes Surg 2017; 26:2393-401. [PMID: 26886930 DOI: 10.1007/s11695-016-2104-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite reported effectiveness, weight loss surgery (WLS) still remains one of the least preferred options for outpatient providers, especially in Germany. The aim of this study was to examine the effect of stigma and knowledge on recommendation of WLS and referral to a surgeon by general practitioners (GPs) and internists. METHOD The sample consists of 201 GPs and internists from Germany. The questionnaire included questions on the perceived effectiveness of WLS, the frequency of recommendations of WLS, and the frequency of referral to WLS. Stigma, as well as knowledge was also assessed in this context. Linear and logistic regression models were conducted. A mediation analysis was carried out within post hoc analysis. RESULTS Knowledge (b = 0.258, p < 0.001) and stigma towards surgery (b = -0.129, p = 0.013) were related to the frequency of recommendation of WLS. Additionally, respondents, who were more likely to express negative attitudes towards WLS, were less likely to recommend WLS and thus refer patients to WLS (b = -0.107, p < 0.05). Furthermore, respondents with more expertise on WLS were more likely to recommend and thus refer patients to WLS (b = 0.026, p < 0.05). CONCLUSION This study showed that stigma plays a role when it comes to defining treatment pathways for patients with obesity. The question remains how this might influence the patients and their decision regarding their treatment selection. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma.
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Affiliation(s)
- Franziska U C E Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany. .,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany. .,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany.
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
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14
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Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. Variation in Outcomes at Bariatric Surgery Centers of Excellence. JAMA Surg 2017; 152:629-636. [PMID: 28445566 DOI: 10.1001/jamasurg.2017.0542] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance In the United States, reports about perioperative complications associated with bariatric surgery led to the establishment of accreditation criteria for bariatric centers of excellence and many bariatric centers obtaining accreditation. Currently, most bariatric procedures occur at these centers, but to what extent they uniformly provide high-quality care remains unknown. Objective To describe the variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers. Design, Setting, and Participants This retrospective review analyzed the claims data of 145 527 patients who underwent bariatric surgery at bariatric centers of excellence between January 1, 2010, and December 31, 2013. Data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. This database included unique hospital identification numbers in 12 states (Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin), allowing comparisons among 165 centers of excellence located in those states. Participants were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Those included in the study cohort were patients with a primary diagnosis of morbid obesity and who underwent laparoscopic Roux-en-Y gastric bypass, open Roux-en-Y gastric bypass, laparoscopic gastric band placement, or laparoscopic sleeve gastrectomy. Excluded from the cohort were patients younger than 18 years or who had an abdominal malignant neoplasm. Data were analyzed July 1, 2016, through January 10, 2017. Main Outcomes and Measures Risk-adjusted and reliability-adjusted serious complication rates within 30 days of the index operation were calculated for each center. Centers were stratified by geographic location and operative volume. Results In this analysis of claims data from 145 527 patients, wide variation in quality was found across 165 bariatric centers of excellence, both nationwide and statewide. At the national level, the risk-adjusted and reliability-adjusted serious complication rates at each center varied 17-fold, ranging from 0.6% to 10.3%. At the state level, variation ranged from 2.1-fold (Wisconsin decile range, 1.5%-3.3%) to 9.5-fold (Nebraska decile range, 1.0%-10.3%). After dividing hospitals into quintiles of quality on the basis of their adjusted complication rates, 38 of 132 (28.8%) had a center in a higher quintile of quality located within the same hospital service area. Variation in rates of complications existed at centers with low volume (annual mean [SD] procedure volume, 156 [20] patients; complication range, 0.6%-6.4%; 9.8-fold variation), medium volume (annual mean [SD] procedure volume, 239 [27] patients; complication range, 0.6%-10.3%; 17.5-fold variation), and high volume (annual mean [SD] procedure volume, 448 [131] patients; complication range, 0.6%-4.9%; 7.5-fold variation). Conclusions and Relevance Even among accredited bariatric surgery centers, wide variation exists in rates of postoperative serious complications across geographic location and operative volumes. Given that a large proportion of centers are geographically located near higher-performing centers, opportunities for improvement through regional collaboratives or selective referral should be considered.
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Affiliation(s)
- Andrew M Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Amir A Ghaferi
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Jyothi R Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor2Surgical Innovation Editor, JAMA Surgery
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Weiss AL, Mooney A, Gonzalvo JP. Bariatric Surgery: The Future of Obesity Management in Adolescents. Adv Pediatr 2017; 64:269-283. [PMID: 28688592 DOI: 10.1016/j.yapd.2017.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Amy L Weiss
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
| | - Ashley Mooney
- Department of Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Suite 410, Tampa, FL 33606, USA
| | - John Paul Gonzalvo
- Department of Surgery, Morsani College of Medicine, University of South Florida, 5 Tampa General Circle, Suite 410, Tampa, FL 33606, USA
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Hillersdal L, Christensen BJ, Holm L. Changing tastes: learning hunger and fullness after gastric bypass surgery. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:474-487. [PMID: 28297084 DOI: 10.1111/1467-9566.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gastric bypass surgery is a specific medical technology that alters the body in ways that force patients to fundamentally change their eating habits. When patients enrol for surgery, they enter a learning process, encountering new and at times contested ways of sensing their bodies, tasting, and experiencing hunger and fullness. In this paper, we explore how patients begin to eat again after gastric bypass surgery. The empirical data used here are drawn from a Danish fieldwork study of individuals undergoing obesity surgery. The material presented shows how the patients used instructions on how to eat. We explore the ways in which diverse new experiences and practices of hunger and fullness are part of the process of undergoing surgery for severe obesity. New sensory experiences lead to uncertainty; as a result, patients practice what we term mimetic eating, which reflects a 'sensory displacement' and hence a rupture in the person's sense of self and social relations. We suggest that eating should be conceptualised as a practice that extends beyond the boundaries of our bodies and into diverse realms of relations and practices, and that changing the way we eat also changes the fundamentally embodied experience of who we are.
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Affiliation(s)
| | | | - Lotte Holm
- Institute of Food and Resource Economics, University of Copenhagen
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Abstract
Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients.
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Hillersdal L, Christensen BJ, Holm L. Patients' strategies for eating after gastric bypass surgery: a qualitative study. Eur J Clin Nutr 2015; 70:523-7. [PMID: 26695722 DOI: 10.1038/ejcn.2015.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/13/2015] [Accepted: 11/02/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES There is considerable variation in the amount of weight patients lose after gastric bypass surgery, and this may be related to the way they adjust to the operation in their daily eating practices. Little is known about how this varies. On the basis of a qualitative research design, this study therefore explores how patients deal with gastric bypass surgery in their daily lives. SUBJECTS/METHODS The study is based on interviews with 24 men and women in Denmark diagnosed with morbid obesity who have had, Roux-en-Y gastric bypass surgery. The interviews were transcribed, coded and analysed using 'grounded theory' methodology. RESULTS Three strategies used by patients to cope with postoperative changes were identified. In the first strategy, patients treat surgery as time-out, using the operation to facilitate a change in their ordinary habits of daily life, but not as a solution to overweight in itself. Patients adopting the second strategy of surgery as solution would expect their smaller stomach to hinder excess food intake automatically. The third strategy of abstaining was adopted by patients who were afraid to experience negative side effects, or who believed they might 'ruin the operation'. CONCLUSIONS Patients adjust to their postoperative condition in very different ways. The variation in the ways patients comprehend and cope with the operation and in its effects on their eating routines and practices needs to be further investigated and compared more systematically with the outcomes of the operation in terms of weight loss and overall well-being.
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Affiliation(s)
- L Hillersdal
- Copenhagen Centre for Health Research in the Humanities, SAXO Institute, University of Copenhagen, Copenhagen S, Denmark
| | - B J Christensen
- Department of Food and Resource Economics, University of Copenhagen, Section for Consumption, Bioethics and Governance, Frederiksberg C, Denmark
| | - L Holm
- Department of Food and Resource Economics, University of Copenhagen, Section for Consumption, Bioethics and Governance, Frederiksberg C, Denmark
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Abstract
The obesity epidemic, combined with the lack of available and effective treatments for morbid obesity, is a scientific and public health priority. Worldwide, bariatric and metabolic surgeries are increasingly being performed to effectively aid weight loss in patients with severe obesity, as well as because of the favourable metabolic effects of the procedures. The positive effects of bariatric surgery, especially with respect to improvements in type 2 diabetes mellitus, have expanded the eligibility criteria for metabolic surgery to patients with diabetes mellitus and a BMI of 30-35 kg/m(2). However, the limitations of BMI, both in the diagnosis and follow-up of patients, need to be considered, particularly for determining the actual adiposity and fat distribution of the patients following weight loss. Understanding the characteristics shared by bariatric and metabolic surgeries, as well as their differential aspects and outcomes, is required to enhance patient benefits and operative achievements. For a holistic approach that focuses on the multifactorial effects of bariatric and metabolic surgery to be possible, a paradigm shift that goes beyond the pure semantics is needed. Such a shift could lead to profound clinical implications for eligibility criteria and the definition of success of the surgical approach.
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Affiliation(s)
- Gema Frühbeck
- Department of Endocrinology &Nutrition, CIBEROBN, Clínica Universidad de Navarra, University of Navarra, IdiSNA, Avda. Pío XII 36, 31008 Pamplona, Spain
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Spreckley E, Murphy KG. The L-Cell in Nutritional Sensing and the Regulation of Appetite. Front Nutr 2015; 2:23. [PMID: 26258126 PMCID: PMC4507148 DOI: 10.3389/fnut.2015.00023] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/06/2015] [Indexed: 12/25/2022] Open
Abstract
The gastrointestinal (GI) tract senses the ingestion of food and responds by signaling to the brain to promote satiation and satiety. Representing an important part of the gut-brain axis, enteroendocrine L-cells secrete the anorectic peptide hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) in response to the ingestion of food. The release of GLP-1 has multiple effects, including the secretion of insulin from pancreatic β-cells, decreased gastric emptying, and increased satiation. PYY also slows GI motility and reduces food intake. At least part of the gut-brain response seems to be due to direct sensing of macronutrients by L-cells, by mechanisms including specific nutrient-sensing receptors. Such receptors may represent possible pathways to target to decrease appetite and increase energy expenditure. Designing drugs or functional foods to exploit the machinery of these nutrient-sensing mechanisms may offer a potential approach for agents to treat obesity and metabolic disease.
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Affiliation(s)
- Eleanor Spreckley
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital , London , UK
| | - Kevin Graeme Murphy
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital , London , UK
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Comment on: Long-term outcomes after Roux-en-Y gastric bypass: 10-13 year data. Surg Obes Relat Dis 2015; 12:20-2. [PMID: 26071848 DOI: 10.1016/j.soard.2015.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022]
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