High Prevalence of Food Insecurity in Participants Attending Weight Management and Bariatric Surgery Programs

The Association of Preoperative Food Insecurity With Early Postoperative Outcomes After Bariatric Surgery

INTRODUCTION

To assess the rate of food insecurity in patients undergoing bariatric surgery. To compare the rates of 30-d postoperative complications based on food security status.

METHODS

Patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 7/2020 - 3/2022 were screened for food insecurity via telephone using questions from the Accountable Health Communities Health-Related Social Needs Screening Tool. Screens were matched to patient data and 30-d outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

RESULTS

In total, 213 (59%) of the 359 bariatric surgery patients were screened with 81 (38%) screening positive for food insecurity. Evaluation of preoperative variables based on food security status showed comparable age, body mass index, and comorbidity status. Food insecure patients were found to have an increased length of stay following surgery compared to food secure patients (P = 0.003). Food insecurity was not associated with higher rates of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program reported 30-d postoperative complications including emergency department/urgent care visits (P = 0.34) and hospital readmissions (P = 0.94).

CONCLUSIONS

Food insecurity was prevalent at 38% of the bariatric surgical population. Food insecure patients had a statistically longer length of stay after primary bariatric surgery but were not associated with an increased risk of 30-d complications. Future studies are needed to determine the mid-term and long-term effects of food insecurity status on bariatric surgical outcomes and the potential impact of food insecurity on length of stay.

Factors contributing to whether or not people with obesity undergo bariatric surgery

BACKGROUND

Bariatric surgery has been suggested as a safe and effective way to treat obesity by facilitating weight loss, but factors that predict the likelihood of bariatric surgery are unknown. The objective of this study was to describe factors associated with individuals with obesity that influence their decision to undergo bariatric surgery.

SUBJECTS AND METHODS

The study design was a cross-sectional study and participants were recruited via a survey link posted on the Obesity Action Coalition website. Demographic data, medical data, weight loss program data, and reports of personal experiences were gathered via an online survey. A multivariate logistic regression model was conducted to examine predictors associated with bariatric surgery (N = 4192).

RESULTS

Participants who took phentermine (OR=2.983), Phentermine-topiramate (Qsymia) (OR=2.863), Naltrexone-bupropion (Contrave) (OR=3.246), or Liraglutide (Saxenda) (OR=2.144) had a higher likelihood of undergoing bariatric surgery for weight loss. Participants with type 2 diabetes (OR=1.728), post-traumatic stress disorder (PTSD) (OR=1.489), or COVID-19 (OR=3.852) had a higher likelihood of undergoing bariatric surgery while sleep apnea (OR=0.760) was associated with a lower likelihood of receiving surgery. Those who used MyFitnessPal™ (OR=2.232), Noom™ (OR=1.400), Jenny Craig™ (OR=1.533), or Keto (OR=1.664) for weight loss had a higher likelihood of obtaining bariatric surgery. Personal trauma experiences of sexual abuse (OR=1.982) and physical abuse (OR=1.490) were more associated with participants who underwent surgery.

CONCLUSIONS

A variety of characteristics were associated with decisions to undergo bariatric surgery. These findings may help to determine ways to support individuals who are considering bariatric surgery.

Food insecurity, weight-based discrimination, weight self-stigma, and mental health in post-bariatric surgery patients

The United States Department of Agriculture defines food insecurity (FI) as reduced quality and variety of diet or overall reduced food intake. To date, limited research has investigated the relationship between FI, weight stigma, and bariatric surgery. The existing literature suggests that FI in bariatric surgery patients is significantly associated with being a person of color, depression, receiving Medicare or Medicaid, and higher eating disorder (ED) pathology. Research also suggests that weight stigma in bariatric surgery patients is associated with worsened weight loss outcomes. No research to our knowledge has investigated FI, internalized weight stigma, weight-based discrimination, and history of bariatric surgery in one sample. Bariatric surgery patients in this study (N = 266) reported elevated rates of FI relative to the general population, via an online questionnaire. Those with FI also reported higher rates of depression, anxiety, ED pathology, internalized weight stigma, and experiences of weight-based discrimination compared to those who were food secure. Given these findings, bariatric surgical centers should evaluate all potential patients for FI before surgery and, at the bare minimum, provide additional support before and post-surgery. The ethics of conducting bariatric surgery in those with FI who lack significant medical comorbidity also must be considered.

Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies

Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.

Binge Eating Before and After Bariatric Surgery

PURPOSE OF REVIEW

The purpose is to review the state of the literature of binge eating in the context of bariatric surgery including prevalence, conceptualization, assessment, course, and related sequela throughout the perioperative continuum, particularly highlighting new advancements and future directions.

RECENT FINDINGS

Accurate assessment of binge eating in bariatric samples is essential for optimization of patient outcomes. Binge eating is less prevalent after bariatric surgery; however, prevalence rates increase over time. Most studies do not find a relationship between pre-operative binge eating and suboptimal weight outcomes after surgery. Refinement in understanding and conceptualization of post-operative binge eating is needed; new conceptualizations have proposed such a definition. Emerging constructs relevant to binge eating for bariatric patients include food addiction and food insecurity. Despite the introduction of formal diagnostic criteria for binge eating disorder, many uncertainties regarding the prevalence, course, and effects of binge eating currently exist; varied assessment methods continue to be a barrier to research on binge eating in bariatric surgery samples. Consensus on operational definitions for post-operative binge eating and best practices for assessment are areas for future consideration.

The role of food and activity environment in a bariatric surgery population: impact on postoperative weight loss

BACKGROUND

Food and activity factors may have an impact on weight in the general population, but little is known about how this affects postbariatric surgery weight loss.

OBJECTIVES

To understand the impact of environmental food and activity factors on weight loss after bariatric surgery.

SETTING

A multidisciplinary integrated health system with an accredited bariatric surgery program.

METHODS

An institutional review board-approved retrospective review of patients who underwent bariatric surgery from 2001-2018 was completed. Food security, food retailers, and activity factors associated with postoperative percentage of total body weight loss (TBWL) at short-term (1-2 yr), medium-term (3-5 yr), and long-term (≥6 yr) follow-up were evaluated.

RESULTS

Overall, 1673 patients were included; 90% experienced ≥20% TBWL in the short term and 65% in the long term. No differences in mean TBWL were observed for food deserts or areas with high versus low food insecurity. Mean TBWL was significantly different for low versus high healthy food density (32.5% versus 33.4%, P = .024) and low versus high fitness facility density (32.6% versus 33.4%, P = .048) at short-term follow-up. Increased mean TBWL was observed for counties with more versus less exercise opportunities at short and medium-term follow-up (33.4% versus 32.5%, P = .025; 31.2% versus 29.7%, P = .019).

CONCLUSION

Patients experienced significant TBWL after bariatric surgery. Living in a food desert or area with high food insecurity did not significantly impact mean TBWL. Healthy food density, fitness facility density, and exercise opportunities had a short- to medium-term impact on TBWL. These data can be used to support patients to maximize the benefits of bariatric surgery.

Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19

Background

Recent studies suggest that eating habits are an area particularly affected by the lockdown imposed by many countries to curb the COVID-19 epidemic. Individuals that received bariatric surgery may represent a particularly susceptible population to the adverse effects of lockdown for its potential impact on eating, psychological, and weight loss outcomes.

Objectives

This study seeks to investigate the incremental impact of COVID-19 lockdown on treatment outcomes of postbariatric patients in the risk period for weight regain.

Setting

Main hospital center.

Methods

This work uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T₀), 1.5 years after sugery (T₁), and 3 years after surgery (T₂). Two independent groups were compared: the COVID-19_Group (n = 35) where T₀ and T₁ assessments were conducted before the pandemic started and T₂ assessment was conducted at the end of the mandatory COVID-19 lockdown; and the NonCOVID-19_Group (n = 66), covering patients who completed T₀, T₁, and T₂ assessments before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes.

Results

General linear models for repeated measures showed that the COVID-19_Group presented significantly higher weight concern (F = 8.403, P = .005, ƞ²_p = .094), grazing behavior (F = 7.166, P = .009, ƞ²_p = .076), and negative urgency (F = 4.522, P = .036, ƞ²_p = .05) than the NonCOVID-19_Group. The COVID-19_Group also showed less total weight loss (F = 4.029, P = .05, ƞ²_p = .04) and larger weight regain at T₂, with more COVID-19_Group participants experiencing excessive weight regain (20% versus 4.5%).

Conclusion

These results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in postbariatric surgery patients.

Food insecurity is linked to poorer dietary quality in prebariatric surgery patients

BACKGROUND

Research exploring dietary quality patterns within bariatric populations is limited, despite the significance of eating behaviors for postoperative outcomes. Recent studies revealed associations between food insecurity and disordered eating behavior in bariatric patients; however, the relationship between food insecurity and dietary quality is not known.

OBJECTIVE

To examine the association between dietary quality and levels of food security within a sample of presurgical bariatric patients.

SETTING

One academic medical center in central Pennsylvania, United States of America.

METHODS

Patients completed three self-report measures as part of their presurgical psychological assessment process. Food security status was measured by the United States Department of Agriculture's Food Security Module, modified for self-reports. Participants also completed the Rapid Eating Assessment for Participants, short version, which is a measure of dietary quality with scores ranging from 13-39, and the Adult Eating Behavior Questionnaire. Hierarchical multiple regressions were used to assess relationships between dietary quality and food security levels, and mediation models were built to explore associations between variables.

RESULTS

Of the 197 participants, 35.5% reported high food security, while 35.0% and 29.5% reported marginal food security and food insecurity, respectively. Compared with patients with high food security, the dietary quality scores of food-insecure patients were 1.3 points lower (95% confidence interval [CI], -3.3 to .7; P = .2) of and marginally food-secure patients were 1.2 points lower (95% CI, -2.9 to .5) than those reporting high food security (P = .2).

CONCLUSIONS

Our findings indicate a need for further exploration into the barriers that prebariatric patients may face when attempting to adhere to pre- and postoperative dietary requirements, particularly for those reporting marginal food security and food insecurity. Future research should target postoperative outcomes, including weight gain, weight regain, and dietary adherence, among the most economically vulnerable bariatric patients.