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

A multimodal mixed-methods approach for holistic insights in Roux-en-Y gastric bypass patients: Protocol for a patient-centered framework

This protocol outlines the methodological approach for a multimodal mixed-methods study to investigate how social determinants impact the pre-and post-operative biochemical parameters and experiences of patients undergoing RYGB. It integrates quantitative and qualitative data from patients in a public hospital. Biochemical, anthropometric, and body composition data will be collected from 717 clinical records of patients who underwent RYGB from 2020 to 2024, with data extracted 30 days before and six months after surgery. Semi-structured interviews will be conducted with patients to explore their experiences and perspectives before and after surgery. To complement patient perceptions, a focus group will be conducted with nutritionists experienced in managing post-bariatric surgery patients to gather insights into nutritional challenges and post-surgical care strategies. The findings of this study will provide a comprehensive analysis of the short-term biochemical, anthropometric, and body composition changes in patients following RYGB surgery while shedding light on the social determinants that influence these outcomes.•This is one of the first multimodal mixed-methods studies in Brazil exploring both biochemical outcomes and lived experiences of RYGB patients in the public health system.•This study targets a vulnerable population by addressing non-communicable disease prevention through improved bariatric care.

Hope and behavioural weight loss: Pathways lead to greater weight loss than agency or goals

BACKGROUND

Hope is a motivational state comprised of agency (internal drive), pathways (perceived external means), and goals (future targets) that may predict weight loss, but evidence is limited. This study examined hope and its subscales (agency, pathways, goals) as predictors of weight loss in a behavioural treatment.

METHOD

Adults (n = 107) with body mass index (BMI) ≥ 27 participated in a 6-month weight loss program with 12-month follow-up. Hope and its subscales were assessed at baseline using the Adult Hope Scale-Revised (HSR-2). Percent weight lost (%WL) was calculated for post-treatment (n = 70) and follow-up (n = 61). Covariates included positive affect, gratitude, optimism, age, sex, education, BMI, and adverse childhood experiences. Linear regressions tested the relationship between HSR-2 total and subscales with %WL at post-treatment and follow-up, adjusting for covariates. Complete case and intention-to-treat analyses with multiply imputed data were conducted.

RESULTS

Complete case analyses showed HSR-2 total scores predicted greater %WL (β = .16, p = .001 post-treatment; β = .29, p = .003 follow-up). This effect was driven by pathways (β = .63, p = .001 post-treatment; β = 1.02, p < .001 follow-up), with agency and goals unrelated to %WL (ps ≥ .353). Gratitude inversely related to %WL (β = -.82, p = .001 post-treatment; β = -.78, p = .020 follow-up). Among the intention-to-treat sample, HSR-2 total trended towards follow-up %WL (β = .14, p = .062); pathways predicted at both timepoints (β = .32, p = .047 post-treatment; β = .59, p = .001 follow-up).

CONCLUSION

Higher pathways thinking, a component of hope, predicted clinically significant weight loss and weight maintenance. Lower gratitude may predict weight loss (among completers), suggesting dissatisfaction with one's current state, combined with a belief in pathways to a better future, drove greater weight loss.

An Exploration of Food Deserts and Acute Biliary Disease in Emergency General Surgery Patients

INTRODUCTION

Living in a food desert may increase the risk of health conditions related to biliary disease, such as obesity. However, there is limited understanding of food deserts' relationship with biliary disease. In this retrospective study, we explored food deserts in our region and examined the relationship between food deserts and biliary severity and outcomes using food census tracts.

METHODS

We performed a retrospective review of 1609 patients presenting to our urban safety-net hospital that underwent cholecystectomy for acute cholecystitis, acute biliary pancreatitis, and choledocholithiasis between 2020 and 2021. Patients undergoing elective or outpatient cholecystectomy were excluded. Our primary end point was the association between living in a low-income and low-access to food (LILA) census tract and severity of biliary disease. Secondary end points included assessing associations between body mass index (BMI) and 30-d readmission, and geospatial patterns of BMI, severity of disease, and readmission. Statistical tests and the Getis-Ord Global Gi and local G statistic were performed for intergroup differences and geospatial mapping.

RESULTS

The median age was 39 y (29-49); 76% of patients were female, 84% identified as Hispanic, and 8.5% Black. Geospatial hotspots in LILA census tracts were identified and were significant for patients with higher BMI (P < 0.001) but not significant for 30-d readmissions (P = 0.12). Hotspots of patients with greater median disease severity were not in LILA census tracts and were not significant (P = 0.3). Overweight and/or obese patients undergoing cholecystectomy were more likely to reside in LILA census tracts. There was no association with disease severity or readmission and residing in a LILA census tract.

CONCLUSIONS

Higher BMI was more prevalent in LILA census tracts in this single-center study. There was no significant association between patient severity of disease and 30-d readmission, but there was overlap between readmission hot spots and LILA census tracts in geospatial analysis. We will continue to explore the relationship between food deserts and our patients' outcomes for targeted interventions to address any disparities.

The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record, census, and county data

BACKGROUND

While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss.

OBJECTIVE

To integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio.

SETTING

Seven hundred seventy-two patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015 to 2019 at Ohio State University.

METHODS

EHR variables included race, insurance, procedure, and percent total weight lost (%TWL) at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between-subjects factor; race, census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within-group differences for Black and White patients.

RESULTS

Access to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (P = .029). Black patients with access to more food stores within a 10-minute (P = .017) and White patients with more access within a 5-minute walk (P = .015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (P = .036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas.

CONCLUSIONS

Close proximity to food stores is associated with better weight loss 2 years after bariatric surgery. Lower poverty levels did not negatively affect weight loss in Black patients.

Effects of Whey Protein, Omega-3 Fatty Acid and Roux-En-Y Gastric Bypass on Body Weight, Biochemical Parameters and Organ Functions in an Obese Rat Model: Experimental Research

PURPOSE

Extreme obesity (EO) is one of the biggest public health problems in the world and has grown considerably over the years. The aim of the study is to examine the effect of Roux-en-Y gastric bypass (RYGB), whey protein (WP), and omega-3 polyunsaturated fatty acid (PUFA) supplementation applied to EO rats on weight loss, histopathological changes in internal organs and biochemical alterations.

MATERIALS AND METHODS

Wistar albino female rats (n = 28) were used in the study and randomly divided into four groups. All rats were made obese by adding high fructose corn syrup (HFCS) to their drinking water. After the EO, WP and omega-3 PUFA supplementation was given and RYGB process was applied. At the end of the study, glucose, total cholesterol, HDL, VLDL, AST, ALT and uric acid changes and liver, kidney and pancreatic tissues were evaluated histopathologically.

RESULTS

WP and omega-3 PUFA supplementation decreased body weight (p > 0.05). Omega-3 PUFA and RYGB caused a decrease in total cholesterol (p < 0.05), WP decreased HDL (p < 0.05), WP and omega-3 PUFA caused an increase in ALT (p < 0.05). WP has been shown to have greater curative effects in rat liver and kidney tissues. It has been determined that RYGB causes necrosis in the liver and HFCS causes inflammation in the kidney.

CONCLUSION

In the study; the positive effects of WP, omega-3 PUFA and bariatric surgery on obesity and dyslipidemia have been demonstrated. With this result, it was determined that WP, omega-3 PUFA supplementation and bariatric surgery were not superior to each other.

Proximity to High/Moderate vs Low Diversity Selection Food Stores and Patient Weight loss through 24 Months

PURPOSE

Explorations into the neighborhood food environment have not adequately extended to adults with obesity who undergo bariatric surgery. The objective of this study is to determine how diversity of food selection at food retail stores within proximities of 5- and 10-min walks associate with patient postoperative weight loss over 24 months.

MATERIALS AND METHODS

Eight hundred eleven patients (82.1% female; 60.0% White) who had primary bariatric surgery (48.6% gastric bypass) from 2015 to 2019 at The Ohio State University were included. EHR variables included race, insurance, procedure, and percent total weight loss (%TWL) at 2, 3, 6, 12, and 24 months. Proximity from patients' home addresses to food stores within a 5- (0.25 mile)- and 10-min (0.50 mile) walk were totaled for low (LD) and moderate/high (M/HD) diversity food selections. Bivariate analyses were conducted with %TWL at all visits and LD and M/HD selections within 5- (0, ≥ 1) and 10-min (0, 1, ≥ 2) walk proximities. Four mixed multilevel models were conducted with dependent variable %TWL over 24 months with visits as the between subjects factor and covariates: race, insurance, procedure, and interaction between proximity to type of food store selections with visits to determine association with %TWL over 24 months.

RESULTS

There were no significant differences for patients living within a 5- (p = 0.523) and 10-min (p = 0.580) walk in proximity to M/HD food selection stores and weight loss through 24 months. However, patients living in proximity to at least 1 LD selection store within a 5- (p = 0.027) and 1 or 2 LD stores within a 10-min (p = 0.015) walk had less weight loss through 24 months.

CONCLUSION

Overall, living in proximity to LD selection stores was a better predictor of postoperative weight loss over 24 months than living within proximity of M/HD selection stores.