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Diep C, Lee S, Xue Y, Xiao M, Pivetta B, Daza JF, Jung JJ, Wijeysundera DN, Ladha KS. Preoperative depression and outcomes after metabolic and bariatric surgery: A systematic narrative review. Obes Rev 2024:e13743. [PMID: 38572605 DOI: 10.1111/obr.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient-reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta-analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies (n = 3390) the associations between preoperative depression and weight loss outcomes at 6-72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient-important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations.
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Affiliation(s)
- Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maggie Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Bianca Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
| | - James J Jung
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
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2
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Camastra S, Palumbo M, Santini F. Nutrients handling after bariatric surgery, the role of gastrointestinal adaptation. Eat Weight Disord 2022; 27:449-461. [PMID: 33895917 PMCID: PMC8933374 DOI: 10.1007/s40519-021-01194-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/10/2021] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after surgery. Most of the changes depend on the accelerated gastric emptying observed in Roux-en-Y gastric bypass (RYGB) and, to a lesser extent, in sleeve gastrectomy (SG). The rapid delivery of meal into the jejunum, particularly after RYGB, contributes to the prompt appearance of glucose in peripheral circulation. Glucose increase is the principal determinant of GLP-1 increase with the consequent stimulation of insulin secretion, the latter balanced by a paradoxical glucagon increase that stimulates EGP to prevent hypoglycaemia. Protein digestion and amino acid absorption appear accelerated after RYGB but not after SG. After RYGB, the adaptation of the gut to the new condition participates to the metabolic change. The intestinal transit is delayed, the gut microbioma is changed, the epithelium becomes hypertrophic and increases the expression of glucose transporter and of the number of cell secreting hormones. These changes are not observed after SG. After RYGB-less after SG-bile acids (BA) increase, influencing glucose metabolism probably modulating FXR and TGR5 with an effect on insulin sensitivity. Muscle, hepatic and adipose tissue insulin sensitivity improve, and the gut reinforces the recovery of IS by enhancing glucose uptake and through the effect of the BA. The intestinal changes observed after RYGB result in a light malabsorption of lipid but not of carbohydrate and protein. In conclusion, functional and morphological adaptations of the gut after RYGB and SG activate inter-organs cross-talk that modulates the metabolic changes observed after surgery.Level of evidence Level V, narrative literature review.
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Affiliation(s)
- Stefania Camastra
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy. .,Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy.
| | - Maria Palumbo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.,Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy
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3
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Jamil LC, Suzuki VY, Ferreira LM. Preoperative Nutritional Parameters for Postbariatric Patients: A Review of Key Recommendations. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Liliane Carvalho Jamil
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Vanessa Yuri Suzuki
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Lydia Masako Ferreira
- Department of Surgery, Plastic Surgery Discipline, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
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Kindel TL, Ganga RR, Baker JW, Noria SF, Jones DB, Omotosho P, Volckmann ET, Williams NN, Telem DA, Petrick AT, Gould JC. American Society for Metabolic and Bariatric Surgery: Preoperative Care Pathway for Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2021; 17:1529-1540. [PMID: 34148848 DOI: 10.1016/j.soard.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Rama Rao Ganga
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - John Wilder Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Philip Omotosho
- Department of Surgery, Rush Medical College, Chicago, Illinois
| | - Erick T Volckmann
- Department of Surgery, University of Utah and Affiliated Hospitals, Salt Lake City, Utah
| | - Noel N Williams
- Department of Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon C Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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5
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Welbourn R, Hopkins J, Dixon JB, Finer N, Hughes C, Viner R, Wass J. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev 2018; 19:14-27. [PMID: 29024367 DOI: 10.1111/obr.12601] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/26/2022]
Abstract
The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.
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Affiliation(s)
- R Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - J Hopkins
- North Bristol Centre for Weight Loss, Metabolic and Bariatric Surgery, Southmead Hospital, Bristol, UK
| | - J B Dixon
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - N Finer
- UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, UK
| | - C Hughes
- Fakenham Weight Management Service, Norfolk, UK.,University of East Anglia, Norwich, UK
| | - R Viner
- Royal College of Paediatrics and Child Health, UCL GOS Institute of Child Health, University College London, London, UK
| | - J Wass
- Royal College of Physicians, London, UK
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6
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Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia. Surg Obes Relat Dis 2017; 13:2012-2020. [DOI: 10.1016/j.soard.2016.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 12/16/2022]
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Abstract
Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.
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Hawkins RB, Mehaffey JH, McMurry TL, Kirby J, Malin SK, Schirmer B, Hallowell PT. Clinical significance of failure to lose weight 10 years after roux-en-y gastric bypass. Surg Obes Relat Dis 2017; 13:1710-1716. [PMID: 28919184 DOI: 10.1016/j.soard.2017.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/17/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although Roux-en-Y gastric bypass (RYGB) induces short-term weight loss and co-morbidity amelioration, long-term data suggest that a subset of patients return to their preoperative body mass index (BMI). OBJECTIVES To identify the clinical implications of 10-year weight loss failure after RYGB. SETTING An academic teaching hospital. METHODS Adults undergoing RYGB (1985-2004) were included in this study (n = 1087). Absolute weight loss failure was defined as ≤0% reduction in excess BMI 10 years after surgery. Univariate analyses compared co-morbidity rates and resolution by weight loss classification. Multivariable regression modeling analyzed preoperative predictors of 10-year percent reduction in excess BMI and weight loss failure. RESULTS Complete follow-up was available for 617 (57%) patients with a 10-year median percent reduction in excess BMI of 57.1%; 10.2% of patients had weight loss failure. Prevalence of all co-morbidities decreased, even in patients with weight loss failure (all P<.05). Compared with patients with successful weight loss, patients with weight loss failure had similar rates of resolution of pre-existing co-morbidities, except for reduced resolution of apnea and cardiac co-morbidities (both P<.05). Risk factors for weight loss failure included lower BMI, nongovernmental insurance, longer travel time to hospital, and year of surgery. Nongovernmental insurance (odds ratio 2.03, P = .036) conferred the highest adjusted odds of weight loss failure. CONCLUSIONS The vast majority of patients experience dramatic health improvement 10 years after RYGB, even though some patients fail to maintain their weight loss. Renewed focus should be placed on prevention and treatment of chronic disease, with further investigation of weight loss independent mechanisms of health improvement.
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Affiliation(s)
- Robert B Hawkins
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Jennifer Kirby
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Steven K Malin
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, Virginia; Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Bruce Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Peter T Hallowell
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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9
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Yang NY, Wolever RQ, Roberts R, Perlman A, Dolor RJ, Abrams DI, Ginsburg GS, Simmons LA. Integrative health care services utilization as a function of body mass index: A BraveNet practice-based research network study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood) 2017; 242:1086-1094. [PMID: 28103699 DOI: 10.1177/1535370216688567] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids. Impact statement Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been studied. Furthermore, whether differences in the microbiota may alter the therapeutic responses to vitamin D is not known.
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Affiliation(s)
- Eric Lespessailles
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
| | - Hechmi Toumi
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
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11
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Stein J, Connor S, Virgin G, Ong DEH, Pereyra L. Anemia and iron deficiency in gastrointestinal and liver conditions. World J Gastroenterol 2016; 22:7908-25. [PMID: 27672287 PMCID: PMC5028806 DOI: 10.3748/wjg.v22.i35.7908] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.
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12
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Solsky I, Edelstein A, Brodman M, Kaleya R, Rosenblatt M, Santana C, Feldman DL, Kischak P, Somerville D, Mudiraj S, Leitman IM, Shamamian P. Perioperative care map improves compliance with best practices for the morbidly obese. Surgery 2016; 160:1682-1688. [PMID: 27622571 DOI: 10.1016/j.surg.2016.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. METHODS A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines. RESULTS In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices. CONCLUSION After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes.
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Affiliation(s)
- Ian Solsky
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY
| | - Alex Edelstein
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Michael Brodman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Ronald Kaleya
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Meg Rosenblatt
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Calie Santana
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY
| | | | | | | | | | | | - Peter Shamamian
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY.
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Gesquiere I, Augustijns P, Lannoo M, Matthys C, Van der Schueren B, Foulon V. Barriers in the Approach of Obese Patients Undergoing Bariatric Surgery in Flemish Hospitals. Obes Surg 2016; 25:2153-8. [PMID: 25893653 DOI: 10.1007/s11695-015-1680-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bariatric surgery is associated not only with weight loss and improvement of comorbidities of obesity but also with short and long-term complications. Preoperative screening and lifelong follow-up of these patients are important to optimize the effect of bariatric surgery and minimize complications. The objective of this study was to create an inventory of the current care offered to bariatric patients before and after surgery in Flemish hospitals, Belgium and to identify barriers for optimal care. METHODS Semi-structured interviews with healthcare professionals involved in screening and follow-up of bariatric patients in 12 hospitals in Flanders, Belgium were performed. Interviews were transcribed verbatim and analyzed with NVivo 10.0. RESULTS In each participating hospital, except one, biochemical screening before and after bariatric surgery was performed, but the extent and timing varied between hospitals. In ten hospitals, a standard multivitamin preparation was started in all patients after surgery, but there was a large variation for timing of initiation and duration between hospitals. The interviewees indicated that the knowledge about appropriate dosage and formulation adjustments after surgery was limited. Most of the performed drug adjustments were due to improvement of comorbidities. In 9 out of 12 hospitals, a multidisciplinary team was involved, but the approach varied widely. Only in 3 out of 12 hospitals, eligibility of patients for bariatric surgery was discussed in team meetings. CONCLUSIONS Strategies to implement existing guidelines are required in order to obtain more uniform, interdisciplinary support for bariatric patients, resulting in an increase of efficiency of surgery and improved patient care.
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Affiliation(s)
- Ina Gesquiere
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 521, 3000, Leuven, Belgium.
| | - Patrick Augustijns
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 921, 3000, Leuven, Belgium.
| | - Matthias Lannoo
- Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, KU Leuven, O&N 1, Herestraat 49, Box 902, 3000, Leuven, Belgium. .,Department of Endocrinology, University Hospitals Leuven, Leuven, Campus Gasthuisberg, Herestraat 49, Box 7003, 3000, Leuven, Belgium.
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, KU Leuven, O&N 1, Herestraat 49, Box 902, 3000, Leuven, Belgium. .,Department of Endocrinology, University Hospitals Leuven, Leuven, Campus Gasthuisberg, Herestraat 49, Box 7003, 3000, Leuven, Belgium.
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N2, Herestraat 49, Box 521, 3000, Leuven, Belgium.
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14
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Brown WA, Burton PR, Shaw K, Smith B, Maffescioni S, Comitti B, Cowley MA, Laurie C, Way A, Nottle P. A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery. Obes Surg 2016; 26:2074-2081. [DOI: 10.1007/s11695-016-2075-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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15
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Welbourn R, Dixon J, Barth JH, Finer N, Hughes CA, le Roux CW, Wass J. NICE-Accredited Commissioning Guidance for Weight Assessment and Management Clinics: a Model for a Specialist Multidisciplinary Team Approach for People with Severe Obesity. Obes Surg 2016; 26:649-59. [DOI: 10.1007/s11695-015-2041-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Sioka E, Tzovaras G, Katsogridaki G, Bakalis V, Bampalitsa S, Zachari E, Zacharoulis D. Desire for Body Contouring Surgery After Laparoscopic Sleeve Gastrectomy. Aesthetic Plast Surg 2015; 39:978-84. [PMID: 26395092 DOI: 10.1007/s00266-015-0561-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/28/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an effective approach for the treatment of morbid obesity. Surgically induced massive weight loss provokes skin deformities that can be addressed with plastic surgery. However, there is a paucity of data regarding the esthetic outcome of patients after LSG. The aim of the study was to assess the postoperative appearance and the request for body contouring surgery after LSG. METHODS All the patients who underwent LSG between August 2006 and September 2014 with a minimum follow-up of 1 year were interviewed using the Post-Bariatric Surgery Appearance Questionnaire. Postoperative satisfaction with their appearance, and the desire and frequency for body contouring surgery were assessed. RESULTS A total of 175 patients were interviewed. Overall, 75% of the patients rated that they felt attractive with their appearance. More specifically, 84% of men and 72% of women were satisfied with their appearance. Females were most dissatisfied with waist/abdomen, chest/breasts, and upper arms, in descending order. Males were dissatisfied with chest/breasts, upper arms, and waist/abdomen, respectively. The most desired procedures were abdominoplasty, chest/breast lift, and upper arm lift in females and abdominoplasty, thigh lift and upper arm lift in males. Only 3.6% of patients underwent body contouring surgery postoperatively. CONCLUSION LSG patients rated their overall appearance from slightly to moderately attractive. There was a strong desire for abdominoplasty; breast lift and upper arm lift in females, although only a small proportion of patients proceeded to plastic surgery. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Freitas C, Araújo C, Caldas R, Lopes DS, Nora M, Monteiro MP. Effect of new criteria on the diagnosis of gestational diabetes in women submitted to gastric bypass. Surg Obes Relat Dis 2014; 10:1041-6. [DOI: 10.1016/j.soard.2014.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/12/2014] [Accepted: 03/17/2014] [Indexed: 02/01/2023]
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Godley J, Glenn NM, Sharma AM, Spence JC. Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. J Multidiscip Healthc 2014; 7:459-70. [PMID: 25336965 PMCID: PMC4199836 DOI: 10.2147/jmdh.s68555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Students training in obesity research, prevention, and management face the challenge of developing expertise in their chosen academic field while at the same time recognizing that obesity is a complex issue that requires a multidisciplinary and multisectoral approach. In appreciation of this challenge, the Canadian Obesity Network (CON) has run an interdisciplinary summer training camp for graduate students, new career researchers, and clinicians for the past 8 years. This paper evaluates the effects of attending this training camp on trainees’ early careers. We use social network analysis to examine the professional connections developed among trainee Canadian obesity researchers who attended this camp over its first 5 years of operation (2006–2010). We examine four relationships (knowing, contacting, and meeting each other, and working together) among previous trainees. We assess the presence and diversity of these relationships among trainees across different years and disciplines and find that interdisciplinary contact and working relationships established at the training camp have been maintained over time. In addition, we evaluate the qualitative data on trainees’ career trajectories and their assessments of the impact that the camp had on their careers. Many trainees report that camp attendance had a positive impact on their career development, particularly in terms of establishing contacts and professional relationships. Both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in the health sciences.
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Affiliation(s)
- Jenny Godley
- Department of Sociology, University of Calgary, Calgary, AB, Canada
| | - Nicole M Glenn
- School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - John C Spence
- Sedentary Living Laboratory, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
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Bächler T, Schiesser M, Lutz TA, le Roux CW, Bueter M. Where to begin and where to end? Preoperative assessment for patients undergoing metabolic surgery. Dig Surg 2014; 31:25-32. [PMID: 24819494 DOI: 10.1159/000354553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is the most effective treatment of obesity and its associated diseases like type 2 diabetes mellitus. Given the obesity epidemic and the efficacy of surgical treatment, the number of surgical weight loss procedures has grown in recent years. Nevertheless, there is little consensus regarding the extent of preoperative investigations required prior to patients undergoing surgery. This article aims to discuss the available evidence on which preoperative tests are useful for the detection and treatment of conditions such as venous thromboembolism, obstructive sleep apnea syndrome and Helicobacter pylori-positive gastritis prior to an operation. The present literature suggests that only a few preoperative investigations are essential, but that preoperative multidisciplinary care is beneficial.
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Affiliation(s)
- Thomas Bächler
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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The anatomy of a weight recidivism and revision bariatric surgical clinic. Gastroenterol Res Pract 2014; 2014:721095. [PMID: 24672540 PMCID: PMC3942332 DOI: 10.1155/2014/721095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012) of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic), 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.
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Natvik E, Gjengedal E, Råheim M. Totally changed, yet still the same: patients' lived experiences 5 years beyond bariatric surgery. QUALITATIVE HEALTH RESEARCH 2013; 23:1202-1214. [PMID: 23921810 DOI: 10.1177/1049732313501888] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Bariatric surgery provides sustainable weight loss and increased quality of life for most, but not all patients. To increase the knowledge of this complex patient group and their needs during follow-up, we aimed to describe the essential meaning of bariatric surgery patients' long-term experiences by using a phenomenological lifeworld approach. Eight patients were interviewed between 5 and 7 years after bariatric surgery. Life after bariatric surgery was described as living with tension, ambivalence, and reinforced attention toward one's own body. The tension was related to embodied change and altered relations to the social world. The patients express an ongoing demand for control of health-related habits and practices, and to not lose control over the body again. Surgical weight loss and improved physical function do not necessarily mean changed health-related habits and practices in the long term. Experiencing weight regain is connected with emotional stress, shame, and self-contempt.
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Benson-Davies S, Davies ML, Kattelmann K. Understanding Eating and Exercise Behaviors in Post Roux-en-Y Gastric Bypass Patients: A Quantitative and Qualitative Study. Bariatr Surg Pract Patient Care 2013; 8:61-68. [PMID: 24761367 PMCID: PMC3827846 DOI: 10.1089/bari.2013.9989] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Weight regain following gastric bypass (GB) surgery continues to plague many individuals across the United States. However, understanding long-term eating and exercise behaviors to promote and sustain a lower weight following GB surgery is limited. METHOD The purpose of this study was to explore the perceptions and attitudes of eating and exercise behaviors associated with weight maintenance in post-GB patients (n=24) 2 or more years postsurgery. Demographic, anthropometric, and food record data were collected. Focus groups and personal interviews were used to understand behaviors and support systems associated with weight stabilization. Focus groups were audio-taped, transcribed, and organized into common themes. RESULTS All participants were female, with a mean of 6 years postsurgery, and had a mean age of 51.8±10.5 years. The majority were married (71%) and had a college degree (58%). Although the average weight regain postsurgery was estimated at 16.2±12.7 kg, most of the women (75%) had maintained a significant weight loss of at least 50% of their excess body weight. Themes associated with weight regain emerging from the focus groups included variable family support and a return to "old eating habits." CONCLUSION Focus group participants identified lack of long-term emotional support from family members and limited community support for weight loss surgery patients.
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Affiliation(s)
- Sue Benson-Davies
- Bariatric Nutrition Consultant, Private Practice, Whitewood, South Dakota
| | | | - Kendra Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brooking, SD
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Evaluation of Weight Loss Failure, Medical Outcomes, and Personal Experiences after Roux-en-Y Gastric Bypass: A Critical Analysis. ISRN OBESITY 2013; 2013:943423. [PMID: 24555160 PMCID: PMC3901958 DOI: 10.1155/2013/943423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/15/2013] [Indexed: 01/06/2023]
Abstract
Background. Roux-en-Y gastric bypass (RYGB) is considered an effective and well-tolerated surgical procedure. In this retrospective study, we critically assessed efficacy and negative personal experiences (NPEs) after RYGB with a self-administered questionnaire (SAQ). Methods. This questionnaire study included 404 patients who had undergone RYGB. Analysis was performed using data from medical records, referral letters, and SAQs at an average of 33 months after procedure. We evaluated the occurrence of hypertension, CPEP use and type 2 diabetes mellitus (T2DM), the amount of excess weight loss, degree of satisfaction and negative personal experiences (NPEs) related to the procedure, and adherence to a dedicated life style program and (non)attendance to followup. consults after surgery. Results. 42.3% of all SAQs were evaluable for analysis. T2DM remained similar, while hypertension and continuous positive airway pressure (CPAP) use decreased significantly; excess weight loss of ≥40% was reported in 69% and of <40% in 19%, a significant improvement. Absolute weight gain was reported in 10.5%, fatigue in 44.4%, dysphagia in 11.6%, and other NPEs in 7.6%. Dissatisfaction over weight loss was reported in 9.4%. Mean number of follow-up visits was 9.6 per respondent, while nonattendance of any follow-up visit consults occurred in 1.8%. Conclusions. The use of post-RYGB SAQs provided evaluable data in 42.3%. Treatment failure after RYGB appears to be relevant, encouraging the use of SAQ studies in large cohorts.
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Ribaric G, Buchwald JN, d'Orsay G, Daoud F. 3-year real-world outcomes with the Swedish adjustable gastric band™ in France. Obes Surg 2013; 23:184-96. [PMID: 23054572 PMCID: PMC3560940 DOI: 10.1007/s11695-012-0765-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The study objective was to ascertain outcomes with the Swedish adjustable gastric band (SAGB) on an intention-to-treat basis in multiple centers across the French social health insurance system. SAGB results at 3-year follow-up are reported. The noncomparative, observational, prospective, consecutive cohort study design sought a 500-patient minimum recruitment geographically representative of continental France. Safety (adverse events [AEs], device-related morbidity, and mortality) and effectiveness (change in body mass index [BMI, kilograms per square meter], percentage excess weight loss, comorbidities, quality of life [QoL]) were assessed. Adjustable gastric band survival was calculated. Thirty-one surgeons in 28 multidisciplinary teams/sites enrolled patients between September 2, 2007 and April 30, 2008. SAGB was successfully implanted in 517 patients: 88.0 % female; mean age, 37.5 years; obesity duration, 15.3 years (baseline: mean BMI, 41.0; comorbidities, 773 in 74.3 % of patients; Bariatric Analysis and Reporting Outcome System (BAROS), 1.4; EuroQoL 5-Dimensions (EQ-5D), 0.61; EuroQoL-visual analog scale (EQ-VAS), 52.3). At 3 years: BMI, 32.2 (mean change, -9.0; p < 0.0001); excess weight loss, 47.4 %; comorbidities, 161 in 27.2 %; BAROS, 3.6 (+2.2, p < 0.0001); EQ-5D, 0.84 (+0.22, p < 0.0001); EQ-VAS, 73.4 (+21.4, p < 0.0001). SAGB-induced weight loss was associated with substantially improved QoL. One death occurred and was unrelated to the treatment. No AE was reported in 68.3 % of patients, and no confirmed device-related AE in 77.0 %. Overall AE rate was 0.19 per patient year. Device retention was 87.0 %. Analysis of patients lost to follow-up showed a nonsignificant effect on overall study results. In a prospective, consecutive cohort, "real-world", nationwide study, the Swedish Adjustable Gastric Band was found safe and effective at 3-year follow-up.
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Affiliation(s)
- G Ribaric
- Ethicon Endo-Surgery (Europe), European Surgical Institute, Hamburg, Germany.
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Nguyen N, Champion JK, Ponce J, Quebbemann B, Patterson E, Pham B, Raum W, Buchwald JN, Segato G, Favretti F. A review of unmet needs in obesity management. Obes Surg 2012; 22:956-66. [PMID: 22438220 DOI: 10.1007/s11695-012-0634-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prevalence of obesity continues to escalate in the USA; however, there is no consensus regarding the optimal therapy for obesity. For the vast majority of severely obese patients, conventional medical therapies (i.e., diet, exercise, behavioral counseling) often fail over the long term. Existing pharmacotherapy adjunctive to behavioral therapy has limited effectiveness and an imperfect safety record. In contrast, bariatric surgery has a high degree of weight loss efficacy, yet only a small fraction of the qualifying obese population undergoes these procedures because of the associated perioperative risks and potential late complications. In addition, the role of bariatric surgery is unclear in certain patient populations, such as patients with lower body mass index (BMI, 30-35 kg/m(2)), the high-risk super-super obese patients (BMI > 60), the morbidly obese adolescent, and obese patients requiring weight reduction in preparation for other procedures, such as orthopedic, transplant, or vascular surgeries. In these circumstances, there is a need for an effective but less invasive treatment to bridge the gap between medical and surgical therapy. This review examines current treatment outcomes, identifies prominent areas of unmet clinical needs, and provides an overview of two minimally invasive "temporary procedures for weight loss" that may eventually address some of the unmet needs in obesity management.
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Affiliation(s)
- N Nguyen
- Division of GI Surgery, University of California Irvine Medical Center, 333 City Bldg. West, Suite 850, Orange, CA 92868, USA.
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An assessment of patient behavioral requirements pre- and post-surgery at accredited weight loss surgical centers. Obes Surg 2012; 21:1950-7. [PMID: 21337000 DOI: 10.1007/s11695-011-0366-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Without changes to diet and exercise behaviors, weight losses achieved through surgical procedures may be short lived. There is no data currently available on how accredited bariatric facilities are implementing best-practice guidelines related to behavioral and psychological care to help patients make long-lasting change. METHODS One hundred twenty-three ACS-accredited facility websites were analyzed using document and content analyses to determine behavioral and psychological services. Categories of common facility practices were identified according to best-practice recommendations and website data was coded by category. Descriptive statistics were then generated to summarize the implementation of services. RESULTS Behavioral and psychological services were more likely to be required prior to surgery than after surgery. In addition, there is great variance in the staff employed by facilities to assist patients, with more facilities employing dietary staff than exercise staff. Data patterns are reported across the categories of psychological assessment, pre- and post-surgical behavioral requirements, type of support groups, follow-up protocol, and staffing. CONCLUSIONS Most facilities implement some type of dietary counseling or consultation; however, few include services related to helping patients improve physical activity patterns. Greater incorporation of behavioral and psychological services following surgery is recommended to prevent weight regain and to help patients adopt and maintain regular physical activity.
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Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BGA, Wong JLA, Norman RJ, Costello MF. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust 2011; 195:S65-112. [PMID: 21929505 DOI: 10.5694/mja11.10915] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 08/26/2011] [Indexed: 12/19/2022]
Affiliation(s)
- Helena J Teede
- Research Unit, Jean Hailes Foundation for Women's Health, Melbourne, VIC, Australia.
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Ginsberg GG, Chand B, Cote GA, Dallal RM, Edmundowicz SA, Nguyen NT, Pryor A, Thompson CC. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011; 74:943-53. [PMID: 22032311 DOI: 10.1016/j.gie.2011.08.053] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 08/29/2011] [Indexed: 02/08/2023]
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Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) is dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. The American Society for Metabolic and Bariatric Surgery (ASMBS) is dedicated to improving public health and well-being by lessening the burden of the disease of obesity and related diseases. They are the largest professional societies for their respective specialties of gastrointestinal endoscopy and bariatric surgery in the world. The ASGE/ASMBS task force was developed to collaboratively address opportunities for endoscopic approaches to obesity, reflecting the strengths of our disciplines, to improve patient and societal outcomes. This white paper is intended to provide a framework for, and a pathway towards, the development, investigation, and adoption of safe and effective endoscopic bariatric therapies (EBT).
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Fierabracci P, Pinchera A, Martinelli S, Scartabelli G, Salvetti G, Giannetti M, Pucci A, Galli G, Ricco I, Querci G, Rago T, Di Salvo C, Anselmino M, Vitti P, Santini F. Prevalence of endocrine diseases in morbidly obese patients scheduled for bariatric surgery: beyond diabetes. Obes Surg 2011; 21:54-60. [PMID: 20953730 DOI: 10.1007/s11695-010-0297-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery allows stable body weight reduction in morbidly obese patients. In presurgical evaluation, obesity-related co-morbidities must be considered, and a multidisciplinary approach is recommended. Precise guidelines concerning the endocrinological evaluation to be performed before surgery are not available. The aim of this study was to evaluate the prevalence of common endocrine diseases in a series of obese patients scheduled for bariatric surgery. METHODS We examined 783 consecutive obese subjects (174 males and 609 females) aged 18-65 years, who turned to the obesity centre of our department from January 2004 to December 2007 for evaluation before bariatric surgery. Thyroid, parathyroid, adrenal and pituitary function was evaluated by measurement of serum hormones. Specific imaging or supplementary diagnostic tests were performed when indicated. RESULTS The overall prevalence of endocrine diseases, not including type 2 diabetes mellitus, was 47.4%. The prevalence of primary hypothyroidism was 18.1%; pituitary disease was observed in 1.9%, Cushing syndrome in 0.8%, while other diseases were found in less than 1% of subjects. Remarkably, the prevalence of newly diagnosed endocrine disorders was 16.3%. CONCLUSIONS A careful endocrinological evaluation of obese subjects scheduled for bariatric surgery may reveal undiagnosed dysfunctions that require specific therapy and/or contraindicate the surgical treatment in a substantial proportion of patients. These results may help to define the extent of the endocrinological screening to be performed in obese patients undergoing bariatric surgery.
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Affiliation(s)
- Paola Fierabracci
- Department of Endocrinology and Kidney, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy.
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Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation 2011; 123:1683-701. [PMID: 21403092 DOI: 10.1161/cir.0b013e3182149099] [Citation(s) in RCA: 291] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Strohmayer E, Via MA, Yanagisawa R. Metabolic Management following Bariatric Surgery. ACTA ACUST UNITED AC 2010; 77:431-45. [DOI: 10.1002/msj.20211] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Khandalavala BN, Hibma PP, Fang X. Prevalence and Persistence of Vitamin D Deficiency in Biliopancreatic Diversion Patients: A Retrospective Study. Obes Surg 2010; 20:881-4. [DOI: 10.1007/s11695-010-0185-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bays HE, Laferrère B, Dixon J, Aronne L, González-Campoy JM, Apovian C, Wolfe BM. Adiposopathy and bariatric surgery: is 'sick fat' a surgical disease? Int J Clin Pract 2009; 63:1285-300. [PMID: 19691612 PMCID: PMC2779983 DOI: 10.1111/j.1742-1241.2009.02151.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or 'sick fat'), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia. METHODS A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery. RESULTS Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion. CONCLUSIONS In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease.
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Affiliation(s)
- H E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY 40213, USA.
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