Motivation, readiness to change, and weight loss following adjustable gastric band surgery

A comprehensive analysis of health care Inequities in randomized clinical trials following bariatric surgeries

BACKGROUND

Obesity is a global epidemic, leading to an increasing focus on interventions like bariatric surgeries. Despite this, there's a noticeable gap in understanding the demographic distribution of patients in clinical trials for bariatric surgery.

METHODS

We conducted a comprehensive analysis of 117 registered randomized clinical trials related to bariatric surgery on ClinicalTrials.gov. We extracted demographic information, including age, sex, race, and ethnicity, and performed descriptive statistical analyses.

RESULTS

The analysis covered 8,418 participants. The mean age was 43.8 years, with a substantial majority (93.8 ​%) falling within the 18-65 age group. Females comprised 74.9 ​% of participants, surpassing real-world estimates. Racially, 65.3 ​% of participants were White, while African Americans represented 18.5 ​%, Asians 1.2 ​%, Native Hawaiians 0.2 ​%, and American Indians 0.1 ​%, indicating an underrepresentation of diverse racial groups, notably lower compared to real-world demographic data. In terms of ethnicity, only 17.6 ​% were Hispanic.

CONCLUSIONS

This study reveals significant demographic disparities in patients undergoing bariatric surgeries in clinical trials. This suggests a lack of generalizability, emphasizing the need for inclusive recruitment strategies to enhance health equity.

Psychological predictors of adherence to lifestyle changes after bariatric surgery: A systematic review

Objective

Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post-operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery.

Methods

PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters.

Results

A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post-operative instructions. Higher self-efficacy was consistently predictive of better post-operative adherence to diet and physical activity, while pre-operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions.

Conclusions

This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

Weight Self-Efficacy and Recovery Among African-Americans With Serious Mental Illness and High Body Weight

ABSTRACT

Many African-Americans with serious mental illness fail to engage in evidence-based programs that positively affect weight management. We examined how having a weight-related physical illness correlated with self-efficacy, recovery, and quality of life by contrasting illnesses with symptoms that are obviously perceived ( e.g. , sleep apnea and pain related to weight) versus those that are not ( e.g. , hypertension). African-Americans with serious mental illness who were overweight (body mass index ≥25) completed the Weight Efficacy Lifestyle Questionnaire, Recovery Assessment Scale, and Quality of Life Scale in this study assessing the impact of a program on weight and health. Silent weight-related physical disorders were not found to correlate with quality of life, recovery, or weight self-efficacy. Differences in recovery were found in people with versus without sleep apnea and weight-related pain. Findings suggest future directions for affirming approaches to promote engagement among African-Americans with serious mental illness in weight management programs.

Addressing a critical need: A randomised controlled feasibility trial of acceptance and commitment therapy for bariatric surgery patients at 15-18 months post-surgery

Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. To test the feasibility and acceptability of ACT following bariatric surgery a randomised controlled trial of 10 sessions of group ACT or Usual Care Support Group control (SGC) was delivered 15-18 months post bariatric surgery (ISRCTN registry ID: ISRCTN52074801). Participants were compared at baseline, 3, 6 and 12 months using validated questionnaires to assess weight, wellbeing, and healthcare use. A nested, semi-structured interview study was conducted to understand acceptability of the trial and group processes. 80 participants were consented and randomised. Attendance was low for both groups. Only 9 (29%) ACT participants completed > = half of the sessions, this was the case for 13 (35%) SGC participants. Forty-six (57.5%) did not attend the first session. At 12 months, outcome data were available from 19 of the 38 receiving SGC, and from 13 of the 42 receiving ACT. Full datasets were collected for those who remained in the trial. Nine participants from each arm were interviewed. The main barriers to group attendance were travel difficulties and scheduling. Poor initial attendance led to reduced motivation to return. Participants reported a motivation to help others as a reason to join the trial; lack of attendance by peers removed this opportunity and led to further drop out. Participants who attended the ACT groups reported a range of benefits including behaviour change. We conclude that the trial processes were feasible, but that the ACT intervention was not acceptable as delivered. Our data suggest changes to recruitment and intervention delivery that would address this.

"Is it time to throw out the weighing scales?" Implicit weight bias among healthcare professionals working in bariatric surgery services and their attitude towards non-weight focused approaches

BACKGROUND

People living with overweight or obesity (PLwO) can be stigmatised by healthcare professionals (HCPs). Reducing focus on weight is a proposed strategy to provide less threatening healthcare experiences. Given the lack of research on weight bias within obesity services, this study aimed to explore implicit bias among obesity specialist HCPs and explore views on non-weight focused approaches.

METHODS

Obesity specialist HCPs were invited to a webinar, "An exploration of non-weight focused approaches within bariatric services", held in October 2021. Implicit weight bias was examined using the BiasProof mobile device test, based on the Implicit Association Test. Poll data was analysed descriptively, and qualitative data was analysed using framework analysis.

FINDINGS

82 of the 113 HCPs who attended the webinar consented to contribute data to the study. Over half (51%) had an implicit weight bias against PLwO. Most (90%) agreed/strongly agreed that obesity services are too weight focused and that patients should not be weighed at every appointment (86%). Perceived benefits of taking a non-weight focused approach included patient-led care, reducing stigma and supporting patient wellbeing, while perceived barriers included loss of objectivity, inducing risk and difficulty demonstrating effectiveness.

INTERPRETATION

Our findings indicate that half of obesity specialists HCPs in our sample of 82 providers, who are primarily dieticians and psychologists, have an implicit weight bias against PLwO. HCPs feel that a weight-focused approach within services was a barrier to patient care, but that there is a lack of alternative non-weight focused measures. Further research is needed into substitute outcome measures for clinical practice, also seeking the views of PLwO, and into interventions to address implicit weight bias.

FUNDING

Johnson & Johnson funded the BiasProof licence and publication open access charge.

Health-related outcomes in patients enrolled on surgical and non-surgical routes in a weight management service

BACKGROUND AND AIMS

This study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non-surgical routes to support weight loss.

METHODS

Four hundred and forty eight participants were assessed on various weight-related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight-related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non-surgery) and time in the service were facilitated by doubly multivariate analyses of variance models.

RESULTS

Between referral and discharge, participants improved significantly on a combination of outcomes (P < .001) and on each outcome assessed individually. The magnitude of overall improvement was moderate (partial-η2 = 0.141). Individual improvement components varied; including a moderate reduction of 3.2% in the BMI outcome measure and a substantive gain of 64.6% in quality of life. Participants on non-surgical routes performed significantly better than participants on surgical routes on a linear combination of outcomes (P < .001) and on all outcomes except nutrition; with an effect of route small-to-moderate in magnitude (partial-η2 = 0.090).

CONCLUSIONS

Weight management services are successful in achieving weight management-related outcomes in the short- and long-term, with large overall improvements between referral and discharge averaged over all participants observed. Non-surgical routes appear to confer benefits between referral and discharge compared to surgical routes.

Improvement in mood symptoms ​after post-bariatric surgery among people with obesity: A systematic review and meta-analysis

AIMS

We aimed to examine if bariatric surgery was associated with a reduction in the prevalence of depressive and anxiety symptoms among people with obesity.

MATERIALS AND METHODS

We pooled data from 49 studies involving 11,255 people with obesity who underwent bariatric surgery. The study outcomes were the prevalence of depressive and anxiety symptoms among these patients pre- and post-surgery.

RESULTS

There was a significant reduction in body mass index (BMI) post-operatively (pooled d+: -13.3 kg/m² [95% confidence interval [CI] 15.19, -11.47], p < 0.001). The pooled proportion of patients with anxiety symptoms reduced from 24.5% pre-operatively to 16.9% post-operatively, with an odds ratio (OR) of 0.58 (95% CI 0.51, 0.67, p < 0.001). The reduction remained significant in women aged ≥40 years and irrespective of post-operative BMI. There were significant reductions in Hospital Anxiety and Depression Score (HADS) (anxiety component) by 0.64 (pooled d+: -0.64 [95% CI -1.06, -0.22], p = 0.003) and Generalized Anxiety Disorder Assessment-7 score by 0.54 (pooled d+: -0.54 [95% CI -0.64, -0.44], p < 0.001). The pooled proportion of depressive symptoms reduced from 34.7% pre-operatively to 20.4% post-operatively, with an OR of 0.49 (95% CI 0.37, 0.65, p < 0.001). The reduction remained significant irrespective of patient's age and post-operative BMI. There were also significant reductions in HADS score (depressive component) (pooled d+: -1.34 [95% CI -1.93, -0.76], p < 0.001), Beck's Depression Inventory score (pooled d+: -1.04 [95% CI -1.46, -0.63], p < 0.001) and Patient Health Questionnaire-9 score (pooled d+: -1.11 [95% CI -1.21, -1.01], p < 0.001).

CONCLUSION

Bariatric surgery was associated with significant reduction in the prevalence and severity of depressive and anxiety symptoms among people with obesity.

Grit, Self-Efficacy, Motivation and the Readiness to Change Index Toward Exercise in the Adult Population

This study examined the relationships between grit personality, self-efficacy, motivation (autonomous, controlled, and amotivation), and the readiness to change index toward exercise. Participants were 391 adults aged between 18 and 64 years old (M = 31.16; SD = 12.45) from Hermosillo, Sonora (Mexico) who completed questionnaires (i.e., the Grit Personality Scale, the Exercise Self-Efficacy Questionnaire, the Treatment Self-Regulation Questionnaire and the Stages of Change Questionnaire for Physical Activity) measuring the variables of interest. The reliability of the instruments was tested using Cronbach's alpha, whereas confirmatory factor analyses were performed for each instrument separately. A measurement model and a structural equation model were assessed as well. The results of the structural equations model showed that grit personality was positively associated with self-efficacy, and in turn, with autonomous motivation and with the readiness to change index. On the other hand, self-efficacy was negatively correlated with controlled motivation, and positively correlated with the readiness to change index. Finally, self-efficacy also showed a negative correlation with amotivation, which, in turn, was negatively correlated with the readiness to change index. These results provide information to develop psychological intervention programs based on grit personality and motivation, with the aim of increasing the number of participants who engage in exercise.

Laparoscopic Adjustable Gastric Banding with the Adhesix® Bioring® for Weight Regain or Insufficient Weight Loss After a Roux-en-Y Gastric Bypass: Midterm Data from the Pronto Registry

PURPOSE

Although Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures, insufficient weight loss is described to be as high as 20-35%. To treat weight regain/inadequate weight loss, laparoscopic adjustable gastric banding (LAGB) could be a feasible revisional strategy.

MATERIALS AND METHODS

We report on a prospective study which included 35 patients who presented inadequate weight loss or significant weight regain after primary RYGB (percentage excess weight loss [%EWL] at revision < 50%). All patients underwent revisional LAGB with the placement of an Adhesix® Bioring® adjustable gastric band (Cousin Biotech, Wervicq-Sud, France). Patients' weight loss, complications, frequency of revisions and quality of life were evaluated.

RESULTS

Follow-up data at 24 months are available for 80% of the included patients. The mean BMI before RYGB was 43.6 ± 5.4 kg/m² and before revisional LAGB was 38.8 ± 4.3kg/m². The %EWL before revisional surgery was 23.3 ± 24.8%. The average time between both procedures was 6.7 (mean) ± 3.6 (SD) years. Twenty-four months after revisional LAGB, the average BMI calculated from the weight at RYGB dropped to 32.0 ± 4.5 kg/m², with an additional %EWL of 49.9 ± 30.3% resulting in a total %EWL of 60.7 ± 28%. The reoperation rate for complications related to LAGB was 21.2%. No band erosions occurred, but two bands needed to be removed during the study.

CONCLUSION

Revisional LAGB may be considered a valid salvage procedure in patients with weight regain or inadequate weight loss after RYGB, though band- and port-related complications remain a notable concern.

Predictors of Weight Loss and Weight Gain in Weight Management Patients during the COVID-19 Pandemic

OBJECTIVE

To examine the associations between patient struggles, health, and weight management changes during the COVID-19 pandemic.

METHODS

585 patients attending a publicly funded clinical weight management program responded to an electronic survey.

RESULTS

Over half of the patients reported worsened overall health, mental health, physical activity, or diet during the pandemic. Approximately 30% of patients lost ≥3% of their body weight and 21% gained ≥3% of their body weight between March and July of the pandemic. Reports of social isolation was associated with increased odds for weight loss in women (OR = 2.0, 1.2-3.3), while low motivation (OR = 1.9, 1.0-3.7), depression (OR = 2.5, 1.0-6.3), and struggles with carbohydrate intake (OR = 2.1, 1.0-4.3) were associated with weight gain. Cooking more at home/eating less take out was associated with increased likelihood of weight loss (OR = 2.1, 1.1-3.9) and lower odds for weight gain (OR = 0.2, 0.1 to 0.97). Working from home was not associated with weight loss or weight gain (P > 0.6).

CONCLUSION

The COVID-19 pandemic is associated with certain factors that may facilitate weight loss and other factors that promote weight gain. Thus, depending on the patient experience during the pandemic, prevention of weight gain may be more appropriate than weight loss.

Developing Integrated Clinical Pathways for the Management of Clinically Severe Adult Obesity: a Critique of NHS England Policy

PURPOSE OF THE REVIEW

Pathways for obesity prevention and treatment are well documented, yet the prevalence of obesity is rising, and access to treatment (including bariatric surgery) is limited. This review seeks to assess the current integrated clinical pathway for obesity management in England and determine the major challenges.

RECENT FINDINGS

Evidence for tier 2 (community-based lifestyle intervention) and tier 3 (specialist weight management services) is limited, and how it facilitates care and improve outcomes in tier 4 remains uncertain. Treatment access, rigidity in pathways, uncertain treatment outcomes and weight stigma seems to be major barriers to improved care. More emphasis must be placed on access to effective treatments, treatment flexibility, addressing stigma and ensuring treatment efficacy including long-term health outcomes. Prevention and treatment should both receive significant focus though should be considered to be largely separate pathways. A simplified system for weight management is needed to allow flexibility and the delivery of personalized care including post-bariatric surgery care for those who need it.

Weight loss during medical weight management does not predict weight loss after bariatric surgery: a retrospective cohort study

BACKGROUND

Many bariatric surgical centers mandate achieving weight loss targets through medical weight management (MWM) programs before offering bariatric surgery, but the evidence for this is unclear.

OBJECTIVES

To examine the relationship between weight changes during (1) MWM, and (2) preoperative low-energy-diet (LED), and weight changes at 12 and 24 months after surgery.

SETTING

Multicenter community- and acute-based MWM services referring to one regional bariatric center, United Kingdom.

METHODS

A retrospective cohort study of patients who attended MWM and then underwent a primary laparoscopic bariatric procedure (adjustable gastric banding [LAGB], or Roux-en-Y gastric bypass [RYGB]) in a single bariatric center in the United Kingdom between 2013 and 2015. Data were collected from patient electronic records.

RESULTS

Two hundred eight patients were included (LAGB n = 128, RYGB n = 80). Anthropometric data were available for 94.7% and 88.0% of participants at 12 and 24 months, respectively. There was no relationship between weight loss during MWM and after surgery at either 12 or 24 months. Weight loss during the preoperative LED predicted greater weight loss after LAGB (β = .251, P = .006) and less weight loss after RYGB (β = -.390, P = .003) at 24 months, after adjusting for age, sex, ethnicity, baseline weight, and LED duration.

CONCLUSIONS

Weight loss in MWM does not predict greater weight loss outcomes up to 24 months after LAGB or RYGB. Greater weight loss during the preoperative LED predicted greater weight loss after LAGB and less weight loss after RYGB. Our results suggest that patients should not be denied bariatric surgery because of not achieving weight loss in MWM. Weight loss responses to preoperative LEDs as a predictor of postsurgical weight loss requires further investigation.

Five-year outcomes for laparoscopic sleeve gastrectomy from a single center in Turkey

BACKGROUND

There are no long-term results for laparoscopic sleeve gastrectomy (LSG) from Turkey.

OBJECTIVES

Assess the outcomes of LSG at 5 years.

DESIGN

Retrospective.

SETTING

Training and research hospital.

PATIENTS AND METHODS

The study included patients with LSG performed from August 2012 to December 2013. The data was prospectively collected with the aim of providing 5-year outcomes.

MAIN OUTCOME MEASURES

Changes in percentage excessive weight loss (%EWI) and BMI. Changes in the pharmacological treatment status of patients with type 2 diabetes mellitus and hypertension.

SAMPLE SIZE AND CHARACTERISTICS

120 patients (89 female) completed follow up; mean age 37 years (range, 19-63 years), mean preoperative BMI 48.3 kg/m² (range 40-80.4 kg/m²).

RESULTS

After a mean 5.6-year follow-up, the mean (SD) postoperative weight loss was 43.5 (11.8) kg and the mean (SD) BMI loss was 16.1 (4.4). The mean %EWL value was 62.9% (range, 30-101%). Most patients (87.5%, n=105) achieved satisfactory %EWL values. The major complication rate was 6.6%. After surgery, 74.2% of patients taking medication for hypertension were able to stop treatment, while 12.9% reduced the dose, of patients that took medication for diabetes, all had a dosage reduction.

CONCLUSIONS

We showed that LSG is an acceptable bariatric procedure, but in the long-term there may be weight gain and frequent reflux symptoms. We think renewed weight gain can be partially prevented by close clinical follow-up. There is a need for long-term randomized controlled studies with long-term follow-up to clearly define the indications for LSG.

LIMITATIONS

Retrospective, incomplete clinical visits, GERD symptoms not objectively assessed.

CONFLICT OF INTEREST

None.

Is it possible to improve long-term results of laparoscopic adjustable gastric banding with appropriate patient selection?

Introduction

The gastric band is still offered as a good bariatric option for highly motivated and carefully selected patients. The question is whether this faith is justified or not.

Aim

To assess long-term clinical outcomes of patients who underwent laparoscopic adjustable gastric banding (LAGB) at a single bariatric center and to examine variables associated with patients’ adherence to scheduled postoperative appointments.

Material and methods

A retrospective review of patients who underwent LAGB between 2004 and 2009 was performed. The initial cohort included 167 patients. Data regarding sex, age, preoperative weight, hometown population and distance from the bariatric center, and gastric band volume were collected. Compliance was measured as the number of postoperative appointments. Clinical outcome was defined as percent excess weight loss (%EWL) at the end of the observation period or at band removal.

Results

The LAGB was performed in 167 patients between 2004 and 2009. The mean follow-up time was 90 ±24 months. Five (3%) patients were lost to follow-up; 37 (22.2%) had their band removed. The remaining 125 (74.8%) patients retained their bands and were included in the analysis. The mean %EWL was 33.0 ±26.6%. Thirty-one (18.6%) patients achieved %EWL > 50%.

Conclusions

This study found that LAGB was not an effective bariatric procedure in long-term observation. Only 25% of 125 patients who maintained a functioning band achieved %EWL > 50%. Compliance was the only independent prognostic factor for weight loss. Other factors had no influence on outcome.

Postoperative outcomes based on patient participation in a presurgery education and weight management program

BACKGROUND

The benefits of presurgery weight management programs (WMPs) for bariatric patients are mixed; some show a positive impact on percent excess weight loss (%EWL) at 12 months postsurgery, while others show no effect.

OBJECTIVES

The purpose of this study was to compare pre- and postoperative 6- and 12-month outcomes between patients who attended a 12-week presurgery WMP and patients who did not participate.

SETTING

Ohio State Wexner Medical Center, University Hospital, United States.

METHODS

A retrospective medical record analysis was conducted to compare preoperative and 6- and 12-month postoperative outcomes for patients who attend the presurgery WMP (n = 56) and patients who did not (n = 441) within a 2-year time period (N = 497). Descriptive statistics and independent t tests were conducted to determine mean differences between groups, while controlling for surgery type, for weight status outcomes (%EWL, change in body mass index) preoperatively and 6 and 12 months postsurgery, and length of stay and readmission rate.

RESULTS

Patients who attended the preoperative WMP had significantly higher %EWL at 12 months postsurgery compared with patients who did not attend the WMP. Additional findings indicated a positive, but nonsignificant effect, from the WMP on presurgery body mass index, and postsurgery %EWL at 6 months and body mass index change at 6 and 12 months postsurgery.

CONCLUSIONS

Patients attending the WMP had better 12-month %EWL and outcomes compared with those who did not attend the WMP, though this was not true for 6-month outcomes and differed based on surgery type.

Measurement of adherence in bariatric surgery: a systematic review

After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.

Patients' Preoperative Estimate of Target Weight and Actual Outcome after Bariatric Surgery

BACKGROUND

Evidence about the impact of psychological factors on weight loss after bariatric surgery is scarce. This study explores whether patients' preoperative estimate of target weight influences actual weight loss for different types of bariatric procedures.

METHODS

Patients eligible for bariatric surgery were instructed twice on how to calculate their expected target weight. They were divided into three groups based on their percentage excess weight loss (%EWL) and percentage total body weight loss (%TBWL). Weight loss 12 and 24 months after surgery was analyzed for each group and per type of surgery.

RESULTS

Six hundred fifty-six patients participated in this study. Types of surgery performed were the Roux-en-Y gastric bypass (RYGB, 75%), sleeve gastrectomy (SG, 8.1%), REDO-RYGB (12.5%), and laparoscopic adjustable gastric banding (LAGB, 4.4%). Data of 622 and 410 patients were available for analysis at 12 and 24 months, respectively. Surprisingly, 415 patients (63.3%) overestimated their expected weight loss as opposed to our calculation, based on our own historic data. One hundred thirty-four patients (20.4%) estimated their weight loss correctly and 107 patients (16.3%) underestimated their weight loss. There was a significant higher %EWL 12 months after RYGB surgery for patients who overestimated their weight loss compared to those who estimated their weight loss correctly (p = 0.001). After 24 months and for other types of procedures, no statistically significant differences were found between the three groups.

CONCLUSION

Despite instructions on how to calculate target weight, the majority of patients overestimated their weight loss. Actual %EWL 12 months after RYGB surgery might be influenced by setting a low target weight.

Bariatric patients' reported motivations for surgery and their relationship to weight status and health

BACKGROUND

Literature on patient motivation for bariatric surgery remains limited. A few studies have examined relation to outcomes and found no established connection between motivation and weight loss.

SETTING

A retrospective convenience sample of 345 participants was recruited from an obesity support website to complete an online survey.

METHODS

Content analysis was used to describe motivations for surgery, and analysis of variance and covariance were completed to compare groups of participants created from the qualitative analysis on pre- and postsurgical factors like body mass index, number of co-morbidities, and percentage of excess weight loss.

RESULTS

A primary perceived affective response category for motivation was created that included 3 levels: desperate, tired, and pragmatic. Within these levels participants reported motivations related to quality of life, prevent death, last option, and trigger. Participants in the desperate level exhibited higher presurgical body mass index, greater number of presurgical co-morbidities, more attempted methods for weight loss, and more negative perceptions of health before surgery. Participants in the tired group experienced the greatest percentage of excess weight loss and participants in desperate and tired showed greater weight loss, percentage of weight lost, and percentage of excess weight lost compared with the pragmatic group when controlling for presurgical weight.

CONCLUSIONS

Most participants reported a physical health-related motivation, but participants with greater perceived affective motivational responses cited prevention of death and viewing surgery as their last option to a higher extent. Participants with greater perceived affective response exhibited significantly better weight loss outcomes, indicating that some emotional component to motivation may improve long-term success. Presurgical consultation might incorporate principles from the Transtheoretical Model and Motivational Interviewing to connect the emotional impacts of obesity on patients' health and well being to health behaviors promoting weight maintenance.

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

General practitioners (GPs) are increasingly managing patients with class 2 and 3 obesity (body mass index [BMI] > 35 and 40 kg/m² , respectively). Bariatric surgery is considered for patients with class 2 obesity and comorbidities or class 3 obesity where sustained weight loss using non-surgical interventions has not been achieved. In Australia, GPs facilitate access to surgery through referral processes, but the nature of GP involvement in bariatric pre- and post-surgery care is currently unclear. This qualitative study involved 10 in-depth interviews with GPs and 20 interviews with adults who had all undergone laparoscopic adjustable gastric banding (LAGB) for weight management in Tasmania, Australia. Interviews were transcribed and analysed thematically. Referrals for bariatric surgery commonly occurred at the patient's request or to manage comorbidity. Consistent with previous studies, for GPs, referral patterns were influenced by previous case experience and patients' financial considerations. Accessibility of surgery was also a consideration. Post-surgery, there was a lack of clarity about the role of GPs, with patients generally preferring the surgical team to manage the LAGB. In bariatric surgery, patient preference for surgery, access and comorbidity are key drivers for referral and post-surgical monitoring and support. Greater role clarity and enhanced collaboration between surgeons, GPs and patients following surgery is likely to enhance the experience and outcomes for patients.

Presurgery Weight Loss Goals, Depressive Symptoms, and Weight Loss Among Women Undergoing Bariatric Surgery

Purpose: To determine whether preoperative weight loss goals are associated with postoperative weight loss and whether the effect is modified by preoperative depressive symptoms. Methods: Sixty-three women from an ongoing cohort study who were undergoing first-time bariatric surgery at a large, academic hospital in Pittsburgh, PA, were included in this subanalysis. They were assessed preoperatively and 12 months postoperatively in regard to anthropometric and biobehavioral factors. Multivariable linear regression models were used to estimate associations between weight loss goals, expressed as percentage excess body mass index loss (%EBMIL), and postoperative %EBMIL, as well as test effect modification by depressive symptoms. Findings: Presurgery weight loss goals were positively associated with %EBMIL 12 months after bariatric surgery (β = 1.0, p < 0.01), adjusting for preoperative body mass index, age, race, and marital status; this relationship was negatively modified by depressive symptoms (β = -0.1, p = 0.02). The association between goal %EBMIL and postoperative %EBMIL was attenuated when type of surgery was added to the model. Conclusions: This initial report suggests that weight loss goals and depressive symptoms may be associated with achieved weight loss after bariatric surgery. If confirmed in larger cohorts, these findings may indicate that more personalized approaches will be needed when discussing weight loss goals with patients.

Managing severe obesity: understanding and improving treatment adherence in bariatric surgery

Severe obesity (body mass index ≥40 kg/m²) is a chronic disease that is associated with significantly increased risk of serious and chronic health problems as well as impaired quality of life. For those with severe obesity, bariatric surgery is the most effective treatment for significant and long-term weight loss and resolution of comorbid medical conditions, particularly diabetes. Long-term success is thought to depend to some degree on the patient's ability to adhere to a complex set of behaviors, including regular attendance at follow up appointments and following stringent dietary, exercise, and vitamin recommendations. Here, we summarize the current research on behavioral adherence in patients with severe obesity presenting for bariatric surgery and we highlight challenges and make recommendations for improved self-management before and after surgery.

Guidelines for the follow-up of patients undergoing bariatric surgery

Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important.

Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance and Attrition

BACKGROUND

Regular aftercare attendance following laparoscopic adjustable gastric banding (LAGB) is associated with greater weight loss and fewer post-surgical complications. Despite high reported rates of attrition from LAGB aftercare, the reasons for non-attendance have not been previously explored. The present study aimed to explore patient-reported barriers to LAGB aftercare attendance, and the perceived helpfulness of potential attrition-reducing strategies, in both regular attendees and non-attendees of aftercare.

METHODS

One hundred and seventy-nine participants (107 regular attendees and 72 non-attendees) completed a semi-structured questionnaire, assessing barriers to attrition (101 items) and usefulness of attrition prevention strategies (14 items).

RESULTS

Findings indicate that both regular attendees and non-attendees experience multiple barriers to aftercare attendance. Non-attendees generally reported that barriers had a greater impact on their aftercare attendance. There was evidence for some level of acceptability for attrition-reducing strategies suggesting that LAGB patients may be receptive to such strategies.

CONCLUSIONS

Current findings highlight the importance of assessing barriers to treatment in both attendees and non-attendees. It is proposed that addressing barriers that differentiate non-attendees from attendees may be most effective in reducing attrition from aftercare.

Post-operative psychosocial predictors of outcome in bariatric surgery

Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.

Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2-10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

All roads bring to Rome: a different way for predicting success in the therapy of obesity through psychological features

PURPOSE

Obesity treatment based on lifestyle modifications is characterized by a high proportion of treatment failures. The study of predictors of success could be useful for a better definition of therapeutic needs in individual patients. Few studies have attempted a comprehensive assessment of psychological factors related with treatment response. Aim of the study is the identification of psychological and psychopathological features associated with a good treatment response in patients referring for obesity.

METHODS

This prospective observational study was conducted on a consecutive series of 270 obese patients and a six-month follow-up was performed. At enrollment, a complete medical history was collected and, psychopathology and psychological features were assessed with: General psychopathology: Symptom Checklist 90-revised, Eating Disorder Examination-Questionnaire, Obesity Related well-being and Treatment, Motivation and Readiness test.

RESULTS

Among the 231 patients evaluated at follow-up, the mean weight loss was 3.2% of initial body weight and 68 patients (29.4%) reached the pre-defined therapeutic target of 5% weight loss. Higher psychopathology was associated with a worse outcome in women only; whereas motivation was higher in patients achieving therapeutic targets among men, but not in women.

CONCLUSIONS

Mean weight loss obtained with lifestyle interventions is confirmed to be rather small and a more accurate selection of patients to be enrolled in lifestyle intervention programs is needed. The present study provides some intriguing information on predictors of weight loss, which could be useful for the identification of patients with a higher chance of succeeding with lifestyle programs for the treatment of obesity.

Emotional eating, marital status and history of physical abuse predict 2-year weight loss in weight loss surgery patients

BACKGROUND

Weight loss surgery (WLS) is an effective weight loss treatment for individuals with severe obesity. Psychosocial factors can affect short-term WLS outcomes. This study sought to identify psychosocial predictors of medium-term outcomes.

METHODS

In this prospective study, 250 consecutive WLS candidates were evaluated between January 1, 2010 and December 31, 2010. Each completed baseline medical, surgical, and psychological evaluations as part of standard of care. Two hundred and four patients had surgery (81.6%). Successful surgical outcome was defined as ≥50% excess weight loss two years post-surgery.

RESULTS

Comparison of study sample (n=80) and those lost to follow-up (n=124) revealed negligible differences across baseline characteristics. At follow-up, 60% (n=48) of the sample was classified as a success with an average of 72.58% (std dev=13.01%) excess weight lost. The remaining 40% (n=32) was classified as a failure with an average of 33.98% (std dev=13.19%) excess weight lost. Logistic regression revealed that pre-surgical marital status, emotional eating, and history of physical abuse were independently associated with outcome variables, p<0.05.

CONCLUSIONS

Being married, perhaps as a proxy for social support, is associated with 6.9 times increased odds of medium-term WLS success and emotionally driven disordered eating patterns are associated with 7.4 times increased odds of medium-term WLS success. A history of physical abuse is associated with an 84% decreased odds of successful medium-term outcomes. Further research that studies both the quality and impact of spousal support on weight loss as well as longer-term effects of emotional eating on outcomes is needed. Addressing longer-standing consequence of abuse may improve WLS outcomes.

Patients' perspectives on laparoscopic adjustable gastric banding (LAGB) aftercare attendance: qualitative assessment

BACKGROUND

Despite recognition of the importance of laparoscopic adjustable gastric banding (LAGB) aftercare for optimal surgical outcomes and the failure of some patients to attend regularly, factors influencing LAGB aftercare attrition have not been thoroughly examined in the literature.

METHODS

Patients' perspectives on LAGB aftercare attendance were explored using a qualitative research methodology. Twenty-four LAGB patients who either (1) did not attend aftercare (n = 12) or (2) attended aftercare regularly (n = 12) were interviewed. Data were analysed using grounded theory methods.

RESULTS

Four common processes emerged from patients' descriptions: (1) barriers to attendance, (2) purely medical service, (3) non-patient centred approach, and (4) behavioural and psychological aspects of behavioural changes. Regular attendees typically reported (1) a commitment to aftercare, (2) a need to make the band work, (3) regular monitoring motivated attendance, and (4) happiness with the improved health. Non-regular attendees perceived (1) that aftercare is more relevant early on after the surgery, (2) insufficient follow-up from the centre, (3) failure and shame, (4) not comfortable to be vulnerable, and (5) an intention to reconnect.

CONCLUSIONS

Patients perceive LAGB post-operative medical management to be professional, effective, and valuable. Patients' difficulty to actively participate during aftercare visits contributes to reduced satisfaction and a range of compromised outcomes. Management of LAGB post-operative patients may be improved with the use of patient-centred strategies that encourage patients' active participation. Further research is required to evaluate the emerged themes and determine whether interventions targeting identified barriers enhance attendance and improve outcomes.

Assessing Readiness to Lose Weight among Obese Women Attending the Nutrition Clinic

BACKGROUND

Assessing individual's readiness to change and targeting the inter-vention to the level of readiness may improve successful weight loss rates. This study aimed to assess readiness for weight loss in obese women using the trans theoretical model.

METHODS

A cross-sectional study was conducted on 90 volunteer apparently healthy obese women, in Ardabil, Iran. Participants completed the translated and validated University of Rhode Island Change Assessment questionnaire in their first visit. Subjects were categorized into one of the stages of change based on the highest of four z-transformed scale scores. The readiness to change score was calculated.

RESULTS

More than half of the participants were in early stages of weight loss and 24.5% were in the action stage. The readiness score in the precontemplation stage was significantly lower than the other stages, but no significant difference was observed among the contemplation, action and maintenance stages. The significant correlation was observed between the stages of change and waist-to-hip ratio (r=0.33, P<0.05).

CONCLUSION

Obese women attending the nutrition clinic are in different stages to change for weight loss. Understanding person specific stages of change ori-entates the dietitian to use the most appropriate counseling strategies. Hence the stages and readiness to change should be considered before implementing any intervention in clinical settings for optimal outcomes.

Single-stage versus 2-stage sleeve gastrectomy as a conversion after failed adjustable gastric banding: 30-day outcomes

BACKGROUND

Sleeve gastrectomy (SG) is being performed as a conversion after adjustable gastric banding (AGB), often in a single stage. However, some argue that it should be performed in 2 stages to improve safety. Few studies compare complications between 1-stage and 2-stage procedures. Our aim is to compare the 30-day complication rates among these two groups.

METHODS

We retrospectively reviewed patients converted from AGB to SG between 8/2008 and 10/2013 and compared patients undergoing 1-stage and 2-stage techniques. Primary outcome was overall 30-day adverse event rate (postoperative complication, readmission, or reoperation). Secondary outcomes included operating room (OR) time, length of stay (LOS), leak, infection, and bleeding rates, as well as mortality.

RESULTS

A total of 83 patients underwent SG after band removal; three were excluded due to short follow-up, leaving 60 1-stage and 20 2-stage. Mean time from band removal to SG for 2-stage was 438 days. Demographics, intraoperative technique (bougie size, staple reinforcement, oversewing staple line, and leak test), and mean follow-up were not statistically different. Mean OR time (132.1 min 1-stage vs. 127.8 min 2-stage, p = 0.702) and LOS (3.1 vs. 2.4 days, p = 0.676) were similar. Overall 30-day adverse event rate was 12 % for 1-stage versus 15 % for 2-stage procedures (p = 0.705). Differences in 30-day readmission (8 vs. 5 %) and reoperation (5 vs. 0 %) were not statistically significant (p = 0.999 and 0.569, respectively). Leak (3 vs. 0 %, p = 0.999), abscess (2 vs. 5 %, p = 0.440), and bleeding rates (2 vs. 0 %, p = 0.999) were not different. There were no deaths.

CONCLUSIONS

SG performed as a conversion after AGB is safe and feasible. Our findings indicate no statistical difference in 30-day outcomes when performed in 1 or 2 stages. Future studies with larger sample sizes are necessary to further investigate these differences.

Pre-operative weight loss does not predict weight loss following laparoscopic adjustable gastric banding

BACKGROUND

This study aimed to test the hypothesis that the amount of weight lost on a mandatory 2-week pre-operative very-low-calorie diet (VLCD) would predict the longer-term outcomes of laparoscopic adjustable gastric banding (LAGB).

METHODS

All patients treated with a primary LAGB from 21 October 2008 until 30 June 2010, who were prescribed a 2-week pre-operative VLCD, have been included in the study. Patient age, weight, BMI and excess weight (defined as weight above a BMI of 25) were extracted on the day of first visit, day of surgery and at the post-operative visits at 3, 12 and 24 months. From these data, percent excess weight loss (EWL) was calculated and compared at all time points.

RESULTS

The weight loss achieved on a mandatory 2-week pre-operative diet did not predict weight outcomes at 2 years (r = -0.008; p = 0.931). Using multivariate analysis, the best predictor of 24-month percent EWL was percent EWL at 3 months post operation (sr(2) = 0.34; p = 0.003).

CONCLUSIONS

Results from a pre-operative diet should not be used to predict the ultimate outcome of bariatric surgery. The weight loss at 3 months following LAGB was a strong predictor of longer-term outcomes. There may be potential for improving longer-term results with LAGB by better supporting patients who are not achieving good weight loss at this early time point.

Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study

BACKGROUND

For over a decade, the laparoscopic adjustable gastric band (LAGB) was 1 of the most performed bariatric procedures in Europe. This study is a retrospective analysis with prospectively collected data of the experience in 1 specialized Dutch center with the adjustable gastric band over 14 years.

METHODS

Between 1995 and 2003, 201 patients underwent an LAGB for morbid obesity in our hospital. Data on preoperative clinical characteristic, postoperative outcome and weight loss patterns, and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System (BAROS).

RESULTS

Average follow-up was 13.6 (± 2.0) years (163 mo) and 99% of patients with complete follow-up. Two thirds of patients reached an excess weight loss (EWL)>50% at some point after LAGB placement. However, due to insufficient weight loss or complications in 53% of patients, the LAGB had to be removed or converted to a Roux-en-Y gastric bypass. Additionally, half of the remaining patients had disappointing results according to the BAROS score. In total, less than one quarter (22%) of patients had a functioning band with a good result after the follow-up period. Although initially the number of patients experiencing co-morbidities was reduced, most of them returned and a large number of patients developed new co-morbidities. Complications, other than weight regain, were numerous as 47% of patients experienced at least 1. In total, 204 reoperations were performed in 137 (68%) patients. Furthermore, patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up.

CONCLUSION

Morbid obesity is a chronic disease that can be resolved with bariatric surgery. One of the treatment options is the LAGB, which in the short term shows good results in terms of EWL and co-morbidity reduction. In the long term, however, EWL and co-morbidity reduction are disappointing, and the LAGB does not seem to live up to expectations. Besides the decrease in EWL over time, the number of reoperations required is alarming. In total, less than a quarter of patients still had a functioning band after a mean 14 years of follow-up.

Readiness redefined: a behavioral task during screening predicted 1-year weight loss in the look AHEAD study

OBJECTIVE

Predicting outcome in weight loss trials from baseline characteristics has proved difficult. Readiness to change is typically measured by self-report.

METHODS

Performance of a behavioral task, completion of food records, from the screening period in the Look AHEAD study (n = 549 at four clinical centers) was assessed. Completeness of records was measured by the number of words and Arabic numerals (numbers) recorded per day, the number of eating episodes per day, and days per week where physical activity was noted. The primary outcome was weight loss at one year.

RESULTS

In univariable analysis, both the number of words recorded and the number of numbers recorded were associated with greater weight loss. In multivariable analysis, individuals who recorded 20-26, 27-33, and ≥34 words per day lost 9.12%, 11.40%, and 12.08% of initial weight, compared to 8.98% for individuals who recorded less than 20 words per day (P values of 0.87, 0.008, and <0.001, respectively, compared to <20 words per day).

CONCLUSIONS

Participants who kept more detailed food records at screening lost more weight after 1 year than individuals who kept sparser records. The use of objective behavioral screening tools may improve the assessment of weight loss readiness.

Review of long-term weight loss results after laparoscopic sleeve gastrectomy

Sleeve gastrectomy (SG) has gained enormous popularity both as a first-stage procedure in high-risk super-obese patients and as a stand-alone procedure. The objective of this study was to evaluate the long-term weight loss results after SG published in the literature and compare them with the well-documented short-term and mid-term weight loss results. A detailed search in PubMed using the keywords "sleeve gastrectomy" and "long-term results" found 16 studies fulfilling the criteria of this study. A total of 492 patients were analyzed, with a follow-up of at least 5 years after laparoscopic sleeve gastrectomy (LSG) (373 at 5 years, 72 at 6 years, 13 at 7 years, and 34 at 8 or more years). Of the total number of patients, 71.1% were women (15 studies, n = 432 patients). Mean patient age was 45.1 years (15 studies, n = 432 patients). Mean preoperative body mass index in all 16 studies was 49.2 kg/m(2). The mean percentage excess weight loss (%EWL) was 62.3%, 53.8%, 43%, and 54.8% at 5, 6, 7, and 8 or more years after LSG, respectively. The overall mean %EWL (defined as the average %EWL at 5 or more years after LSG) was 59.3% (12 studies, n = 377 patients). The overall attrition rate was 31.2% (13 studies). LSG seems to maintain its well-documented weight loss outcome at 5 or more years postoperatively, with the overall mean %EWL at 5 or more years after LSG still remaining>50%. The existing data support the role of LSG in the treatment of morbid obesity.

Nutrition care for patients with weight regain after bariatric surgery

Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20-30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20-25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

Young adult women's experiences of body image after bariatric surgery: a descriptive phenomenological study

AIM

To understand the lived experience of body image in young women after obesity surgery.

BACKGROUND

Quantitative studies have documented that health-related quality of life and body image are improved after bariatric surgery, probably due to significant weight loss. Female obesity surgery candidates are likely to be motivated by dissatisfaction regarding physical appearance. However, little is known about the experience of the individual woman, leaving little understanding of the association between bariatric surgery and changes in health-related quality of life and body image.

DESIGN

A qualitative descriptive phenomenological study.

METHODS

Data were collected over 4 months during 2010. Selection for interview was carried out through purposeful sampling. The participants were five young women who underwent bariatric surgery (range: 1-12 months). In-depth, semi-structured interviews were analysed by systematic text condensation influenced by Giorgi's phenomenological method and supplemented by elements from narrative analysis.

FINDINGS

The analysis revealed three concepts: solution to an unbearable problem, learning new boundaries and hopes of normalization. These revelatory concepts were synthesized into one major theme: on the edge of control, that is describing these women's feelings of being on the edge of balance between control and loss of control.

CONCLUSION

Perception of control may be an essential aspect of body image and the key to understanding these young women's feelings of empowerment and quality of life through body control postbariatric surgery. Future studies should focus on how body control is an essential aspect of body image, which may contribute to long-term weight loss maintenance and improve quality of life.