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Konrad C, Inhoffen J, Friederich HC, Hartmann M, Wild B. Prevalence of adverse childhood experiences and effect on outcomes in bariatric surgery patients: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:118-129. [PMID: 36270937 DOI: 10.1016/j.soard.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 01/31/2023]
Abstract
Adverse childhood experiences (ACEs) are defined as childhood maltreatment (sexual, physical, and emotional abuse and neglect) and other childhood traumatic experiences. Published prevalence estimates for ACEs in bariatric samples vary greatly and evidence on the association between ACEs and bariatric surgery weight loss and psychosocial outcomes is inconclusive. A systematic literature search on PubMed/Medline, PsycInfo, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Open Grey for studies published until August 30, 2021, yielded 21 publications for qualitative synthesis: 20 reporting on prevalence of ACEs in bariatric surgery candidates and patients, and 10 on the association of ACEs with outcomes. In meta-analysis, overall moderate to high heterogeneity was observed for prevalence estimates and moderate heterogeneity was observed for associations. Prevalence estimate for at least 1 form of ACEs (6 studies, n = 1368 patients) was 51% (95% confidence interval [CI]: 32%-70%). Effect size (Hedge's g) for the difference between the groups of patients reporting any or a high number of ACEs versus no or a low number of ACEs was calculated from means, standard deviations and group size, or P values. Based on 7 studies (n = 946 patients), the association between ACEs and weight loss was not significant (Hedge's g = -.15 [95% CI: -.38 to .09]; I2 = 53%), regardless of short- or long-term follow-up (P = .413) and the proportion of patients in each study receiving Roux-en-Y gastric bypass (RYGB) (β = .0005, P = .868). Preliminary findings based on 3 short- and long-term studies (n = 414 patients) showed that ACEs were significantly (P = .001) associated with higher postoperative depressive symptoms (Hedge's g = .50 [95% CI: .22-.78]; I2 = 36%). Associations between ACEs and other psychosocial outcomes such as eating pathology were reported narratively. There is a need for additional long-term studies using validated assessment tools for ACEs to evaluate the effect of ACEs on weight and psychosocial outcomes after bariatric surgery.
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Affiliation(s)
- Cinara Konrad
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Johannes Inhoffen
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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Mohan S, Samaan JS, Premkumar A, Samakar K. History of abuse and bariatric surgery outcomes: a systematic review. Surg Endosc 2022; 36:4650-4673. [PMID: 35277764 DOI: 10.1007/s00464-022-09147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes. METHODS PubMed and SCOPUS databases were queried to identify relevant published studies. RESULTS Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive. CONCLUSIONS Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.
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Affiliation(s)
- Sukriti Mohan
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA.
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3
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Lo Iacono L, Trentini C, Carola V. Psychobiological Consequences of Childhood Sexual Abuse: Current Knowledge and Clinical Implications. Front Neurosci 2021; 15:771511. [PMID: 34924938 PMCID: PMC8678607 DOI: 10.3389/fnins.2021.771511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023] Open
Abstract
A large body of research has documented the long-term harms of childhood sexual abuse (CSA) on an individual’s emotional-adaptive function and mental health. Recent studies have also provided evidence of the biological impact of CSA, implicating specific alterations in many systems, including the endocrine and immune systems, and in DNA and chromatin, in the pathogenesis of medical disorders. Although the effects of CSA are often examined with regard to the general impact of early-life traumatic experiences, the study of CSA per sè, as a trigger of specific pathogenic pathways, would be more appropriate to understand their long-term implications and develop tailored diagnostic and therapeutic strategies. Based on these premises, this narrative minireview summarizes the research on the short-term and long-term sequelae of CSA, focusing on dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the effects on the immune system, and the changes to DNA through altered methylation. Also, we discuss the literature that examines dysfunctional DNA telomere erosion and oxidative stress markers as a sign of CSA. Finally, recent evidence of the intergenerational transmission of the effects of CSA is reported. The impact of CSA on brain connectivity and functions is out of the scope of this review, thus brain imaging studies are not included. The results of this minireview are discussed, considering their implications for prevention and clinical practice.
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Affiliation(s)
- Luisa Lo Iacono
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Cristina Trentini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
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The Association Between Adverse Childhood Experiences (ACEs) and Postoperative Bariatric Surgery Weight Loss Outcomes. Obes Surg 2020; 30:4258-4266. [PMID: 32562131 DOI: 10.1007/s11695-020-04779-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Previous research demonstrates that exposure to adverse childhood experiences (ACEs) is associated with development of obesity. The same mechanisms mediating this relationship could theoretically affect attempts to lose weight in adulthood. However, it is unclear whether or not exposure to ACEs impacts the effectiveness of bariatric surgery. The present study aimed to examine the association of exposure to ACEs to postoperative weight loss outcomes. MATERIALS AND METHODS One hundred ninety-eight patients undergoing bariatric surgery were evaluated for their exposure to ACEs, determined by a presurgical questionnaire and recorded as an ACEs score. Percent total weight loss (%TWL) was calculated to evaluate postoperative weight loss at 1-, 3-, and 6-month intervals postoperatively. One hundred forty-two participants were available for follow-up at the 6-month postoperative interval. RESULTS The sample consisted of 167 women and 31 men with a mean age of 47.7. Twenty-five percent of participants experienced high exposure to ACEs, defined as experiencing ≥ 4 ACEs. The average %TWL at 6 months was 16.52%. Multilevel modeling found no significant relationship between ACEs score and %TWL at any of the postoperative time intervals, both before and after adjusting for age, sex, and race. CONCLUSION High exposure to ACEs was not associated with poorer weight loss outcomes, and participants with a large number of ACEs generally lost the anticipated amount of weight.
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Lu N, Adambekov S, Edwards RP, Ramanathan RC, Bovbjerg DH, Linkov F. Relationships Between a History of Abuse, Changes in Body Mass Index, Physical Health, and Self-Reported Depression in Female Bariatric Surgery Patients. Bariatr Surg Pract Patient Care 2019; 14:113-119. [PMID: 31572626 DOI: 10.1089/bari.2018.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Objectives: A history of physical and sexual abuse has been implicated in weight gain. Although bariatric surgery is effective for weight loss in severely obese individuals, we investigated whether bariatric surgery patients who self-report a history of physical and/or sexual abuse have differential outcomes regarding weight loss, body mass index (BMI), quality of life (SF-36), and depressive symptoms (Center for Epidemiologic Studies Depression [CESD]) compared with nonabused patients. Materials and Methods: Standardized assessments at baseline and follow-up visits were performed on 103 obese (BMI >35) female bariatric surgery patients (mean age: 44.11 years, standard deviation: 11.67 years). Results: In total 49.5% of participants reported abuse. Abused group had significantly higher BMI (p < 0.01) and depression scores (p < 0.01). After surgery, the BMI between the two groups was no longer significantly different, although the abused group remained significantly more depressed. Mixed models showed that abuse was associated with CESD scores (p < 0.01) and SF-36 mental composite scores (p = 0.03) after adjusting for smoking history. Conclusion: Bariatric surgery leads to a better weight loss in abused patients. Abuse history might be an additional factor for clinicians to consider when advising bariatric surgery, as our study suggests that women with history of abuse may have a higher weight loss benefit but less mental health improvement from the intervention.
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Affiliation(s)
- Nancy Lu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shalkar Adambekov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramesh C Ramanathan
- Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dana H Bovbjerg
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Faina Linkov
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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King WC, Hinerman A, Kalarchian MA, Devlin MJ, Marcus MD, Mitchell JE. The impact of childhood trauma on change in depressive symptoms, eating pathology, and weight after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 15:1080-1088. [PMID: 31153892 DOI: 10.1016/j.soard.2019.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND History of childhood trauma is associated with increased risk of mental disorders, eating pathology, and obesity. OBJECTIVE To examine associations between childhood trauma and changes in depressive symptoms, eating pathology, and weight after Roux-en-Y Gastric Bypass (RYGB). SETTING Three U.S. academic medical centers. METHOD Adults undergoing bariatric surgery (2007-2011) were enrolled in a cohort study. Participants (96 of 114; 86%) completed the Beck Depression Inventory-1 (BDI-1) to assess depressive symptomology, the interviewer-administered Eating Disorder Examination (EDE) to assess subthreshold eating pathology, weight assessment before and 6 months and annually after RYGB for ≥7 years, and the Childhood Trauma Questionnaire (CTQ) once post-RYGB. RESULTS Presurgery, median age was 46 years, and median body mass index was 47 kg/m2; 79% were female. Data completeness across 7-year follow-up was 78% to 90%, 66% to 91%, and 93% to 100% for the BDI-1, EDE, and weight, respectively. Using mixed models, presence/severity of childhood emotional abuse, emotional neglect, and physical neglect, but not sexual abuse or physical abuse, were significantly associated (P < .05) with change (i.e., less improvement/worsening) in the BDI-1 and EDE global scores, as were higher total CTQ score and more types of moderate-intensity trauma. All CTQ measures were associated (P < .05) with less improvement or worsening in the EDE eating concern and shape concern scores. CTQ measures were not significantly related to weight loss or regain. CONCLUSIONS Although childhood trauma did not affect weight outcomes after RYGB, those who experienced childhood trauma had less improvement in depressive symptomology and eating pathology and therefore might benefit from clinical intervention.
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Affiliation(s)
- Wendy C King
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | - Amanda Hinerman
- Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, New York
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery. RECENT FINDINGS Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking. Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
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Affiliation(s)
- Melissa A Kalarchian
- School of Nursing, Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Orcutt M, King WC, Kalarchian MA, Devlin MJ, Marcus MD, Garcia L, Steffen KJ, Mitchell JE. The relationship between childhood maltreatment and psychopathology in adults undergoing bariatric surgery. Surg Obes Relat Dis 2018; 15:295-303. [PMID: 31010652 DOI: 10.1016/j.soard.2018.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/15/2018] [Accepted: 11/09/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND A history of childhood maltreatment and psychopathology are common in adults with obesity. OBJECTIVES To report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery. SETTING Four clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. METHODS The Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported. RESULTS Two thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men. CONCLUSION Among women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders.
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Affiliation(s)
- Molly Orcutt
- Neuropsychiatric Research Institute, Sanford Neuroscience Clinic, Fargo, North Dakota; University of North Dakota, Grand Forks, North Dakota; Fargo VA Healthcare System, Fargo, North Dakota
| | - Wendy C King
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Michael J Devlin
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York; New York State Psychiatric Institute, New York City, New York
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Luis Garcia
- Neuropsychiatric Research Institute, Sanford Neuroscience Clinic, Fargo, North Dakota; University of North Dakota, Grand Forks, North Dakota
| | - Kristine J Steffen
- Neuropsychiatric Research Institute, Sanford Neuroscience Clinic, Fargo, North Dakota; North Dakota State University, Fargo, North Dakota
| | - James E Mitchell
- Neuropsychiatric Research Institute, Sanford Neuroscience Clinic, Fargo, North Dakota; University of North Dakota, Grand Forks, North Dakota.
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Hulme PA, Kupzyk KA, Anthone GJ, Capron KA, Nguyen T. Weight Loss and Timing of J Tube Removal in Biliopancreatic Diversion with Duodenal Switch Patients Who Report Physical or Sexual Abuse. Obes Surg 2018; 28:2361-2367. [PMID: 29512037 DOI: 10.1007/s11695-018-3166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bariatric surgery patients who report physical or sexual abuse form a sizeable cohort that stands out due to psychological comorbidity. Their possible vulnerability to suboptimal weight loss remains of interest. Their risk for malnutrition due to inadequate oral intake following surgery is underexplored. OBJECTIVES Study aims were to determine the effect of self-reported physical or sexual abuse in patients undergoing open biliopancreatic diversion with duodenal switch (BPD/DS) on (a) 3-year weight loss trajectories and (b) timing of feeding jejunostomy tube (J tube) removal. Delayed J tube removal served as an indicator for inadequate oral intake. METHODS In this retrospective cohort study, the sample (N = 189) consisted of all patients who underwent primary BPD/DS by the same surgeon during 2009 and 2010 at a Midwestern health system. All patients had a J tube placed during surgery. Longitudinal mixed models were used for testing differences in weight loss trajectories by abuse status. RESULTS There were no significant differences in weight loss trajectories by abuse status. The abused group had the J tube in place a mean of 61.9 days (SD = 39.5) compared to 44.8 days (SD = 32.8) for the not abused group, a significant difference. CONCLUSIONS Our use of the best available statistical methods lends validity to previous findings that suggest physical or sexual abuse does not affect weight loss after bariatric surgery. Increased likelihood of persistent inadequate oral intake in the abused group suggests the need for early multidisciplinary interventions that include mental health and nutrition experts.
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Affiliation(s)
- Polly A Hulme
- College of Nursing, South Dakota State University, Wagner Hall 204, Brookings, SD, 57007, USA.
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
| | - Gary J Anthone
- Department of Surgery, Creighton University, 10506 Burt Circle, Omaha, NE, 68144, USA
| | | | - Thang Nguyen
- Nebraska Medicine, 987400 Nebraska Medical Center, Omaha, NE, 68198-7400, USA
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