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Beyeler M, Légeret C, Kiwitz F, van der Horst K. Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study. JMIR Hum Factors 2023; 10:e47913. [PMID: 37938894 PMCID: PMC10666014 DOI: 10.2196/47913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/09/2023] [Accepted: 09/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. OBJECTIVE This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. METHODS Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. RESULTS A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. CONCLUSIONS The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies.
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Affiliation(s)
- Marina Beyeler
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Oviva AG, Altendorf, Switzerland
| | | | - Fabian Kiwitz
- Business Information Technology, Zürich University of Applied Sciences, Zürich, Switzerland
- KIRATIK GmbH, Sigmaringen, Germany
| | - Klazine van der Horst
- Nutrition and Dietetics, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Leclercq WK, Bonouvrie DS, Dohmen CE, Uittenbogaart M, Legemaate J, Stassen LP, van Dielen FM. Preoperative Education and Informed Consent in Young Adults Undergoing Bariatric Surgery: Patients' Perspectives on Current Practice. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0045] [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)
| | | | - Charlotte E.J.M. Dohmen
- Obesity Center Máxima, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Johan Legemaate
- Department of Public Health, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Laurents P.S. Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
BACKGROUND Multidisciplinary team (MDT) meetings are widely recommended in the management of bariatric surgery patients; however, there is limited evidence for their effectiveness. The aims of this study were to evaluate the decision-making process of a single-day bariatric MDT clinic and secondly to evaluate whether these MDT decisions were implemented. METHODS This was a retrospective observational study analysing MDT treatment decisions from February 2012 to June 2013 using an MDT proforma. The decision-making process of the MDT meeting was investigated by assessing the alterations in management plan between the surgeon and the rest of the MDT. Adherence to MDT decisions was also assessed. RESULTS Decisions regarding 200 consecutive patients were analyzed. There was MDT agreement for 55%, and patients were listed for surgery on the day of the MDT. There was MDT disagreement regarding 45%, with conflicting opinions expressed by surgeons in 33/200 (17%), anaesthetists in 60/200 (30%) and dieticians in 65/200 (33%). The MDT plan was instigated in 78% and the most common reason for failure was patients failing to attend for further assessment. By the end of the study, 85% of patients underwent bariatric surgery, 11.5% declined further input, 2.5% chose further weight loss and 1% were removed from waiting list. CONCLUSION Use of a single-day MDT clinic format resulted in a change in plan for a significant number of patients. This can be interpreted as improved quality of care for these patients, and we conclude the MDT approach is valuable.
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Schlottmann F, Nayyar A, Herbella FAM, Patti MG. Preoperative Evaluation in Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:925-929. [PMID: 30004270 DOI: 10.1089/lap.2018.0391] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An adequate preoperative workup is critical for the success of bariatric surgery. A key component of the preoperative evaluation involves a comprehensive patient education about surgical outcomes and the postoperative behavioral regimen required. A complete medical evaluation should include the study of the cardiovascular, pulmonary, and gastrointestinal systems as well as a metabolic status assessment. The nutrition professional should be in charge of the nutritional assessment, preoperative weight loss efforts, and diet education regarding postoperative eating behaviors. A psychological evaluation is also needed because psychosocial factors have a significant impact on the long-term outcomes of bariatric surgery, including adherence to recommended postoperative lifestyle regimen, emotional adjustment, and weight loss outcomes. We recommend preoperative abdominal ultrasound to assess for biliary tract pathology, steatosis, fibrosis, and presence of nonalcoholic steatohepatitis. A routine preoperative esophagogastroduodenoscopy is also recommended to evaluate common gastrointestinal disorders associated with obesity. Preoperative weight loss should be strongly encouraged.
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Affiliation(s)
- Francisco Schlottmann
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Department of Surgery, Hospital Alemán of Buenos Aires , Buenos Aires, Argentina
| | - Apoorve Nayyar
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Fernando A M Herbella
- 3 Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo , Sao Paulo, Brazil
| | - Marco G Patti
- 1 Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,4 Department of Medicine, University of North Carolina , Chapel Hill, North Carolina
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Groller KD, Teel C, Stegenga KH, El Chaar M. Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement. Surg Obes Relat Dis 2018; 14:785-796. [PMID: 29703505 DOI: 10.1016/j.soard.2018.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/10/2018] [Accepted: 02/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1-5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6]. OBJECTIVE To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement. SETTING Participants were recruited from a university hospital-based WMC in Pennsylvania. METHODS This qualitative descriptive study used purposive sampling and inductive content analysis. RESULTS A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming. CONCLUSION Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.
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Affiliation(s)
- Karen D Groller
- Moravian College, Helen S. Breidegam School of Nursing, Bethlehem, Pennsylvania.
| | - Cynthia Teel
- University of Kansas School of Nursing, Kansas City, Kansas
| | | | - Maher El Chaar
- Medical School of Temple University, St. Luke's University Hospital and Health Network, Allentown, Pennsylvania
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6
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Applegate KL. Comment on: Patients' reasons for and against undergoing Roux-en-Y gastric bypass, adjustable gastric banding, and vertical sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1896-1898. [PMID: 28917615 DOI: 10.1016/j.soard.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine L Applegate
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Bourne R, Tweedie J, Pelly F. Preoperative nutritional management of bariatric patients in Australia: The current practice of dietitians. Nutr Diet 2017; 75:316-323. [PMID: 28913958 DOI: 10.1111/1747-0080.12384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 07/06/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022]
Abstract
AIM The aim of this observational study was to investigate the reported practices of Australian dietitians managing bariatric surgery patients in the preoperative stage. METHODS An online survey of dietitians providing nutritional care to bariatric patients was developed for the purpose of this investigation. The survey questions were guided by the Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic and Nonsurgical Support of the Bariatric Surgery Patient guidelines and current literature. RESULTS Ninety-nine dietitians completed the survey. Most participants recommended one to two different medical nutrition therapy strategies for preoperative weight loss (n = 69, 74%), with a very-low-energy diet exclusively from liquid meal replacements being the most frequently prescribed (n = 62, 69%). A significantly higher proportion of dietitians working privately reported the involvement of a bariatric surgeon in the multidisciplinary team (P = 0.002). More private practitioners also reported providing education on the nutritional consequences of the different types of bariatric procedures (P = 0.005) and postoperative vitamin and mineral supplementation (P = 0.013), as well as the use of the guidelines to guide their practice (P = 0.014), compared to dietitians who worked in the public sector. A higher proportion of dietitians working in metropolitan areas reported that screening occurred more frequently for vitamin D (P = 0.008), fasting blood lipids (P = 0.03) and glycated haemoglobin (P = 0.003) compared to those in regional/rural/remote areas. CONCLUSIONS Reported preoperative screening practices were not consistent with the recommendations from the literature and current American guidelines. Further investigation into the difference in the nutritional management strategies and work environments is warranted.
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Affiliation(s)
- Ruth Bourne
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Judith Tweedie
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Fiona Pelly
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
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Martin AN, Marino M, Killerby M, Rosselli-Risal L, Isom KA, Robinson MK. Impact of Spanish-language information sessions on Spanish-speaking patients seeking bariatric surgery. Surg Obes Relat Dis 2017; 13:1025-1031. [DOI: 10.1016/j.soard.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/05/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
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Groller KD. Systematic review of patient education practices in weight loss surgery. Surg Obes Relat Dis 2017; 13:1072-1085. [PMID: 28216118 DOI: 10.1016/j.soard.2017.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Education plays a key role in adherence to lifestyle modifications after weight loss surgery (WLS). Education given before and after surgery may decrease weight recidivism rates and improve outcomes. OBJECTIVE The purpose of this systematic review was to analyze educational practices in bariatric centers. METHODS The Cumulative Index to Nursing and Allied Health and PubMed databases were searched in May 2016 for English-language, peer-reviewed studies about WLS patient education practices from 1999 to 2016. Publications were: (1) rated with the Advancing Research and Clinical Practice through Close Collaboration levels of evidence hierarchy (see Melnyk's pryamid [http://guides.lib.umich.edu/c.php?g=282802&p=1888246]) and (2) analyzed according to surgical phase, curriculum, program delivery, and educator. RESULTS Twenty-four publications met the study criteria. Evidence ratings for preoperative (n = 16) and postoperative studies (n = 8) were levels I to III (n = 5) and IV to VII (n = 17). Two publications were not ratable. Preoperative and postoperative education programs varied in curriculum, teaching methods, and educator. Topics varied in depth. Commonalities were surgical procedure, nutrition, activity, and psychosocial behaviors. Preoperative education was mostly provided in small groups, whereas individual sessions were used postoperatively. Lecture and discussion provided by myriad of healthcare experts from multiple disciplines were typical in both phases. Written or web-based aides supported learning needs in both phases. CONCLUSION WLS patient education varied by curriculum and dose and commonly used passive learning methods (e.g., traditional lecture style instruction with minimal engagement from learners). Results shared can inform future bariatric education programs and accreditation standard development (e.g., Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program patient education standards). Additional study is needed, but existing evidence can guide improvements in high-quality, cost-effective, and patient-centered educational programs.
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Affiliation(s)
- Karen D Groller
- Department of Nursing and Public Health, Moravian College, Bethlehem, Pennsylvania.
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Giusti V, Theytaz F, Di Vetta V, Clarisse M, Suter M, Tappy L. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Am J Clin Nutr 2016; 103:18-24. [PMID: 26675775 DOI: 10.3945/ajcn.115.111732] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 10/21/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The effect of a Roux-en-Y gastric bypass (RYGB) on body weight has been amply documented, but few studies have simultaneously assessed the evolution of energy and macronutrient intakes, energy expenditure, and changes in body composition over time after an RYGB. OBJECTIVE We evaluated energy and macronutrient intakes, body composition, and the basal metabolic rate (BMR) in obese female patients during the initial 3 y after an RYGB. METHODS Sixteen women with a mean ± SEM body mass index (in kg/m(2)) of 44.1 ± 1.6 were included in this prospective observational study. The women were studied on 6 different occasions as follows: before and 1, 3, 6, 12 (n = 16), and 36 (n = 8) mo after surgery. On each occasion, food intake was evaluated from 4- or 7-d dietary records, body composition was assessed with the use of bio-impedancemetry, and energy expenditure was measured with the use of indirect calorimetry. RESULTS Body weight evolution showed the typical pattern reported after an RYGB. Total energy intake was 2072 ± 108 kcal/d at baseline and decreased to 681 ± 58 kcal/d at 1 mo after surgery (P < 0.05 compared with at baseline). Total energy intake progressively increased to reach 1240 ± 87 kcal/d at 12 mo after surgery (P < 0.05 compared with at 1 mo after surgery) and 1448 ± 57 kcal/d at 36 mo after surgery (P < 0.05 compared with at 12 mo after surgery). Protein intake was 87 ± 4 g/d at baseline and ± 2 g/d 1 mo after surgery (P < 0.05 compared with at baseline) and increased progressively thereafter to reach 57 ± 3 g/d at 36 mo after surgery (P < 0.05 compared with at 1 mo after surgery). Carbohydrate and fat intakes over time showed similar patterns. Protein intake from meat and cheese were significantly reduced early at 1 mo after surgery but increased thereafter (P < 0.05). The BMR decreased from 1.12 ± 0.04 kcal/min at baseline to 0.93 ± 0.03, 0.86 ± 0.03, and 0.85 ± 0.04 kcal/min at 3, 12, and 36 mo after surgery, respectively (all P < 0.05 compared with at baseline). CONCLUSIONS Total energy, carbohydrate, fat, and protein intakes decreased markedly during the initial 1-3 mo after an RYGB, whereas the BMR moderately decreased. The reduction in protein intake was particularly severe at 1 mo after surgery, and protein intake increased gradually after 3-6 mo after surgery. This trial was registered at clinicaltrials.gov as NCT01891591.
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Affiliation(s)
- Vittorio Giusti
- Cardio-Metabolic Centre, Hôpital of Broye, Estavayer-le-Lac, Switzerland
| | - Fanny Theytaz
- Department of Physiology, University of Lausanne, Lausanne, Switzerland; and
| | | | | | - Michel Suter
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Luc Tappy
- Cardio-Metabolic Centre, Hôpital of Broye, Estavayer-le-Lac, Switzerland; Department of Physiology, University of Lausanne, Lausanne, Switzerland; and Service of Endocrinology, Diabetes and Metabolism, and
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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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12
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Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg 2011; 254:267-73. [PMID: 21772127 DOI: 10.1097/sla.0b013e3182263b66] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present long-term results of a large series of patients submitted to laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity. BACKGROUND Reports on long-term results of RYGBP are scarce and focus primarily on weight loss. Our aim is to provide mid- to long-term data of RYGBP, with detailed results on weight loss, evolution of comorbidities and quality of life, also using the BAROS score. METHODS All patients who underwent a primary RYGBP for morbid obesity in our 2 hospitals between 1999 and August 2008 were included. Data were collected prospectively in a computerized database, and reviewed for the purpose of this study. RESULTS A total of 379 patients were included in the analysis of long-term results, 282 women, and 97 men, with a mean BMI of 46.3 kg/m². After 5 years, 74.9% of the patients achieved an excess weight loss of at least 50%, with a mean of 62.7% and 76.8% achieved a BMI <35 kg/m². The corresponding figures after 7 years were 64.9, 58.1, and 71.9, respectively. There was a small but significant long-term weight regain. All comorbidities improved markedly in the vast majority of patients, with no significant difference between the 3- and 5-year terms. Quality of life also improved markedly, and more than 95% of the patients had a good to excellent 5-year overall result according to the BAROS score. CONCLUSIONS Laparoscopic RYGBP for morbid obesity results in good and maintained weight loss up to 7 years in the majority of patients, improves quality of life and markedly improves all the evaluated comorbidities, resulting in good to excellent overall 5-year results in 97% of the patients according to the BAROS score.
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Hood MM, Corsica JA, Azarbad L. Do patients seeking laparoscopic adjustable gastric banding surgery differ from those seeking gastric bypass surgery? A comparison of psychological profiles across ethnic groups. Obes Surg 2011; 21:440-7. [PMID: 20582637 DOI: 10.1007/s11695-010-0222-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients. METHODS Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation. RESULTS RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients. CONCLUSIONS Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.
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Affiliation(s)
- Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Suter M, Donadini A, Calmes JM, Romy S. Improved Surgical Technique for Laparoscopic Roux-en-Y Gastric Bypass Reduces Complications at the Gastrojejunostomy. Obes Surg 2010; 20:841-5. [PMID: 20443151 DOI: 10.1007/s11695-010-0179-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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15
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Singhal R, Kitchen M, Bridgwater S, Super P. Dietetic-led management of patients undergoing laparoscopic gastric banding: early results. Surg Endosc 2009; 24:1268-73. [DOI: 10.1007/s00464-009-0758-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 10/20/2009] [Indexed: 11/30/2022]
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Apovian CM, Cummings S, Anderson W, Borud L, Boyer K, Day K, Hatchigian E, Hodges B, Patti ME, Pettus M, Perna F, Rooks D, Saltzman E, Skoropowski J, Tantillo MB, Thomason P. Best practice updates for multidisciplinary care in weight loss surgery. Obesity (Silver Spring) 2009; 17:871-9. [PMID: 19396065 PMCID: PMC2859198 DOI: 10.1038/oby.2008.580] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence-based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New recommendations were developed in the areas of patient selection, medical evaluation, and treatment. Regular updates of evidence-based recommendations for best practices in multidisciplinary care are required to address changes in patient demographics and levels of obesity. Key factors in patient safety include comprehensive preoperative medical evaluation, patient education, appropriate perioperative care, and long-term follow-up.
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Affiliation(s)
- Caroline M Apovian
- Department of Endocrinology, Diabetes, and Nutrition, Boston University Medical Center, Boston, Massachusetts, USA.
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Psychosocial evaluation for bariatric surgery: the Boston interview and opportunities for intervention. Obes Surg 2008; 19:369-77. [PMID: 18795379 DOI: 10.1007/s11695-008-9676-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 08/28/2008] [Indexed: 01/14/2023]
Abstract
The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.
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Schernthaner G, Morton JM. Bariatric surgery in patients with morbid obesity and type 2 diabetes. Diabetes Care 2008; 31 Suppl 2:S297-302. [PMID: 18227500 DOI: 10.2337/dc08-s270] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Guntram Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital Vienna, Juchgasse 25, A-1030 Vienna, Austria.
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Marchand C, Poitou C, Pinosa C, Dehaye B, Basdevant A, d'Ivernois JF. Cognitive structures of obese patients undergoing bariatric surgery: a concept mapping analysis. Obes Surg 2007; 17:1350-6. [PMID: 18000723 DOI: 10.1007/s11695-007-9240-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 04/14/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The preparation of patients for bariatric surgery includes education concerning the intervention and its after-effects, and training on the health behaviors that they must put into practice after surgery. In this descriptive study, we have analyzed the cognitive structures of obese patients who have participated in a series of education sessions given by a medical team. METHODS 30 severely obese patients participated in an interview during which a concept map was drawn up. The concept maps were analyzed to describe the nature and organization of the patient's knowledge. RESULTS 10 knowledge domains have been identified concerning the intervention (principles, risks, follow-up care) and its consequences (weight, health, diet, social and psychological well-being, self-image, physical activity). Height domains were brought up by more than two-thirds of the patients. The knowledge organization is quite variable, as shown by the connections drawn between domains. Knowledge is mingled with other mental states in the cognitive structures of the patients. One-third of them expressed erroneous knowledge, especially concerning the surgical intervention and diet. The patients expressed numerous and positive perspectives on the expected change (81% of the mental states). Most concerned their quality of life. Nonetheless, 17 out of 30 patients also expressed themselves in a more negative fashion (12% of the mental states). CONCLUSION This study shows the richness and diversity of the knowledge acquired by patients before a bariatric operation. It confirms the importance of education before surgery and the necessity of pursuing it as part of their long-term care.
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Affiliation(s)
- Claire Marchand
- Health Education Laboratory, EA-3412 - CNRH-IDF Paris 13 University, Bobigny, France.
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Belle SH, Berk PD, Courcoulas AP, Flum DR, Miles CW, Mitchell JE, Pories WJ, Wolfe BM, Yanovski SZ. Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery. Surg Obes Relat Dis 2007; 3:116-26. [PMID: 17386392 PMCID: PMC3805365 DOI: 10.1016/j.soard.2007.01.006] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 01/22/2007] [Accepted: 01/23/2007] [Indexed: 01/17/2023]
Abstract
BACKGROUND Obesity is a leading health concern in the United States. Because traditional treatment approaches for weight loss are generally unsuccessful in the long term, bariatric surgical procedures are increasingly being performed to treat extreme obesity. To facilitate research in this field, the National Institute of Diabetes and Digestive and Kidney Diseases responded to this knowledge gap by establishing the Longitudinal Assessment of Bariatric Surgery (LABS) consortium. METHODS A competitive National Institute of Diabetes and Digestive and Kidney Diseases grant process resulted in the creation of a group of investigators with expertise in bariatric surgery, internal medicine, endocrinology, behavioral science, outcomes research, epidemiology, biostatistics, and other relevant fields. These investigators have worked closely to plan, develop, and conduct the LABS study. The LABS consortium protocol is a prospective, multicenter observational cohort study of consecutive patients undergoing bariatric surgery at 6 clinical centers. LABS includes an extensive database of information systematically collected preoperatively, at surgery, perioperatively during the 30-day postoperative period, and longer term. RESULTS The LABS study has been organized into 3 phases. LABS-1 will include all patients > or =18 years of age who have undergone bariatric surgery by LABS-certified surgeons with the goal to evaluate the short-term safety of bariatric surgery. LABS-2, a subset of approximately 2400 LABS-1 patients, will evaluate the relationship of patient and surgical characteristics to the longer term safety and efficacy of bariatric surgery. LABS-3 will involve a subset of LABS-2 subjects who will undergo detailed studies of mechanisms involved in weight change. The rationale, goals, and approach to study bariatric surgery are detailed in this report, along with a description of the outcomes, measures, and hypotheses used in LABS-1 and -2. CONCLUSION The goal of the LABS consortium is to accelerate clinical research and understanding of extreme obesity and its complications by evaluating the risks and benefits of bariatric surgery. LABS investigators use standardized definitions, high-fidelity data collection, and validated instruments to enhance the ability of clinicians to provide meaningful evidence-based recommendations for patient evaluation, selection for surgery, and follow-up care.
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Affiliation(s)
- Steven H Belle
- Data Coordinating Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Suter M, Paroz A, Calmes JM, Giusti V. European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg 2006; 93:726-32. [PMID: 16671063 DOI: 10.1002/bjs.5336] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGBP) is usually considered as the procedure of choice for morbid obesity, but its use has been limited in Europe. It is not known whether results with European patients match those from the USA. METHODS A total of 466 patients were followed prospectively regarding weight loss, co-morbidities, quality of life and morbidity after primary laparoscopic RYGBP. Overall assessment was done using the bariatric analysis and reporting outcome system (BAROS). RESULTS Conversion to open surgery was necessary in three patients. The overall early morbidity rate was 17.0 per cent and the rate of major complications was 4.7 per cent. The mortality rate was 0.2 per cent. Major morbidity decreased over time. Excess weight loss of over 50 per cent was maintained for up to 4 years in 71.4 per cent of the morbidly obese and 65.2 per cent of the super-obese patients. Co-morbidities resolved or improved in most patients and quality of life improved. At 3 years, the BAROS score was excellent or very good in 77.1 per cent and good in 22.8 per cent. Late complications leading to reoperation developed in 19 patients (4.1 per cent). CONCLUSION These results are satisfactory and comparable to those reported from the USA. Owing to limitations associated with purely restrictive bariatric procedures, laparoscopic RYGBP is likely to become the procedure of choice for treatment of morbid obesity in Europe.
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Affiliation(s)
- M Suter
- Department of Visceral Surgery, Diabetology and Metabolism, Centre Hospitalier Universitaire Vaudois, 1860 Aigle, Lausanne, Switzerland.
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