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Jacobs A, Monpellier VM, Torensma B, Antoniou EE, Janssen IMC, Tollenaar RAEM, Jansen ATM. Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024; 25:e13729. [PMID: 38450930 DOI: 10.1111/obr.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss. METHOD Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately. RESULTS In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. CONCLUSION Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
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Affiliation(s)
- Anne Jacobs
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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2
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Jawhar N, Abi Mosleh K, Bartosiak KZ, Hage K, Kennel KA, Mundi MS, Kendrick ML, Ghanem OM. Comprehensive outcomes after Roux-en-Y gastric bypass with a near-complete 15-year follow-up. Surgery 2024:S0039-6060(24)00181-8. [PMID: 38769035 DOI: 10.1016/j.surg.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass has a well-established safety and efficacy profile in the short and mid-term. Long-term outcomes remain limited in the literature, especially for follow-up periods of >10 years. The purpose of the study is to evaluate the long-term durability and safety of laparoscopic Roux-en-Y gastric bypass over a near-complete 15-year follow-up. METHODS This is a single-center retrospective cohort study of patients who underwent primary laparoscopic Roux-en-Y gastric bypass between 2008 and 2009 with ≥14-year follow-up. Data collected and analyzed were weight loss, obesity-related medical condition resolution and recurrence, weight recurrence, complication rate, and mortality rate. RESULTS A total of 264 patients were included. Patients were predominantly female (81.8%), and the mean age and preoperative body mass index were 48.5 ± 12.2 years and 44.9 ± 7.3 kg/m2, respectively. The maximum mean percentage total weight loss achieved at 1 year was 31.5% ± 5.7% and was consistently >20% throughout follow-up. Sustained resolution of obesity-related medical conditions was achieved with a remission rate of 60.8% for type 2 diabetes mellitus, 46.7% for denoted dyslipidemia, and 40% for hypertension. Obesity-related medical condition recurrence was observed with a recurrence rate of 24.1% for type 2 diabetes mellitus, 17.9% for hypertension, and 14.8% for denoted dyslipidemia. Significant factors associated with weight loss were maximum percentage total weight loss and preoperative type 2 diabetes mellitus. Over 15 years, the weight recurrence rate was 51.1%, with predictors of higher preoperative body mass index and preoperative type 2 diabetes mellitus. CONCLUSION Laparoscopic Roux-en-Y gastric bypass provides sustainable weight loss over a 15-year period, with consistent long-term weight-loss outcomes and resolution of obesity-related medical conditions sustained for ≥10 years after surgery.
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Affiliation(s)
- Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kurt A Kennel
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Manpreet S Mundi
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Sim AXJ, Tsen PY, Ngali NM, Lim SY, Gee T, Hanipah ZN. Enhancing Clinical Success Through Intensive Dietary Support in Bariatric Patients: a Retrospective Study in Asian Population. Obes Surg 2024; 34:509-514. [PMID: 38150118 DOI: 10.1007/s11695-023-07001-7] [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: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Weight loss surgery is an established intervention for obesity and related conditions, ensuring sustained weight reduction and improved comorbidities. Post-bariatric surgery, maintaining nutritional adequacy and weight loss necessitates ongoing, intensive dietary support. This research aims to discern the impact of standard care vs. intensive dietary support on outcomes following bariatric surgery within an Asian demographic. This study aims to research the part that intensive dietary support plays in contrast to standard care in altering weight loss and BMI change following bariatric surgery. METHODS A retrospective analysis of medical records from a Malaysian tertiary care hospital documented bariatric surgeries conducted from January 2020 to January 2022. Rigorous criteria selected 200 patients from 327, evenly split between standard care and intensive dietary support groups. The latter underwent six mandatory visits with a surgeon and a dietitian in the initial 3 months post-surgery. A dual-review mechanism was implemented for data interpretation, increasing robustness, and reducing biases in our findings. RESULTS At 6 and 12 months, the intensive dietary support group exhibited significantly greater weight loss and BMI reduction (p < 0.01). Postoperative complications did not significantly differ between groups. CONCLUSION In an Asian population, intensive dietary support enhances weight loss and BMI reduction compared to standard care after bariatric surgery.
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Affiliation(s)
- Alvina Xin Jie Sim
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia.
| | - Poh Yue Tsen
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Nurhanis Mohd Ngali
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Shu Yu Lim
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Tikfu Gee
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Kuala Lumpur, Malaysia
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4
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Lee Y, Kazi T, Dang J, Kroh M, Doumouras AG, Hong D. Financial toxicity risk among patients with gastric banding complications in the United States: analysis of the National Inpatient Sample. Surg Obes Relat Dis 2023; 19:1405-1414. [PMID: 37550162 DOI: 10.1016/j.soard.2023.07.002] [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: 02/27/2023] [Revised: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (AGB) was historically among the most performed bariatric procedures but has fallen out of favor in recent years due to poor long-term weight loss and high revisional surgery rates. Significant financial hardship of medical care, known as "financial toxicity," can occur from experiencing unexpected complications of AGB. OBJECTIVE To investigate the risk of financial toxicity among patients being admitted for AGB complications. SETTING United States. METHODS All uninsured and privately-insured patients who were admitted for AGB complications were identified from the National Inpatient Sample 2015-2019. Publicly available government data (U.S. Census Bureau, Bureau of Labor, The Centers for Medicare and Medicaid Services) were utilized to estimate patient income, food expenditures, and average maximum out-of-pocket expenditures. Financial toxicity was defined as total admission cost from AGB complications ≥40% of postsubsistence income. RESULTS Among 28,005 patients, 66% patients had private insurance and 44% patients were uninsured. Median total admission cost was $12,443 (interquartile range $7959-$19,859) and $15,182 for those who received revisional bariatric surgery. Approximately 55% of the uninsured patients and 1% of insured patients were at risk of financial toxicity after admission for banding-related complications. Patients who had an emergency admission, revisional surgery, or postoperative intensive care unit admission were more likely to experience financial catastrophe following admission (P < .01). CONCLUSIONS About 1 in 2 uninsured patients admitted for AGB-related complications were at risk of financial toxicity. In addition to surgical risks, providers should consider the potential financial consequences of AGB when counselling patients on their choice of surgery.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Tania Kazi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.
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Levaillant L, Levaillant M, Sfeir N, Bouhours-Nouet N, Amsellem-Jager J, Beaumesnil M, Coutant R, Riquin É, Schmitt F. Factors Associated With Weight Loss After Laparoscopic Adjustable Gastric Banding in Adolescents With Severe Obesity. JPGN REPORTS 2023; 4:e296. [PMID: 37200715 PMCID: PMC10187845 DOI: 10.1097/pg9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 05/20/2023]
Abstract
Childhood obesity is associated with many comorbidities. Bariatric surgery is known to be efficient for reducing weight in adolescents. Objectives The primary outcome was to identify somatic or psychosocial factors associated with success at 24 months after a laparoscopic adjustable gastric banding (LAGB) procedure in our cohort of adolescents with severe obesity. Secondary endpoints were to describe weight loss outcomes, comorbidity resolution, and complications. Methods We have retrospectively reviewed medical records of patients who had LAGB placed between 2007 and 2017. Factors associated with success at 24 months after LAGB were researched, with success being defined as positive percentage of excess weight loss (%EWL) at 24 months. Results Forty-two adolescents underwent a LAGB procedure, the mean %EWL was 34.1% at 24 months, with improvement in most comorbidities and without major complications. Having lost weight before surgery was associated with success, whereas a high body mass index at surgery was associated with a higher risk of failure. No other factor was found to be associated with success. Conclusion Comorbidities mostly improved 24 months after LAGB and no major complication occurred. Having lost weight before surgery was associated with a successful surgery, whereas a high body mass index at surgery increases the risk of failure.
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Affiliation(s)
- Lucie Levaillant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Mathieu Levaillant
- Department of Methodology and Biostatistics, University Hospital of Angers, Angers, France
- University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Nathalie Sfeir
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Natacha Bouhours-Nouet
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Jessica Amsellem-Jager
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Marion Beaumesnil
- Department of Paediatric Physical and Rehabilitation Medicine, Centre des Capucins, Angers, France
| | - Régis Coutant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Élise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Mitovasc Unit, UMR CNRS 6015-INSERM, Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
| | - Françoise Schmitt
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
- Univ Angers, HIFIH, SFR ICAT, Angers, France
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Romagna EC, Mattos DMF, Lopes KG, Kraemer-Aguiar LG. Screening Risks of Alcohol Abuse, Depressive Symptoms, and Decreased Health-Related Quality of Life in Post-Bariatric Patients and Their Relations to Weight Regain. Obes Surg 2023:10.1007/s11695-023-06605-3. [PMID: 37097429 DOI: 10.1007/s11695-023-06605-3] [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: 03/22/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes. MATERIAL AND METHODS Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m2) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey. RESULTS Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group. CONCLUSIONS HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
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Affiliation(s)
- Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom / Postgraduate Program on Electrical and Telecommunications Engineering (PPGEET), Fluminense Federal University, Niteroi, RJ, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de setembro, 77, Vila Isabel, Rio de Janeiro, RJ, Brazil.
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Bennett DJ, Bango J, Rothkopf DM. Hand Therapy after Flexor and Extensor Tendon Repair: Assessing Predictors of Loss to Follow-up. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4941. [PMID: 37124389 PMCID: PMC10132707 DOI: 10.1097/gox.0000000000004941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 05/02/2023]
Abstract
Postoperative hand therapy (HT) is important for regaining function and preventing complications in patients undergoing tendon repair of the hand and wrist. Loss to follow-up (LTFU) can hinder this process; so we sought to determine factors that predict attrition of these patients. Methods Charts were retrospectively reviewed for patients who underwent extensor or flexor tendon repair of the hand, wrist, or forearm between 2014 and 2019. Demographic data, including age, sex, zip code, employment status, education level, and insurance type, were collected, and the rate of LTFU was calculated. Logistic regression was used to analyze factors. Results A total of 149 patients were identified and analyzed. The rate of LTFU was 42%. Factors that predicted loss were younger age, male gender, lower educational degree, and a documented psychiatric history. Employment status, insurance type, and distance from the HT center did not predict attrition. The number of HT weeks recommended by the occupational therapist did not differ between those who were lost and those who were not. Lost patients completed, on average, 57% of their suggested HT course. Conclusions The current study identified demographic factors associated with attrition in patients undergoing tendon repair of the distal upper extremity. Factors included patients who were younger, male gender, less educated, and had a documented psychiatric history. By identifying factors that predict LTFU, specific strategies can be developed to reduce attrition rates, particularly for at-risk populations, to improve patient care after tendon repair.
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Affiliation(s)
- Desmond J. Bennett
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, Mass
| | - Jugert Bango
- Department of Orthopedic Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Fla
| | - Douglas M. Rothkopf
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, Mass
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8
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Elhag W, Lock M, El Ansari W. When Definitions Differ, are Comparisons Meaningful? Definitions of Weight Regain After Bariatric Surgery and Their Associations with Patient Characteristics and Clinical Outcomes - A Need for a Revisit? Obes Surg 2023; 33:1390-1400. [PMID: 36995562 PMCID: PMC10156838 DOI: 10.1007/s11695-023-06528-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Definitions and prevalence of weight regain (WR) after bariatric surgery remains inconsistent and their clinical significance unclear. OBJECTIVES To assess WR five years after sleeve gastrectomy (LSG), employing six definitions; and appraise their association with patient characteristics/clinical outcomes. METHODS Consecutive patients (N = 589) who underwent LSG were followed up for 5 years. WR prevalence was calculated yearly employing six definitions. Regression analysis assessed associations between WR at 5 years, and patient characteristics (age, sex, preop BMI, number of follow-up visits, number of comorbidities) and remission of comorbidities (type 2 diabetes, hypertension, and dyslipidemia). RESULTS Sample's mean age and BMI were 34 ± 11.6 years and 43.13 ± 5.77 kg/m2, and 64% were females. Percentage of patients with WR at 2, 3, 4, and 5 years fluctuated between 2.53% and 94.18%, subject to definition, and time point. The definition "Any WR" generated the highest prevalence of WR (86-94%) across all time points. At 5 years, for patient characteristics, preoperative BMI was associated with three definitions (P 0.49 to < 0.001), sex was associated with two (P < 0.026-0.032), and number of comorbidities was associated with one definition (P = 0.01). In terms of comorbidities, only hypertension was associated with WR (one definition, P = 0.025). No other definitions of WR were associated with any of the variables under examination. CONCLUSION Weight regain is reasonably expected after BMS. WR definitions were of minor clinical significance due to weak associations with limited comorbidities. Dichotomous definitions might offer some guidance while managing individual patients. However, its utility as a comparator metric across patients/procedures requires refinements.
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Affiliation(s)
- Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Merilyn Lock
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Walid El Ansari
- Weill Cornell Medicine-Qatar, Doha, Qatar.
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
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Su YT, Su YH, Tam KW, Yen YC, Wang W, Huang MT, Wang SY, Pai FY, Kuo CY, Shen SC. Prediction of 5-Year Weight Loss and Weight Regain According to Early Weight Loss after Sleeve Gastrectomy. Obes Surg 2023; 33:1366-1372. [PMID: 36940019 DOI: 10.1007/s11695-023-06527-0] [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: 10/06/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Patients with morbid obesity exhibit sustained weight loss after sleeve gastrectomy (SG), but some individuals exhibit subsequent weight regain in the following years. Early weight loss was proven as a predictor of short- and mid-term weight loss and regain. However, the long-term effects of early weight loss have yet to be fully investigated. This study investigated the predictive effects of early weight loss on long-term weight loss and regain after SG. METHODS Data of patients who underwent SG from November 2011 to July 2016 and followed through July 2021 were collected retrospectively. Weight regain was defined by weight increase more than 25% of their lost weight at the first postoperative year. Linear regression analysis and Cox proportional hazards analysis were performed to evaluate the correlations among early weight loss, weight loss, and weight regain. RESULTS Data of 408 patients were included. The percentages of total weight loss (%TWL) at postoperative months 1, 3, 12, and 60 were 10.6%, 18.1%, 29.3%, and 26.6%, respectively. The %TWL at months 1 and 3 were significantly correlated with %TWL after 5 years (P < .01). The weight regain rate was 29.8% at 5 years. The %TWL at months 1 and 3 significantly influenced weight regain (hazard ratio: 0.87 and 0.89, P = .017 and .008). CONCLUSION Early weight loss may be used to predict weight loss and regain 5 years after SG. Patients with poor early weight loss are recommended to receive early interventions to achieve long-term weight loss and prevent weight regain.
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Affiliation(s)
- Yi-Ting Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hao Su
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.,Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, 11031, Taiwan.,TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chun Yen
- Clinical Information Department, Quality Management Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Weu Wang
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | | | - Shih-Yun Wang
- Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Fang-Yi Pai
- Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Ying Kuo
- Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Chiang Shen
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, 11031, Taiwan. .,TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
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10
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Aly A, Spiro C, Liu DS, Mori K, Lim HK, Blackham R, Erese RJ. Bariatric surgery in a public hospital: a 10-year experience. ANZ J Surg 2022; 92:2129-2136. [PMID: 35603768 PMCID: PMC9546354 DOI: 10.1111/ans.17768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 12/31/2022]
Abstract
Introduction Obesity is common and adversely impacts quality‐of‐life and healthcare cost. In Australia, less than 10% of bariatric surgeries are performed in the public sector. This study reports our 10‐year experience from a high volume public bariatric service which delivers multi‐disciplinary care for primary and revisional procedures with mid‐ to long‐term follow‐up. Methods A prospectively maintained database of all patients who underwent bariatric surgery from January 2010 to January 2020 at a tertiary metropolitan hospital was analysed. We analysed patient demographics, comorbidities, perioperative outcomes, 2‐ and 5‐year weight loss as well as comorbidities reduction. Results A total of 995 patients underwent 1086 (674 primary and 412 revisional) bariatric procedures with mean age of 46.9 years, mean BMI of 49.6 ± 9.1 kg/m2 and 92% patients with ≥1 obesity‐related co‐morbidity. Length‐of‐stay was longer for revisional than primary surgery (5.6 vs. 3.5 days). Major complication rate was 4.2%. Overall, % Total body weight loss (%TBWL) for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At 2 years follow‐up, treatment was ceased or reduced in 65% of diabetics, 29% of hypertensive patients and 69% of sleep apnoea patients. Conclusion This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector.
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Affiliation(s)
- Ahmad Aly
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Calista Spiro
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - David S Liu
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,General and Gastrointestinal Surgery Research Group, The University of Melbourne Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Krinal Mori
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Hou K Lim
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ruth Blackham
- Department of Surgery, University Western Australia, Western Australia, Australia
| | - Raymund J Erese
- Section of Bariatric Surgery, The Medical City/Ateneo School of Medicine and Public Health, Pasig, Philippines
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11
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Samaan JS, Srinivasan N, Mirocha J, Premkumar A, Toubat O, Qian E, Subramanyam C, Malik Y, Lee N, Sandhu K, Dobrowolsky A, Samakar K. Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes. Am Surg 2022; 88:2445-2450. [PMID: 35575161 DOI: 10.1177/00031348221101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9 years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7 years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.
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Affiliation(s)
- Jamil S Samaan
- Department of Medicine, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitin Srinivasan
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - James Mirocha
- Cedars-Sinai Medical Center, Biostatistics and Bioinformatics Research Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Omar Toubat
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elaine Qian
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Chaitra Subramanyam
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yousaf Malik
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nayun Lee
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Adrian Dobrowolsky
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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12
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Is Adherence to Follow-Up After Bariatric Surgery Necessary? A Systematic Review and Meta-Analysis. Obes Surg 2022; 32:904-911. [PMID: 35020125 PMCID: PMC8866276 DOI: 10.1007/s11695-021-05857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022]
Abstract
The association of adherence to follow-up (FU) after laparoscopic gastric bypass — and gastric sleeve with weight loss (WL) is unclear. The aim of this study was to evaluate this association. Fourteen full text articles were included in the systematic review. Eight studies were included in the meta-analysis concerning FU up to 3 years postoperatively and 3 for the FU between 3 and 10 years postoperatively. Results showed a significant association between adherence to FU 0.5 to 3 years postoperatively and percentage excess WL (%EWL) but did not demonstrate a significant association between FU > 3 years postoperatively and total WL (%TWL). In conclusion, adherence to FU may not be associated with WL and therefore stringent lifelong FU in its current form should be evaluated.
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13
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Yu Y, Ma Q, Johnson JA, O'Malley WE, Sabbota A, Groth SW. Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Surg Obes Relat Dis 2021; 18:384-393. [PMID: 34974998 DOI: 10.1016/j.soard.2021.12.003] [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: 05/07/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- School of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Joseph A Johnson
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - William E O'Malley
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Aaron Sabbota
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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14
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Tat C, Barajas-Gamboa JS, Lee-St. John T, Diaz Del Gobbo G, Klingler M, AlNuaimi A, Raza J, Abril C, Corcelles R, Kroh M. Impact of Patient Follow-Up with a Multidisciplinary Team After Bariatric Surgery in a Middle Eastern Academic Medical Center. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0139] [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)
- Christine Tat
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan S. Barajas-Gamboa
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Terrence Lee-St. John
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Gabriel Diaz Del Gobbo
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Michael Klingler
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Asma AlNuaimi
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Javed Raza
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ricard Corcelles
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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15
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The impact of patient-reported outcomes on loss to follow-up care after bariatric surgery. Surg Endosc 2021; 36:936-940. [PMID: 33624156 DOI: 10.1007/s00464-021-08352-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND High rates of attrition to post-bariatric surgical care continue to be common, despite recommendations for lifelong follow-up. There is little available work focusing on the etiology of attrition to post-bariatric surgical follow-up. Patient-reported outcomes (PROs) are metrics of patients' perceptions of their own health and have been used for their predictive value in other specialties. The relationships between PROs and loss to follow-up have not been explored. METHODS PRO data from patients who met the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) definition of loss to follow-up at 1-year postoperatively were reviewed and compared to patients who were compliant with 1-year follow-up. Patient-reported outcomes measurement information system (PROMIS) measures are routinely collected pre- and postoperatively at our institution using a series of validated computer-adaptive tests that assess depression, satisfaction with social roles, pain interference, and physical function. A series of univariate logistic regressions tested whether baseline PROs or change in PROs from baseline to 6-month postoperatively predicted loss to follow-up at 1 year. RESULTS Neither baseline PROs nor change in depression, satisfaction with social roles, pain interference, or physical function were significant predictors of loss to follow-up. Similarly, patient state of residence, Charlson Comorbidity Index, BMI, and percent excess weight loss were not significant predictors of follow-up attrition. CONCLUSION The PROs in this study were not significant predictors of loss to follow-up at 1-year postoperatively. The rate of bariatric procedures continues to increase nationally, so does the potential for late post-surgical complications. Given the potential impact of loss to follow-up on adverse late post-surgical outcomes, there is a need to facilitate long-term post-surgical follow-up and more investigation is needed to identify and intervene on underlying causes of bariatric patient follow-up attrition.
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16
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Martinez PL, McGarrity LA, Turner NA, Volckmann ET, Kohler RM, Morrow EH, Ibele AR. Self-Pay Payer Status Predicts Long-Term Loss to Follow-Up After Bariatric Surgery. Obes Surg 2021; 31:1590-1596. [PMID: 33515181 DOI: 10.1007/s11695-020-05161-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE In spite of widespread recommendations for lifelong patient follow-up with a bariatric provider after bariatric surgery, attrition to follow-up is common. Over the past two decades, many programs have sought to expand access to care for patients lacking insurance coverage for bariatric surgery by offering "self-pay" packages; however, the impact of this financing on long-term follow-up is unclear. We sought to determine whether payer status impacts loss to follow-up within 1 year after bariatric surgery. MATERIALS AND METHODS Records of 554 consecutive patients undergoing bariatric surgery who were eligible for 1-year post-surgical follow-up between 2014 and 2019 were retrospectively reviewed. Multiple logistic regression examined the relationship between demographics, psychological variables, payer status, and loss to follow-up. RESULTS Self-pay status more than tripled the odds of loss to follow-up (OR = 3.44, p < 0.01) at 1 year following surgery. Males had more than double the odds of attrition (OR = 2.43, p < 0.01), and members of racial and ethnic minority groups (OR = 2.51, p < 0.05) were more likely to experience loss. CONCLUSIONS Self-pay patients, males and members of racial and ethnic minority groups, may face additional barriers to long-term access to postoperative bariatric care. Further investigation is greatly needed to develop strategies to overcome barriers to and disparities in long-term post-surgical care for more frequently lost groups.
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Affiliation(s)
- Paige L Martinez
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Larissa A McGarrity
- Division of Physical Medicine & Rehabilitation, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Natalie A Turner
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Eric T Volckmann
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Rebecca M Kohler
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Ellen H Morrow
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Anna R Ibele
- Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
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17
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Where Are My Patients? Lost and Found in Bariatric Surgery. Obes Surg 2021; 31:1979-1985. [PMID: 33428161 DOI: 10.1007/s11695-020-05186-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Follow-up is a cornerstone of the success of bariatric surgery. However, adherence to monitoring decreases over time. The reasons for non-compliance with follow-up still remain unclear. MATERIALS AND METHODS This is a retrospective, single-center, cohort study, including all patients undergoing bariatric surgery between 2014 and 2017. Patients lost to follow-up were called back and questioned about the reasons of non-adherence. Patients followed and lost to follow-up were compared in terms of weight loss. RESULTS Overall, 29.7% of patients were lost to follow-up. After a callback, we obtained information on 89.9% of patients. The first reason of non-attendance was considering follow-up as unnecessary (29.5%). Almost a quarter of patients (24%) discontinued follow-up due to geographic distance, while 23.3%, 18.6%, and 14.0% of patients explained the lack of follow-up due to family, professional, or health problems. Only 7.0% declared to renounce to follow-up because of poor weight loss. Percentage of excess weight loss at 3 and 5 years after surgery was respectively 73.6% and 81.2% in attendant patients, and 70.7% and 68.4% in non-adherent patients (p = ns). Despite a greater weight loss in the group of patients regularly followed, the difference with patients lost to follow-up remained not significant in multivariate analysis. CONCLUSIONS Follow-up is of crucial importance in the management of bariatric patients. Follow-up disruption is associated to individual patient choice and external constraints. In order to improve the quality of long-term care, care providers will probably need to adapt to these constraints, diversifying the offer of care.
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18
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Lujan J, Tuero C, Landecho MF, Moncada R, A Cienfuegos J, Rotellar F, Silva C, Lapuente F, Martínez P, Frühbeck G, Valenti V. Impact of Routine and Long-Term Follow-Up on Weight Loss after Bariatric Surgery. Obes Surg 2020; 30:4293-4299. [PMID: 32583298 DOI: 10.1007/s11695-020-04788-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Weight loss after bariatric surgery varies among patients. Patients who do not complete long-term follow-up are considered to loose less weight than those with regular follow-up visits. OBJECTIVE To evaluate the influence of patients' follow-up compliance on long-term excess weight loss (%EWL) and total weight loss (%TWL) after bariatric surgery, comparing results between gastric bypass (GB) and sleeve gastrectomy (SG). METHODS Patients with up to 5 years of follow-up data after bariatric surgery were included in this retrospective analysis. Patients were divided in 2 groups: those in group 1 who had attended every scheduled postoperative appointment and those in group 2 who had been lost to follow-up before 1 year and were later contacted by telephone. %EWL and %TWL were compared to determine the possible relationship between type of surgery and regularity of the follow-up. RESULTS A total of 385 patients were included. A significant difference in EWL was observed at 5 years in the SG group (78% for group 1 versus 39% for group 2; p = 0.02) and GB group (75% for group 1 versus 62% for group 2; p = 0.01). No significant differences between surgeries were found when comparing long-term EWL in group 1 patients 77% for SG versus 75% for GB. For group 2 patients, GB achieved greater EWL than SG; p = 0.005. %TWL patients in group 2 showed significant differences in all periods of study (p < 0.05). CONCLUSION Bariatric surgery patients who attended all scheduled follow-up appointments experienced significantly greater long-term EWL and TWL than those who did not. GB has apparent increased benefits for weight loss in long-term follow-up when compared with SG for patients who did not attend long-term follow-up. Therefore, continued long-term follow-up of bariatric patients should be encouraged to increase postoperative weight loss results.
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Affiliation(s)
- J Lujan
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - C Tuero
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - M F Landecho
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - R Moncada
- Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| | - J A Cienfuegos
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - F Rotellar
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Silva
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - F Lapuente
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - P Martínez
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - G Frühbeck
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Victor Valenti
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain. .,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
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19
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Monfared S, Martin A, Selzer D, Butler A. Travel distance reduces follow-up compliance but has no effect on long-term weight loss success in bariatric patients. Surg Endosc 2020; 35:1579-1583. [PMID: 32297055 DOI: 10.1007/s00464-020-07535-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients seeking bariatric surgery are traveling longer distances to reach Bariatric Centers. The purpose of this study was to evaluate the impact of travel distance on adherence to follow-up and outcomes after bariatric surgery. METHODS A retrospective review of all consecutive patients who had undergone bariatric surgery from June 2013 to May 2014 was performed, and the patients were divided into two groups: those who traveled 50 miles or less and those who traveled more than 50 miles. Primary outcome assessed was the influence of distance on post-operative follow-up attrition over 4-year period. Secondary outcomes assessed were excess weight loss, length of stay (LOS), complications and readmission rates. RESULTS A total of 228 patients underwent bariatric surgery with 4 years of follow-up available. Of these, 145 patients traveled 50 miles or less and 83 patients traveled greater than 50 miles. Patient demographics were similar between the two groups. Those who traveled more had statistically higher probability of attrition up to 3-year follow-up mark. There was no difference in percent excess weight loss at each follow-up visit between the two cohorts. Furthermore, there was no difference in readmission rates (2% vs 5%), minor complications (14% vs 10%), major complications (3% vs 2%) and LOS (2.6 days vs 2.6). CONCLUSION The distance patients traveled for bariatric surgery did not affect their weight loss success, length of stay, postsurgical complications or readmission rate. Despite the lack of influence on postoperative outcomes, follow-up compliance was statistically affected by distance.
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Affiliation(s)
- Sara Monfared
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA.
| | - Anna Martin
- Purdue University School of Science, West Lafayette, USA
| | - Don Selzer
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA
| | - Annabelle Butler
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA
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20
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Abstract
Bariatric surgery research has focused predominantly on weight loss outcomes and complications of surgery in relation to the type of surgical procedure. The psychological impact of having bariatric surgery has received less attention. This study investigated whether patients who receive psychological counselling have better physical and mental well-being post-bariatric surgery. Eighty-eight persons (81 female, 7 male, M age 43.99 years) who had undergone weight loss surgery were recruited from bariatric surgery and obesity online support groups to answer an electronic survey which included the Health Survey Short Form (SF-12) to assess mental and physical well-being. Patients who had attended ≥ 6 counselling sessions after gastric sleeve surgery had better physical well-being, compared to those who attended < 6 sessions. Patients who attended between one and four psychological counselling sessions had significantly higher mental well-being. Psychological support for the mental health needs of obese patients post-surgery requires more attention.
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21
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Hung KC, Ho CN, Chen JY, Liu WC, Sun CK, Soong TC. Association of preoperative hemoglobin with weight loss after bariatric surgery: a retrospective study. Surg Obes Relat Dis 2019; 15:1595-1603. [PMID: 31416688 DOI: 10.1016/j.soard.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the known positive correlation between exercise and weight loss after bariatric surgery as well as the established association of hemoglobin level with maximal aerobic power and endurance performance, the correlation between preoperative hemoglobin concentration (pre-Hb) and postoperative weight loss remains unknown. OBJECTIVE This study aimed at assessing the association of pre-Hb with postoperative percentage weight loss (%WL) at 3, 6, 12, and 24 months after surgery. SETTING A single tertiary referral center. METHODS Outcomes of 282 patients undergoing laparoscopic sleeve gastrectomy at the 4 timepoints within a 24-month follow-up period were assessed. The primary study endpoint was the relationship between pre-Hb and postoperative %WL at 12-month follow-up. RESULTS The 282 patients had a mean preoperative body mass index of 39.0 ± 4.5 kg/m2 with a slight female predominance (57.4%). Follow-up data were available for 221 of 282 (78.4%) patients (mean %WL: 30.9% ± 6.6%) at 1 year. Pearson's correlation showed that pre-Hb correlated positively with post-Hb (r = 0.778, P < .001) and %WL (r = .237, P < .001) at 12-month follow-up but not at 24 months (r = .145, P = .331). Multiple linear regression analyses including baseline variables of age, sex, preoperative body mass index, and diabetes revealed that pre-Hb, age, and preoperative body mass index were independent predictors of %WL. There was no evidence of multicollinearity among these variables. CONCLUSION The present study showed a potential positive relationship between pre-Hb and postoperative weight loss. More well-designed, large-scale studies are warranted to clarify the effect of hemoglobin level on postoperative weight loss in this patient population.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Wei-Cheng Liu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tien-Chou Soong
- School of Medicine, I-Shou University, Kaohsiung, Taiwan; Weight loss and Health Management Center, E-Da Dachang Hospital, Kaohsiung, Taiwan.
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22
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Fox W, Borgert A, Rasmussen C, Kallies K, Klas P, Kothari S. Long-term micronutrient surveillance after gastric bypass surgery in an integrated healthcare system. Surg Obes Relat Dis 2019; 15:389-395. [PMID: 30709752 DOI: 10.1016/j.soard.2018.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/07/2018] [Accepted: 12/29/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The number of patients undergoing bariatric surgery in the United States is growing. While gastric bypass surgery is an important tool in the management of obesity, it requires lifelong metabolic monitoring and medical management. Data describing compliance with recommended laboratory follow-up are limited, particularly in long-term and primary care settings. OBJECTIVES To evaluate postoperative follow-up laboratory testing for patients after laparoscopic Roux-en-Y gastric bypass (LRYGB). SETTING Academic-affiliated community hospital. METHODS A review of patients who underwent LRYGB from 2001 to 2016 was performed. The location of patients' follow-up care and compliance with recommended laboratory testing were determined from patient records. Compliance was analyzed at 1-year intervals. RESULTS One thousand four hundred ninety patients underwent LRYGB. Five years after their surgical date, patients were more likely to follow-up with primary care than bariatric surgery clinic (369 versus 159 patients). At 5 years postoperative, 82%, 85%, and 68% of patients that followed-up with primary care did not have a vitamin D, parathyroid hormone, or vitamin B12 test, respectively. Patients that followed-up in bariatric clinic were slightly more likely to have recommended labs completed. At 5 years postprocedure, 81%, 55%, and 48% did not have a vitamin D, parathyroid hormone, or vitamin B12 test, respectively. CONCLUSION Most patients do not have the recommended laboratory testing completed, regardless of where their follow-up care occurred. This study identified a gap in long-term postoperative care for patients who have undergone gastric bypass surgery. Further studies will be necessary to develop interventions aimed at improving adherence to recommended monitoring after LRYGB.
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Affiliation(s)
- Wesley Fox
- Gundersen Health System, La Crosse, Wisconsin.
| | | | | | | | - Paul Klas
- Gundersen Health System, La Crosse, Wisconsin
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Carmichael SP, Veasey EC, Davenport DL, Jay K, Bernard AC. Patient-Surgeon Relationship Influences Outcomes in Bariatric Patients. Am Surg 2018. [DOI: 10.1177/000313481808401227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bariatric surgery is an important therapy in weight loss. However, adherence to follow-up is critical and may be influenced by the patient-surgeon relationship. To test this hypothesis, bariatric surgical patients were surveyed from March 2013 to March 2015 via the National Association for Weight Loss Surgery webpage and social media outlets. Surgical outcomes and adherence to follow-up were collected, and aspects of the patient-surgeon relationship were assessed via the Likert scale. Correlations between survey item responses were calculated using Fisher's exact test, Student's t test, and Spearman's rho rank correlation. Three hundred twenty patients responded (n = 287 completed in entirety and n = 33 partially completed); 48 months was the median time to survey from operation (interquartile range, 22–84 months). Eighty-six per cent (n = 276) of patients rated their relationship with their operative surgeon as “average” to “very good.” Thirteen per cent (n = 43) rated their relationship as “poor” to “very poor.” Positive relationship with the operative surgeon and lack of complication were associated with adherence to follow-up ( P = 0.0001 and P = 0.002, respectively). The presence of complication did not affect the overall patient-surgeon relationship ( P = 0.5), although aspects of the patient-surgeon relationship were correlated to complications. There was no association between weight loss at one year and patient-surgeon relationship ( P = 0.6) or presence of complication ( P = 0.1). The findings of this study support the role of a positive patient-surgeon relationship in achieving long-term follow-up in post-bariatric surgical patients.
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Affiliation(s)
- Samuel P. Carmichael
- Graduate Medical Education, General Surgery Residency Program, University of Kentucky, Lexington, Kentucky
| | | | | | - Katie Jay
- The National Association for Weight Loss Surgery (NAWLS), Wilmington, North Carolina
| | - Andrew C. Bernard
- Section of Trauma and Acute Care Surgery, Division of General Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky
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Perna S, Spadaccini D, Riva A, Allegrini P, Edera C, Faliva MA, Peroni G, Naso M, Nichetti M, Gozzer C, Vigo B, Rondanelli M. A path model analysis on predictors of dropout (at 6 and 12 months) during the weight loss interventions in endocrinology outpatient division. Endocrine 2018; 61:447-461. [PMID: 29470776 DOI: 10.1007/s12020-018-1563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study aimed to identify the dropout rate at 6 and 12 months from the first outpatient visit, and to analyze dropout risk factors among the following areas: biochemical examinations, anthropometric measures, psychological tests, personal data, and life attitude such as smoking, physical activity, and pathologies. METHODS This is a retrospective longitudinal observational study. Patients undergo an outpatient endocrinology visit, which includes collecting biographical data, anthropometric measurements, physical and pathological history, psychological tests, and biochemical examinations. RESULTS The sample consists of 913 subjects (682 women and 231 men), with an average age of 50.88 years (±15.80) for the total sample, with a BMI of 33.11 ± 5.65 kg/m2. 51.9% of the patients abandoned therapy at 6 months after their first visit, and analyzing the dropout rate at 12 months, it appears that 69.5% of subjects abandon therapy. The main predictor of dropout risk factors at 6 and 12 months is the weight loss during the first 3 months (p < 0.05). As regards the hematological predictors, white blood cell and iron level stated dropout at 12 months. Patients who introduced physical activity had a reduction of - 17% (at 6 months) and -13% (at 12 months) of dropout risk (p < 0.05). As regards the "worker" status, patients classified as"retired" had a decrease risk of dropout vs. other categories of worker (i = 0.58; p < 0.05). Dropout risk at 12 months decrease in patients with a previous history of cancer, Endocrine and psychic and behavioral disorders (p < 0.001). CONCLUSIONS The main factor that predisposes patients to continue therapy or to abandon it is the success (or failure) of the diet in the initial period, based on weight lost (or not lost) in the early months of the initiation of therapy. Furthermore, considerable differences were found in different categories of "workers", and with previous "pathologies". The level of physical activity and previous diseases also seem to be predictors of dropout.
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Affiliation(s)
- Simone Perna
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy.
| | - Daniele Spadaccini
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | | | | | - Chiara Edera
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Milena Anna Faliva
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Maurizio Naso
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mara Nichetti
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Carlotta Gozzer
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Beatrice Vigo
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona, University of Pavia, Pavia, Italy
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Predictors for Adherence to Multidisciplinary Follow-Up Care after Sleeve Gastrectomy. Obes Surg 2018; 28:3054-3061. [DOI: 10.1007/s11695-018-3296-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hood MM, Kelly MC, Feig EH, Webb V, Bradley LE, Corsica J. Measurement of adherence in bariatric surgery: a systematic review. Surg Obes Relat Dis 2018; 14:1192-1201. [PMID: 29853195 DOI: 10.1016/j.soard.2018.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Megan M Hood
- Rush University Medical Center, Chicago, Illinois.
| | | | - Emily H Feig
- Rush University Medical Center, Chicago, Illinois
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Sherf Dagan S, Keidar A, Raziel A, Sakran N, Goitein D, Shibolet O, Zelber-Sagi S. Do Bariatric Patients Follow Dietary and Lifestyle Recommendations during the First Postoperative Year? Obes Surg 2018; 27:2258-2271. [PMID: 28303504 DOI: 10.1007/s11695-017-2633-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on adherence to postoperative lifestyle recommendations by bariatric patients are scarce. Thus, the aim of this study was to evaluate adherence to selected recommendations during the first year following laparoscopic sleeve gastrectomy (LSG) surgery. METHODS A prospective cohort study with 12 months of follow-up on 100 LSG patients was conducted. Data were collected at baseline and at 3 (M3), 6 (M6), and 12 (M12) months post-surgery and included anthropometrics, biochemical tests, food intake, food tolerance, common surgery-related side effects, physical activity (PA), supplementation, and number of follow-up meetings with a dietitian. RESULTS Data were available for 77 patients (57.1% women, mean age 43.1 ± 9.3 years and preoperative BMI 42.1 ± 4.8 kg/m2). Only a minority of the patients adhered to the recommended protein intake ≥60 g/day at all time points (≤40.3%) and ≥6 meetings with a dietitian at M12 (41.6%). Half of the patients performed ≥150 min/week of PA at all time points (≤50.6%) as recommended. PA of ≥150 min/week was associated with better lipid and glucose changes at M6 and M12 (P ≤ 0.044). Most of the patients adhered to the recommended supplementation at all time points (≥57.1%). Adherence to supplementation at M12 was significantly associated with higher serum levels of folic acid, iron, hemoglobin, and vitamins D and B12 (P ≤ 0.056 for all). Adherence to all recommendations was not significantly associated with excess weight loss ≥60% at M12 (P ≥ 0.195 for all). CONCLUSION Bariatric patients have medium to high adherence to the major lifestyle recommendations during the first year following LSG; however, adherence to those recommendations was not related to better weight loss at short-term follow-up. Adherence to recommended supplementation was associated with better micronutrient status 1 year postoperatively.
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Affiliation(s)
- Shiri Sherf Dagan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Assuta Medical Center, Tel-Aviv, Israel.
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel.
| | - Andrei Keidar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | | | - Nasser Sakran
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - David Goitein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Assuta Medical Center, Tel-Aviv, Israel
- Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
| | - Shira Zelber-Sagi
- Department Gastroenterology, Tel-Aviv Medical Center, 6 Weizman St., 6423906, Tel-Aviv, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Comment on: an update on bariatric tourism: time for a national registry? Surg Obes Relat Dis 2018; 14:532-534. [PMID: 29456177 DOI: 10.1016/j.soard.2018.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 11/20/2022]
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29
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Khoraki J, Moraes MG, Neto AP, Funk LM, Greenberg JA, Campos GM. Long-term outcomes of laparoscopic adjustable gastric banding. Am J Surg 2018; 215:97-103. [DOI: 10.1016/j.amjsurg.2017.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
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Elrefai M, Hasenberg T, Vassilev G, Otto M. Adherence to a Follow-Up Program Is Improving Weight Loss. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mohamad Elrefai
- Department of Surgery, UMM, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt
| | - Till Hasenberg
- Department of Surgery, Alfried Krupp Krankenhaus, Essen, Germany
| | - Georgi Vassilev
- Department of Surgery, UMM, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, UMM, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
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Schwoerer A, Kasten K, Celio A, Pories W, Spaniolas K. The effect of close postoperative follow-up on co-morbidity improvement after bariatric surgery. Surg Obes Relat Dis 2017; 13:1347-1352. [DOI: 10.1016/j.soard.2017.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/25/2022]
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Thereaux J, Lesuffleur T, Païta M, Czernichow S, Basdevant A, Msika S, Millat B, Fagot-Campagna A. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg 2017; 104:1362-1371. [PMID: 28657109 DOI: 10.1002/bjs.10557] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/20/2017] [Accepted: 03/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. METHODS All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. RESULTS Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P < 0.001) and calcium (from 14·4 to 7·7 per cent; P < 0·001), but increased for vitamin D (from 33·1 to 34·7 per cent; P < 0·001). The percentage of patients with one or more visits to a surgeon decreased between the first and fifth years, from 87·1 to 29·6 per cent (P < 0·001); similar decreases were observed for visits to a nutritionist/endocrinologist (from 22·8 to 12·4 per cent; P < 0·001) or general practitioner (from 92·6 to 83·4 per cent; P < 0·001). The mean number of visits to a general practitioner was 7·0 and 6·1 in the first and the fifth years respectively. In multivariable analyses, male sex, younger age, absence of type 2 diabetes and poor 1-year follow-up were predictors of poor 5-year follow-up. CONCLUSION Despite clear national and international guidelines, long-term follow-up after bariatric surgery is poor, especially for young men with poor early follow-up.
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Affiliation(s)
- J Thereaux
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.,Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, and University of Bretagne Occidentale, EA, 3878, Brest, France
| | - T Lesuffleur
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - M Païta
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - S Czernichow
- Department of Nutrition, Hôpital Européen Georges-Pompidou, Paris Descartes University, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité Mixe de Service 011, Villejuif, France
| | - A Basdevant
- Institute of Cardiometabolism and Nutrition, Heart and Nutrition Department, AP-HP, Pitié-Salpêtrière Hospital, and Sorbonne Universities, University Pierre et Marie Curie, Paris, France
| | - S Msika
- Department of General, Digestive and Metabolic Surgery, Louis Mourier Hospital, AP-HP, Diderot Paris 7 University, Paris, France
| | - B Millat
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - A Fagot-Campagna
- Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
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Natural History of Adjustable Gastric Banding: Lifespan and Revisional Rate: A Nationwide Study on Administrative Data on 53,000 Patients. Ann Surg 2017; 265:439-445. [PMID: 27433894 DOI: 10.1097/sla.0000000000001879] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the adjustable gastric banding (AGB) natural history on a national basis. BACKGROUND Adjustable gastric banding represented the most common bariatric procedure in France until 2010. Since then, the number of AGBs has decreased and the rate of band removal and revisional surgeries has progressively increased. METHODS For analysis, we included all adult patients operated on with AGB in France between 2007 and 2013. Data were extracted from a national administrative database ("Programme De Médicalisation des Systèmes d'Information," PMSI), which is an exhaustive source of all surgical procedures performed in France. The Cox proportional hazard model was used to test univariate and multivariate associations with band survival and revisional rate. To control for center-specific effects, we performed a frailty analysis, in which each center was assumed to have a random effect indicating the possibility of different baseline risks for patients at different centers. RESULTS During the study period, 52,868 patients underwent AGB, and 10,815 bands were removed. The removal rate at 5, 6, and 7 years was 28%, 34%, and 40%, respectively. Female sex, body mass index >50 kg/m, type 2 diabetes, hypertension, dyslipidemia, and sleep apnea were found to be significantly associated with band removal by multivariate analysis. A significant center effect was also found, but this did not change the impact of the highly significant factors already identified. After band removal, the median time to revisional surgery was 1 year (95% confidence interval 1.0-1.1) and the conversion rate at 7 years was 71%. CONCLUSIONS With a removal rate of about 6% annually and the need for revisional surgery for more than two-thirds of patients after removal, AGB does not appear to provide a long-term solution for obesity.
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Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr 2017; 8:382-394. [PMID: 28298280 PMCID: PMC5347111 DOI: 10.3945/an.116.014258] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
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Affiliation(s)
- Shiri Sherf Dagan
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, and
| | - Ariela Goldenshluger
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Inbal Globus
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Chaya Schweiger
- The Israel Dietetic Association, Herzliya, Israel
- Herzliya Medical Center, Herzliya, Israel
- Nutrition Service, Rabin Medical Center, Petach Tiqva, Israel; and
| | - Yafit Kessler
- The Israel Dietetic Association, Herzliya, Israel
- The Israeli Center for Bariatric Surgery of Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Galit Kowen Sandbank
- The Israel Dietetic Association, Herzliya, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tair Ben-Porat
- The Israel Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tali Sinai
- The Israel Dietetic Association, Herzliya, Israel;
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
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Sillén L, Andersson E. Patient Factors Predicting Weight Loss after Roux-en-Y Gastric Bypass. J Obes 2017; 2017:3278751. [PMID: 28596920 PMCID: PMC5449731 DOI: 10.1155/2017/3278751] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/18/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify preoperative factors predicting weight loss following Roux-en-Y gastric bypass (RYGB) surgery. MATERIAL AND METHODS 281 patients subjected to RYGB between January 2006 and June 2012 were included. Demographic, physical, and socioeconomic factors were assessed with regression analysis. Dependent variable was percent of excess weight loss (% EWL) at follow-up. RESULTS Follow-up data at one year was available in 96%, at two years in 88%, and at three years in 65% of the patients. Mean EWL was 72.5%. The success rate (defined as ≥60% EWL) at 1 year was 73% and at 2 years 74% and was 71% after 3 years. An earlier onset of obesity and high preoperative BMI were independently associated with unsuccessful weight loss at 1-year follow-up. At 2-year follow-up, an association between unsuccessful weight loss and psychiatric disorder, diabetes, hypertension, and preoperative BMI was seen. At 3-year follow-up no statistically significant associations were detected. CONCLUSIONS RYGB provides successful weight loss for most patients. The results from this study indicate that an earlier age of onset of obesity, high preoperative BMI, psychiatric disorder, diabetes, and hypertension are associated with unsuccessful weight loss.
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Affiliation(s)
- Linda Sillén
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden
| | - Ellen Andersson
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden
- *Ellen Andersson:
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Binda A, Jaworski P, Kudlicka E, Ciesielski A, Cabaj H, Tarnowski W. The impact of selected factors on parameters of weight loss after sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2016; 11:288-294. [PMID: 28194250 PMCID: PMC5299089 DOI: 10.5114/wiitm.2016.64999] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The effectiveness of sleeve gastrectomy has been confirmed in many studies. The impact of individual factors on the parameters of weight loss is still not clear. AIM To identify important factors affecting the parameters of weight loss after sleeve gastrectomy. MATERIAL AND METHODS The impact of prognostic factors and postoperative care components on body mass index (BMI) and percentage excess weight loss (%EWL) was assessed in a group of 100 consecutive patients who underwent laparoscopic sleeve gastrectomy. RESULTS The baseline BMI and body mass in patients with BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 12 months after surgery were, respectively, 39.7 ±3.2 vs. 45.9 ±4.6 kg/m2, p < 0.0001, and 114.4 ±16.8 vs. 130.3 ±18.5 kg, p < 0.0001. In the group with EWL < 50%, the average age was 47.1 ±7.7 vs. 40.6 ±10.8 in the group with EWL ≥ 50%, p = 0.0025. In the group of patients with preoperative weight loss, %EWL was 61.4 ±17.2 vs. 53.3 ±19.3% in the group with no weight loss, p = 0.0496. Body mass index of the patients who started physical activities was 30.6 ±4.2 kg/m2 vs. 34.0 ±5.6 kg/m2 in the patients with no physical activity, p = 0.0013, and %EWL was 63.4 ±14.6 vs. 47.0 ±19.9%, p < 0.0001, respectively. In the case of patients regularly consulted by a dietician BMI was 30.6 ±4.2 kg/m2 vs. 35.1 ±5.5 kg/m2 in the group without systematic consultations, p < 0.0001, and %EWL was 63.1 ±15.1% vs. 42.3 ±18.2%, p < 0.0001. CONCLUSIONS Lower baseline body weight parameters, younger age, preoperative weight loss, starting systematic physical activities and constant care of a dietician were conducive to achieving better results of surgery, as assessed on the basis of changes in BMI and %EWL.
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Affiliation(s)
- Artur Binda
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Paweł Jaworski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Emilia Kudlicka
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Adam Ciesielski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Hubert Cabaj
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Digestive Tract Surgery, Medical Centre of Postgraduate Education, Orlowski Hospital, Warsaw, Poland
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Bradley LE, Sarwer DB, Forman EM, Kerrigan SG, Butryn ML, Herbert JD. A Survey of Bariatric Surgery Patients' Interest in Postoperative Interventions. Obes Surg 2016; 26:332-8. [PMID: 26084251 DOI: 10.1007/s11695-015-1765-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A substantial minority of bariatric surgery patients display clinically significant weight regain and recurrence of obesity-related comorbidities. Although postoperative follow-up and behavioral interventions are associated with better weight loss outcomes, many patients fail to attend or receive these services. More information is needed to better target and increase the probability of sustained treatment in those patients experiencing postoperative weight regain. The purpose of this study was to understand the challenges that patients perceive themselves to be facing and assess their receptivity and preferences for postoperative interventions. METHODS A survey developed by the authors was sent to patients who received bariatric surgery from a program based in an academic medical center between September 2008 and December 2010 (n = 751). RESULTS Data from 154 responders indicate that the vast majority of individuals who have undergone bariatric surgery are satisfied with surgery and their weight losses; however, most reported being on a trajectory of weight regain. Patients endorsed concerns about both current eating behavior and, additional, future weight regain. In addition, these patients expressed strong interest in participating in postoperative programs aimed at stopping and reversing regain. CONCLUSIONS The results provide novel information about bariatric surgery patients' receptivity to and preferences for interventions after bariatric surgery.
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Affiliation(s)
- Lauren E Bradley
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
| | - David B Sarwer
- Departments of Psychiatry and Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Evan M Forman
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
| | - Stephanie G Kerrigan
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
| | - Meghan L Butryn
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
| | - James D Herbert
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut St., Philadelphia, PA, 19104, USA.
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Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo A. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med 2016; 39:1092-1103. [PMID: 27444752 DOI: 10.1007/s10865-016-9772-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 07/12/2016] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA.
| | - Joyce Corsica
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Lauren Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Rebecca Wilson
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Diana A Chirinos
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Amanda Vivo
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
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A postoperative nutritional consult improves bariatric surgery outcomes. Surg Obes Relat Dis 2016; 12:1052-1056. [DOI: 10.1016/j.soard.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/18/2022]
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Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
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Bellows CF, Gauthier JM, Webber LS. Bariatric aftercare and outcomes in the Medicaid population following sleeve gastrectomy. JSLS 2016; 18:JSLS-D-13-00280. [PMID: 25489220 PMCID: PMC4254484 DOI: 10.4293/jsls.2014.00280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Medicaid patients tend to have poor access to care and suffer from more obesity and obesity-related co-morbidities compared to their privately insured counterparts. The impact of Medicaid status on outcomes after laparoscopic sleeve gastrectomy (LSG) is unknown. The aim of this study was to identify factors that influence outcomes following LSG in the adult Medicaid population of Louisiana with particular focus on adherence to bariatric aftercare attendance and access to care. METHODS A retrospective review of 63 Medicaid patients undergoing LSG was performed. Demographic data, access to care, weight, co-morbidities morbidity, and mortality were analyzed. Changes in weight and obesity-related co-morbidities were analyzed for patients with ≥12 months of follow-up. Regression analyses were used for estimating the relationships among variables. RESULTS The majority of patients were female and non-Caucasian. The mean age was 38.6 years. Morbidity was 16% and mortality was 0%. The average distance traveled to clinic was 71.9 miles. Within the first year only 10% of the patients attended all post-operative clinic visits. A multiple logistic model showed that the only predictor of clinic attendance was increased age. At a mean follow-up of 17.7 months, the mean percent excess body weight loss was 47.2%. Greater pre-surgical weight was the only variable associated with suboptimal weight loss. Improvement or resolution of all major co-morbidities was seen in 65% of patients. CONCLUSION Medicaid patients had a poor attendance at bariatric surgery follow up appointments. Since long-term follow-up is critical, we needed to develop strategies that will optimize follow-up in this patient population.
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Affiliation(s)
- Charles F Bellows
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Jason M Gauthier
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Larry S Webber
- Department of Biostatistics and Bioinformatics, Tulane University, New Orleans, Louisiana, USA
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Brown WA, Burton PR, Shaw K, Smith B, Maffescioni S, Comitti B, Cowley MA, Laurie C, Way A, Nottle P. A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery. Obes Surg 2016; 26:2074-2081. [DOI: 10.1007/s11695-016-2075-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tess BH, Scabim VM, Santo MA, Pereira JCR. Obese patients lose weight independently of nutritional follow-up after bariatric surgery. Rev Assoc Med Bras (1992) 2016; 61:139-43. [PMID: 26107363 DOI: 10.1590/1806-9282.61.02.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/21/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. METHODS a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. RESULTS 81% (n = 195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1 ± 21.2 kg and mean preoperative body mass index of 47.2 ± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald's test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald's test p = 0.00). CONCLUSIONS our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up.
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Affiliation(s)
- Beatriz Helena Tess
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Marco Aurélio Santo
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Júlio César R Pereira
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, SP, Brazil
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Spaniolas K, Kasten KR, Celio A, Burruss MB, Pories WJ. Postoperative Follow-up After Bariatric Surgery: Effect on Weight Loss. Obes Surg 2016; 26:900-3. [DOI: 10.1007/s11695-016-2059-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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47
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Gourash WF, Lockhart JS, Kalarchian MA, Courcoulas AP, Nolfi D. Retention and attrition in bariatric surgery research: an integrative review of the literature. Surg Obes Relat Dis 2016; 12:199-209. [DOI: 10.1016/j.soard.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
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Hochberg LS, Murphy KD, O'Brien PE, Brennan L. Laparoscopic Adjustable Gastric Banding (LAGB) Aftercare Attendance and Attrition. Obes Surg 2015; 25:1693-702. [PMID: 25670531 DOI: 10.1007/s11695-015-1597-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Lisa S Hochberg
- Centre for Obesity Research and Education, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia,
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Gallo AS, DuCoin CG, Berducci MA, Nino DF, Almadani M, Sandler BJ, Horgan S, Jacobsen GR. Endoscopic revision of gastric bypass: Holy Grail or Epic fail? Surg Endosc 2015; 30:3922-7. [PMID: 26675939 DOI: 10.1007/s00464-015-4699-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately 20-30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. METHODS We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. RESULTS Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m(2), respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, -10.7, -13.5, -5.8, -4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. CONCLUSION Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.
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Affiliation(s)
- Alberto S Gallo
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. .,Baptist Health Louisville, 4001 Kresge Way Suite 200, Louisville, KY, 40207, USA.
| | - Christopher G DuCoin
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Martin A Berducci
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Diego F Nino
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Moneer Almadani
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Bryan J Sandler
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Santiago Horgan
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Garth R Jacobsen
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Larjani S, Spivak I, Hao Guo M, Aliarzadeh B, Wang W, Robinson S, Sockalingam S, Aarts MA. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery. Surg Obes Relat Dis 2015; 12:350-6. [PMID: 26806726 DOI: 10.1016/j.soard.2015.11.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 10/31/2015] [Accepted: 11/09/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low. OBJECTIVE To identify patient factors that contribute to adherence to follow-up care after bariatric surgery. SETTING Three university-affiliated hospitals in Canada METHODS A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients' socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent. RESULTS The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017). CONCLUSION Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up.
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Affiliation(s)
- Soroush Larjani
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Division of General Surgery, Toronto East General Hospital, Toronto, Canada
| | - Israel Spivak
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Ming Hao Guo
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Babak Aliarzadeh
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Wei Wang
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Sandra Robinson
- The University of Toronto Bariatric Collaborative, Toronto, Canada
| | - Sanjeev Sockalingam
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada
| | - Mary-Anne Aarts
- The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada.
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