Health-related quality of life and symptoms of depression in extremely obese persons seeking bariatric surgery

Psychological considerations for the holistic management of obesity

Psychological presence in multidisciplinary obesity teams has been highlighted as an important component of such teams. Although mentioned in guidelines and recommendations, there is little information regarding the extent to which this is present currently in weight management services, and in what form. Here, we discuss important ways in which psychological aspects of obesity can impact a person living with obesity and how psychology can be incorporated to provide holistic support in weight management services. Recommendations are also made to create clearer guidelines to provide a more robust reference for the inclusion of psychology in multidisciplinary teams.

Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity

Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.

Patterns of eating behavior in people with severe obesity seeking weight loss treatment: An exploratory study

Although subjects with severe obesity need specific interventions, knowledge about their eating behavior, physical and mental health profiles remains insufficient. This cross-sectional study aimed to identify profiles of individuals with severe obesity based on clinical, psychological and eating behavior characteristics. We included 126 participants (103 women; mean age: 47.2 ± 13.9 years; mean BMI: 41.0 ± 5.7 kg/m²). Cluster analyses were performed to identify profiles based on age, waist circumference, eating behavior, depressive symptoms, food-related quality of life and physical activity. Metabolic syndrome components and type 2 diabetes prevalence were compared between the clusters. Three clusters were identified. Cluster 1 labelled struggling with food (48% of the population) had high scores on both emotional eating and uncontrolled eating, low score on comfort with food and they had depressive symptoms. Cluster 2, low loss of eating control (29%), had low scores on emotional eating and uncontrolled eating, and high quality of life in the psychosocial dimension. Cluster 3, pleasure from eating (22%), had the greatest score on comfort with food, the highest physical activity level, and depressive symptoms. In cluster 2, prevalence of type 2 diabetes was higher, although not statistically significant. Otherwise, no differences were found between clusters. Conclusion: Subjects with severe obesity have different profiles, partly explained by their eating behavior, associated with clinical and behavioral patterns. Further studies should confirm this cluster structure and assess how these profiles impact the evolution of obesity and whether they can help to improve the personalization of care programs.

Psychiatric morbidities of female obesity before and after dieting: an Egyptian sample

Background

The rate of occurrence of psychiatric morbidities like anxiety, depression, perceived stress, and the overall quality of life are very high among female patients with obesity; therefore, our study investigates such variables before and after weight loss in female patients on diet restriction; this can help obesity-multidisciplinary teams target these psychiatric correlates to reach a more satisfactory outcome.

Results

Anxiety, depression, and perceived stress scores decreased significantly in parallel to the weight loss reported (p < 0.0001). Except for social functioning, all other domains of quality of life improved significantly after weight loss. Those with higher education level showed significantly lower stress, anxiety, and depression scores before weight loss compared to married and highly educated ones respectively. After weight loss, highly educated participants showed lower perceived stress and depression scores than those with middle education.

Conclusions

Anxiety, depression, and perceived stress factors are significantly decreased after weight reduction with an improved quality of life as well compared to their scores prior.

Quality of Life and Gastrointestinal Symptoms Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: a Systematic Review

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common bariatric operations performed worldwide. Quality of life (QoL) is a crucial outcome metric. An electronic systematic search using PubMed, EMBASE, and Web of Science of studies comparing QoL after LSG and LRYGB was performed. QoL after both LSG and LRYGB considerably improves regardless the type of surgery. The QoL has a slight downward trend from the second to the fifth year postoperatively, but it remains higher than the baseline. LSG patients are more likely to suffer from gastroesophageal symptoms (GES). GES represent the only significant difference between the two procedures. A routine screening with gastroscopy and 24 h pH metry to help tailor the most appropriate surgical approach is advised.

Risk of Suicide and Self-harm Is Increased After Bariatric Surgery-a Systematic Review and Meta-analysis

BACKGROUND

Bariatric surgery is endorsed by multiple societies as the most effective treatment for obesity. Psychosocial functioning has also been noted to improve for most patients after bariatric surgery. However, some studies have shown an increase in post-operative suicide risk. The aim of this study was to review the published literature and evaluate the association of bariatric surgery with suicide events and suicide/self-harm attempts in patients who have undergone weight loss surgery.

METHODS

MEDLINE and Embase were searched from inception through January 2018 for retrospective or prospective studies reporting mortality outcomes and self-harm or suicide rates after bariatric procedures. The primary outcome was the pooled event rate with 95% confidence interval (95% CI) for suicide. Secondary outcomes were suicide/self-harm attempts after bariatric surgery compared to same population prior to surgery and to matched control subjects, with the respective calculated odds ratios (OR) and 95% CI.

RESULTS

From 227 citations, 32 studies with 148,643 subjects were eligible for inclusion. The patients were predominantly females (76.9%). Roux-en-Y gastric bypass (RYGB) was the most commonly performed procedure (58.9%). The post-bariatric suicide event rate was 2.7/1000 patients (95% CI 0.0019-0.0038), while the suicide/self-harm attempt event rate was 17/1000 patients (95% CI 0.01-0.03). The self-harm/suicide attempt risk was higher after bariatric surgery within the same population with OR of 1.9 (95% CI 1.23-2.95), and compared to matched control subjects, OR 3.8 (95% CI, 2.19-6.59).

CONCLUSIONS

Post-bariatric surgery patients had higher self-harm/suicide attempt risk compared to age-, sex-, and BMI-matched controls. Various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved.

Prospective Longitudinal Patient-Reported Satisfaction and Health-Related Quality of Life following DIEP Flap Breast Reconstruction: Relationship with Body Mass Index

BACKGROUND

Breast reconstruction plays a significant role in breast cancer treatment recovery. Introduction of the BREAST-Q questionnaire has facilitated quantifying patient-reported quality-of-life measures, promoting improved evidence-based clinical practice. Information regarding the effects of body mass index on patient-reported outcomes and health-related quality of life is significantly lacking.

METHODS

Consecutive deep inferior epigastric perforator (DIEP) flap breast reconstruction patients prospectively completed BREAST-Q questionnaires preoperatively and at two points postoperatively. The first (postoperative time point A) and second (postoperative time point B) postoperative questionnaires were completed 1 month postoperatively and following breast revision, respectively. Postoperative flap and donor-site complications were recorded prospectively. BREAST-Q scores were compared at all time points and stratified by body mass index group (≤25, >25 to 29.9, 30 to 34.9, and ≥35 kg/m).

RESULTS

Between July of 2012 and August of 2016, 73 patients underwent 130 DIEP flap breast reconstructions. Breast satisfaction and psychosocial and sexual well-being scores increased significantly postoperatively. Chest and abdominal physical well-being scores returned to baseline levels by postoperative point B. Preoperatively, stratified by body mass index, breast satisfaction and psychosocial well-being scores were significantly lower among patients with body mass index of 35 or higher and of more than 30, respectively. After reconstruction, not only were breast satisfaction, psychosocial, and sexual well-being scores significantly improved in all body mass index groups versus baseline, but also between-body mass index group differences were no longer present. Outcome satisfaction, flap, and donor-site morbidity were similar irrespective of body mass index.

CONCLUSIONS

Patient-reported outcomes demonstrate significant improvements in breast satisfaction and psychosocial and sexual well-being among patients following DIEP flap reconstruction. Preoperative differences in quality-of-life scores were improved in patients with obesity (body mass index ≥30 kg/m).

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Problematic Eating Behaviors and Eating Disorders Associated with Bariatric Surgery

Bariatric surgery candidates often report problematic and/or eating disordered behaviors. For most patients, these eating behaviors improve after surgery. A subset, however, experience a recurrence or new onset of problematic eating behaviors as early as 2 months to 18 months after surgery, which can result in compromised weight loss/excessive weight regain. Those most at risk are individuals with comorbid psychopathology (ie, loss-of-control eating or depression) after surgery. For some, such problems are present before surgery. Therefore, it is critical to monitor patients closely after surgery so that appropriate psychiatric treatments can be provided if indicated.

Sexual Dysfunctions in Obese Women Before and After Bariatric Surgery

Background

Obesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women.

Material/Methods

60 obese women (mean initial BMI of 43.7±5.9 kg/m²; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m²). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m²; mean age of 36.4±10.7 years).

Results

Our findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold.

Conclusions

These findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.

Body mass index and health-related quality of life

OBJECTIVE

There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains.

METHODS

This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity.

RESULTS

A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7).

CONCLUSIONS

This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.

Health-Related Quality of Life, Anxiety, and Depression in Bariatric Surgery Candidates Compared to Patients from a Psychosomatic Inpatient Hospital

BACKGROUND AND AIM

Past research indicated high psychiatric comorbidity and poor health-related quality of life (HRQOL) in patients seeking surgical treatment for obesity. This study investigated if preoperative bariatric surgery patients perceive equally poor HRQOL and increased levels of anxiety and depression as mentally ill patients.

METHODS

The study included four groups: 192 bariatric surgery candidates (PRE, 71% women, BMI 48.35 ± 8.98 kg/m²), 96 psychotherapy inpatients with mental disorders (PSY, 77% women, BMI 27.12 ± 9.17 kg/m²), 103 postoperative bariatric surgery patients (POST, 78% women, BMI 30.38 ± 2.88 kg/m²), and a convenience sample of 96 non-clinical volunteers with pre-obesity or obesity grade 1 (CG, 52% women, BMI 29.22 ± 2.64 kg/m²). HRQOL was measured using the 12-item short form health survey (SF-12), and psychopathology was assessed with the hospital anxiety and depression scale (HADS).

RESULTS

The PRE group exhibited the lowest physical HRQOL, and the PSY group the lowest mental HRQOL. The highest mental/physical HRQOL was reported by the POST group and the CG, without significant differences between these two groups. While the PSY group scored higher on HADS-anxiety scale than the PRE group, neither group differed with regards to symptoms of depression. The lowest levels of HADS-depression were found in the POST group and the CG.

CONCLUSIONS

The present findings suggest that bariatric surgery candidates may suffer from equally high levels of depression as psychotherapy inpatients, but they perceive better mental well-being. Routine mental health evaluation should incorporate assessments for both psychopathology and HRQOL.

TRIAL REGISTRATION

DRKS00009901.

Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy

OBJECTIVE

The principal aim of the study was to investigate the effect of the sleeve gastrectomy (SG) in the quality of life (QoL) and pain in a population of morbidly obese patients.

METHODS

Seventy-two SG patients were assessed in this descriptive observational study, before the surgery and 6 months after that. We evaluated health-related QoL (Gastrointestinal Quality of Life Index [GIQLI]) and pain (spontaneous low back pain by Numerical Point Rate Scale [NPRS] and pressure pain thresholds [PPTs]).

RESULTS

The results of the analysis of variance (ANOVA) revealed significant improvements in nearly all of the subscales of GIQLI questionnaire after 6 months: gastrointestinal symptoms (P = .01), physical well-being (P < .001), social well-being (P = .03), and total GIQLI score (P < .001), but not for the emotional condition (P = .20). Patients also had improvements in spontaneous low back pain (P = .002), but not in the PPTs in all the body areas explored, including the cervical area, low back, and hands (P > .05).

CONCLUSION

Patients receiving SG improved their health-related QoL and low back pain 6 months after the intervention, but this improvement was not so important for pressure pain thresholds in different body areas.

Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study

OBJECTIVES

Studies exploring the impact of pre-surgery psychiatric status as a predictor of health related quality of life (QOL) after bariatric surgery have been limited to short-term follow-up and variable use of psychosocial measures. We examined the effect of pre-operative psychiatric factors on QOL and weight loss 2-years after surgery.

METHODS

156 patients participated in this prospective cohort study, the Toronto Bariatric Psychosocial Cohort Study, between 2010 and 2014. Patients were assessed pre-surgery for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and 2years post-surgery.

RESULTS

At 2-years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores as compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (p<0.001), younger age (p=0.005), and a history of a mood disorder as significant predictors of physical QOL. Only a history of a mood disorder (p=0.032) significantly predicted mental QOL (p=0.006). Pre-surgery weight (p<0.001) and a history of a mood disorder (p=0.047) were significant predictors of weight loss 2-years post-surgery.

CONCLUSIONS

Bariatric surgery had a sustained impact on physical QOL but not mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. Further research is needed to determine if these results are due to bariatric surgery candidate selection within this program.

Comparison Between Marital Satisfaction and Self-Esteem Before and After Bariatric Surgery in Patients With Obesity

Background

Obesity is one of the most common chronic diseases with important medical effects, as well as mental and social health problems. Bariatric surgery is one of the most effective treatments of morbid obesity.

Objectives

Because of the possible psychological changes, and its effects on weight loss after surgery, the current study aimed to compare marital satisfaction and self-confidence in patients with obesity before and after bariatric surgery in Rasoul-e-Akram hospital in 2013.

Materials and Methods

This prospective observational study was conducted on 69 candidates for bariatric surgery. Marital satisfaction and self-confidence were assessed before and six months after the surgery by Enrich marital satisfaction scale and Coopersmith self-esteem inventory. Descriptive statistics and T-tests were utilized to analyze data. Values of P ≤ 0.01 were considered statistically significant.

Results

Despite the improvement of sexual relationship, marital satisfaction scores significantly decreased from141.26 ± 12.75 to 139.42 ± 12.52 six months after the surgery (P = 0.002). Satisfaction in scales of conflict resolution and communication showed a descending pattern (P < 0.001). No significant difference was found between self-esteem before and after the surgery (P = 0.321).

Conclusions

Weight loss after bariatric surgery did not improve self-esteem and marital satisfaction six months post operatively; therefore, psychiatric assessment of patients before and after the surgery is crucial; since even if they are not associated with prognosis of the surgery, it is important to provide treatment for psychiatric problems. Prospective studies are recommended to assess post-operative changes of other psychological aspects.

Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms

Currently the effects of bariatric surgery are generally expressed in excess weight loss or comorbidity reduction. Therefore the aim of this review was to provide insight in the available prospective evidence regarding the short and long-term effects of bariatric surgery on Quality of Life (QoL) and a comparison with community norms. A systematic multi-database search was conducted for 'QoL' and 'Bariatric surgery'. Only prospective studies with QoL before and after bariatric surgery were included. The 'Quality Assessment Tool for Before-After Studies with No Control Group' was used to assess the methodological quality. Thirty-six studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. Ten different questionnaires were used to measure QoL. Follow-up ranged from 6 months to 10 years, sample sizes from 26 to 1276 and follow-up rates from 45 to 100%. A significant increase in QoL after bariatric surgery was found in all studies (P⩽0.05), however, mostly these outcomes stay below community norms. Only outcomes of the IWQoL, SF-36 and OWQoL show QoL outcomes that exceed community norms. The QoL is increased after bariatric surgery on both the short and long term. However, due to the heterogeneity of the studies and the generality of the questionnaires is it hard to make a distinction between different surgeries and difficult to see a relation with medical profit. Therefore, tailoring QoL measurements to the bariatric population is recommended as the focus of future studies.

The Psychosocial Burden of Obesity

Obesity is associated with several comorbidities, including cardiovascular disease, type 2 diabetes, sleep apnea, osteoarthritis, and several forms of cancer. Obesity and its comorbidities also come with a significant psychosocial burden, impacting numerous areas of psychosocial functioning. The evaluation of psychosocial functioning is an important part of the assessment and treatment planning for the patient with obesity. This article provides an overview of the psychosocial burden of obesity. The article also describes the psychological changes typically seen with weight loss. A particular focus is on the psychosocial functioning of individuals with extreme obesity who present for and undergo bariatric surgery.

Repressive coping, stigmatization, psychological distress, and quality of life among behavioral weight management participants

Repressive coping has been associated with elevated risk of disease and negative health outcomes in past studies. Although a prior study of healthy men found that repression was associated with lower body mass index (BMI), no study has examined repressive coping among obese individuals. This study examined the relationship of repressive coping with BMI and obesity-relevant psychosocial factors among 104 overweight and obese participants in a behavioral weight management program. Participants completed questionnaires assessing repressive coping, stigmatization, psychological distress, and quality of life. BMI was objectively measured. Repressors reported lower stigmatization, anxiety, and depression as well as higher emotional and weight-related quality of life. Repressors and non-repressors had equivalent BMI and reported similar impairment in physical quality of life, but stigmatization moderated the relationship between repressive coping and physical quality of life (b=0.31, p=0.039), reflecting better physical quality of life among non-repressors with lower stigmatization. Obese individuals who engage in repressive coping may tend to underreport psychological symptoms, social difficulties, and impairments in quality of life. Higher physical quality of life among non-repressors with lower stigmatization may reflect a combined influence of coping and social processes in physical quality of life among obese individuals.

Depression and postoperative complications: an overview

BACKGROUND

The interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality.

LITERATURE SEARCH

Several electronic data bases, including PubMed, were searched pairing "depression" with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer's disease.

REVIEW OF THE LITERATURE

The suppression of the immune system in depressive disorders may expose the patients to increased rates of postoperative infections and increased mortality from cancer. Depression is commonly associated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute postoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong predictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent risk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery after surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related quality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery bypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery events, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have an increased risk of depression. Postoperative depression may also be associated with less weight loss at one year and longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of functional outcome and patient's dissatisfaction, especially after revision surgery. General postoperative mortality is increased.

CONCLUSIONS

Depression is a frequent cause of morbidity in surgery patients suffering from a wide range of conditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments. Counseling interventions may be useful in ameliorating depression, but should be subject to clinical trials.

Quality of life as a mediator in the association between body mass index and negative emotionality in overweight and obese non-clinical sample

PURPOSE

The present study investigates the differences in physical health-related quality of life (HRQoL) among overweight and obese people, as well as the correlates of HRQoL in this population and the association between BMI, depression, anxiety, and potential mediating effects of HRQoL.

METHODS

The research was conducted on a sample of overweight and obese adults who visited their primary care physician. A total of 143 women and 130 men were enrolled in the study, 43% of the subjects were overweight, and 57% of the subjects were obese. The subjects ranged in age between 21 and 60 years. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, and HRQoL was evaluated using the Medical Outcome Study Short-Form 36.

RESULTS

The analysis of variance results showed that women in comparison to men have lower physical HRQoL (e.g. worst physical functioning, more bodily pain), and that severely obese patients have lower physical HRQoL in comparison to overweight ones. The regression analysis results indicated that some of the aspects of physical HRQoL (e.g. physical functioning, role limitations) mediate the relationship between BMI and depression only in women. The higher level of body mass decreased the physical HRQoL, which became a potential risk factor for the development of depressive symptoms.

CONCLUSIONS

The results from the present study show that a different pattern of functioning exists between men and women. It is important to identify the factors that can effectively motivate and stimulate obese people to change their lifestyle and to consider the differences in psychological functioning between women and men.

Psychological outcome 4 years after restrictive bariatric surgery

Extreme obesity is associated with severe psychiatric and somatic comorbidity and impairment of psychosocial functioning. Bariatric surgery is the most effective treatment not only with regard to weight loss but also with obesity-associated illnesses. Health-related psychological and psychosocial variables have been increasingly considered as important outcome variables of bariatric surgery. However, the long-term impact of bariatric surgery on psychological and psychosocial functioning is largely unclear. The aim of this study was to evaluate the relationship between the course of weight and psychological variables including depression, anxiety, health-related quality of life (HRQOL), and self-esteem up to 4 years after obesity surgery.By standardized questionnaires prior to (T1) and 1 year (T2), 2 years (T3), and 4 years (T4) after surgery, 148 patients (47 males (31.8 %), 101 females (68.2 %), mean age 38.8 ± 10.2 years) were assessed.On average, participants lost 24.6 % of their initial weight 1 year after surgery, 25.1 % after 2 years, and 22.3 % after 4 years. Statistical analysis revealed significant improvements in depressive symptoms, physical dimension of quality of life, and self-esteem with peak improvements 1 year after surgery. These improvements were largely maintained. Significant correlations between weight loss and improvements in depression, physical aspects of HRQOL (T2, T3, and T4), and self-esteem (T3) were observed.Corresponding to the considerable weight loss after bariatric surgery, important aspects of mental health improved significantly during the 4-year follow-up period. However, parallel to weight regain, psychological improvements showed a slow but not significant decline over time.

Factors associated with health-related quality of life among overweight and obese Korean women

Health-related quality of life (HRQOL) tends to be lower among individuals who are overweight and obese than those of normal weight, and women may be more vulnerable to lower HRQOL associated with obesity than men. Identifying factors associated with HRQOL may be crucial for improving HRQOL for overweight/obese women. We aimed to determine the factors associated with obesity-specific HRQOL among overweight/obese Korean women. A cross-sectional study was conducted with 125 women aged 20-64 years, who comprised a baseline sample in the Community-based Heart and Weight Management Trial. The data were collected from September 2010 to November 2011. The Weight Efficacy Lifestyle, Beck Depression Inventory-II, Interpersonal Social Evaluation List, and Impact of Weight on Quality of Life (IWQOL)-Lite scales were used to measure self-efficacy for weight control, depressive symptoms, social support, and HRQOL, respectively. Increased body mass index, lower self-efficacy for weight control, and higher levels of depressive symptoms were significantly associated with greater impairment in total IWQOL in the regression models. However, social support was not significantly associated with IWQOL. Along with weight loss strategies, other strategies for improving self-efficacy and alleviating depressive symptoms may be essential for improving HRQOL among overweight and obese women.

Sexual functioning and sex hormones in men who underwent bariatric surgery

BACKGROUND

The relationship between obesity and impairments in male sexual functioning is well documented. Relatively few studies have investigated changes in sexual functioning and sex hormones in men who achieve significant weight loss with bariatric surgery. The objective of this study was to assess changes in sexual functioning, sex hormones, and relevant psychosocial constructs in men who underwent bariatric surgery.

METHODS

A prospective cohort study of 32 men from the Longitudinal Assessment of Bariatric Surgery-2 (LABS) investigation who underwent a Roux-en-Y gastric bypass (median body mass index [25th percentile, 75th percentile] 45.1 [42.0, 52.2]) and completed assessments between 2006 and 2012. Bariatric surgery was performed by a LABS-certified surgeon. Sexual functioning was assessed by the International Index of Erectile Functioning (IIEF). Hormones were assessed by blood assay. Quality of life (QoL), body image, depressive symptoms and marital adjustment were assessed by questionnaire.

RESULTS

Men lost, on average, (95% confidence interval) 33.3% (36.1%, 30.5%) of initial weight at postoperative year 1, 33.6% (36.8%, 30.5%) at year 2, 31.0% (34.1%, 27.9%) at year 3, and 29.4% (32.7%, 26.2%) at year 4. Participants experienced significant increases in total testosterone (P<.001) and sex hormone binding globulin (SHBG) (P<.001) through postoperative year 4. Although men reported improvements in sexual functioning after surgery, these changes did not significantly differ from baseline, with the exception of overall satisfaction at postoperative year 3 (P = .008). Participants reported significant improvements in physical domains of health-related quality of life (HRQoL), all domains of weight-related QOL, and body image, but not in the mental health domains of HRQoL or relationship satisfaction.

CONCLUSIONS

Men who lost approximately one third of their weight after Roux-en-Y gastric bypass experienced significant increases in total testosterone and SHBG. They did not, however, report significant improvements in sexual functioning, relationship satisfaction, or mental health domains of HRQoL. This pattern of results differs from that of women who have undergone bariatric surgery, who reported almost uniform improvements in sexual functioning and psychosocial status.

Quality of life after laparoscopic adjustable gastric banding (LAP-BAND): APEX interim 3-year analysis

BACKGROUND

Obesity is often associated with diminished health-related quality of life (HRQOL), but significant gains in HRQOL have been observed after bariatric surgery. Laparoscopic adjustable gastric banding has been established as a safe, effective treatment to reduce weight in patients with obesity. This report summarizes interim 3-year changes in HRQOL and body weight, as well as safety postimplantation of the LAP-BAND AP (LBAP) system.

METHODS

The LAP-BAND AP EXperience (APEX) trial, an ongoing, prospective, 5-year, open-label study, assessed changes in HRQOL (Obesity and Weight-Loss Quality of Life [OWLQOL] questionnaire) and body weight, and safety after placement of LBAP. This interim analysis represents patients with evaluable OWLQOL data at baseline and at 3 years (n = 183).

RESULTS

The OWLQOL total score and individual scores significantly improved within 6 months post-LBAP and continued to improve during a 3 year period (P < 0.0001, both). Total score improved from 71.0 to 34.0 (mean improvement from baseline, 52%; range, 18%-65%); mean change in individual scores was -2.2 (range, -0.7 to -3.0). Percent weight loss was maintained through 3 years (19.4%; n = 174). Improvement in OWLQOL was associated with percent weight loss at 3 years (r = -0.5407; P < 0.0001). Revisions and explants were performed in 7 (3.8%) and 20 (10.9%) out of 183 patients, respectively.

CONCLUSIONS

Meaningful improvement in quality of life occurred through clinically significant weight loss after LBAP placement, extending throughout the 3 years of this analysis.

The effects of weight loss after bariatric surgery on health-related quality of life and depression

BACKGROUND

In severe obesity, impairments in health-related quality of life (HRQoL) and dysphoric mood are reported. This is a post-surgery analysis of the relationship between HRQoL and depressive symptoms, and weight change after four different types of bariatric procedures.

METHODS

A total of 105 consented patients completed the Short-Form-36 Health Survey (SF-36), the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and the Beck Depression Inventory (BDI) before and 25 months after surgery. Analysis of variance or Kruskal-Wallis test evaluated changes.

RESULTS

Patients with Roux-en Y gastric bypass (46 patients), decreased body mass indexes (BMIs; kg m(-)(2)) 47-31 kg m(-)(2) (P<0.0001); biliopancreatic diversion with duodenal switch (18 patients), decreased BMIs 57-30 kg m(-)(2) (P<0.0001); adjustable gastric banding (18 patients), decreased BMIs 45-38 kg m(-)(2) (P<0.0001); and sleeve gastrectomies (23 patients), decreased BMIs 58 42 kg m(-)(2) (P<0.0001). The excess percentage BMI loss was 69, 89, 36 and 53 kg m(-)(2), respectively (P<0.0001). Before surgery, the SF-36 differences were significant regarding bodily pain (P=0.008) and social functioning (P=0.01). After surgery, physical function (P=0.03), general health (P=0.05) and physical component (P=0.03) were different. IWQOL-Lite recorded no differences until after surgery: physical function (P=0.003), sexual life (P=0.04) and public distress (P=0.003). BDI scores were not different for the four groups at baseline. All improved with surgery, 10.6-4.4 (P=0.0001).

CONCLUSIONS

HRQoL and depressive symptoms significantly improvement after surgery. These improvements do not have a differential effect over the wide range of weight change.Nutrition & Diabetes (2014) 4, e132; doi:10.1038/nutd.2014.29; published online 1 September 2014.

Predictors of changes in physical, psychosocial, sexual quality of life, and comfort with food after obesity surgery: a 12-month follow-up study

PURPOSE

Although obesity surgery provides significant postoperative improvement in quality of life (QoL), it is still unclear which factors might predict improvement in QoL after surgery. We aimed to determine which factors might predict changes in physical, psychosocial, sexual QoL, and comfort with food 12 months after surgery, by putting to the test a QoL model based on Wilson and Cleary's model.

METHODS

We included 126 obese patients (48.4% had gastric banding, 34.1% had sleeve gastrectomy, and 17.5% had gastric bypass). At baseline, we assessed QoL (Quality of Life, Obesity and Dietetics rating scale), BMI, depression (Beck Depression Inventory), and binge eating (Bulimic Investigatory Test, Edinburgh). At 12 months, we assessed QoL and BMI. To determine the predictors for changes in each QoL dimension after surgery, we used linear mixed models adjusted for preoperative age, BMI, time, type of surgery, preoperative binge eating severity, and preoperative depression severity.

RESULTS

After 12 months, we found significant improvement in physical, psychosocial, sexual QoL, but not in comfort with food. Increased weight loss was associated with better improvement in physical and psychosocial QoL. Higher preoperative depression severity predicted poorer improvement in physical, psychosocial, and sexual QoL. Higher preoperative binge eating severity predicted poorer improvement in psychosocial, sexual QoL, and comfort with food.

CONCLUSIONS

In addition to weight loss, preoperative levels of binge eating and depression should be considered as important predictors for QoL changes after bariatric surgery. Screening and treatment for preoperative depression and binge eating might improve QoL after bariatric surgery.

Interdisciplinary European guidelines on metabolic and bariatric surgery

In 2012, an expert panel composed of presidents of each of the societies, the European Chapter of the International Federation for the Surgery of Obesity (IFSO-EC), and of the European Association for the Study of Obesity (EASO), as well as of the chair of EASO Obesity Management Task Force (EASO OMTF) and other key representatives from IFSO-EC and EASO, devoted the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery in advance of the 2013 European Congress on Obesity held in Liverpool. This meeting was prompted by the extraordinary advancement made in the field of metabolic and bariatric surgery during the past decade. It was agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced by focusing in particular on the evidence gathered in relation to the effects on diabetes and the changes in the recommendations of patient eligibility criteria. The expert panel allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

The impact of a primary care-based weight loss intervention on the quality of life

OBJECTIVE

This study investigated changes in the quality of life of men and women who participated in a primary care-based weight loss intervention program.

METHODS

Participants were enrolled in a 2-year randomized clinical trial (POWER-UP) conducted at the University of Pennsylvania and in six affiliated primary care practices. Inclusion criteria included the presence of obesity (body mass index of 30-50 kg m(-2)) and at least two components of the metabolic syndrome.

MAIN OUTCOME MEASURES

Quality of life was assessed by three measures: the Short Form Health Survey (SF-12); the Impact of Weight on Quality of Life-Lite; and the EuroQol-5D.

RESULTS

Six months after the onset of treatment, and with a mean weight loss of 3.9 ± 0.3 kg, participants reported significant improvements on all measures of interest with the exception of the Mental Component Score of the SF-12. These changes remained significantly improved from baseline to month 24, with the exception of the EuroQol-5D. Many of these improvements were correlated with the magnitude of weight loss and, for the most part, were consistent across gender and ethnic group.

CONCLUSIONS

Individuals with obesity and components of the metabolic syndrome reported significant improvements in most domains of the quality of life with a modest weight loss of 3.7% of initial weight, which was achieved within the first 6 months of treatment. The majority of these improvements were maintained at month 24, when participants had lost 3.0% of their weight.

Changes in quality of life after short and long term follow-up of Roux-en-Y gastric bypass for morbid obesity

CONTEXT

It is unclear whether health-related quality of life (HRQL) is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB). Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up.

METHODS

We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery.

RESULTS

The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions.

CONCLUSIONS

RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality) in the short-term and two SF-36 domains (general health perceptions and vitality) in the long-term.

Additive Effects of Anxiety and Depression on Body Mass Index among Blacks: Role of Ethnicity and Gender

BACKGROUND

Most studies on mental health associates of obesity have focused on depression and less is known about the role of anxiety in obesity.

OBJECTIVES

This study compared the additive effects of General Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) on Body Mass Index (BMI) across sub-populations of Blacks based on the intersection of ethnicity and gender.

METHODS

Data came from the National Survey of American Life (NSAL), 2001 - 2003. The participants consisted of 3,570 African Americans and 1,621 Caribbean Blacks. Twelve-month MDD and GAD were determined using the World Mental Health Composite International Diagnostic Interview (CIDI). Levels of BMI were categorized based on being equal to or larger than 25, 30, 35, and 40 kg/m(2). We fitted linear regression models specific for our groups, which were defined based on the intersection of ethnicity and gender. Additionally, age, education, marital status, employment, and region were controlled.

RESULTS

Among Caribbean Black men and African American women, lifetime GAD, but not MDD, was associated with high BMI. Among Caribbean Black women, lifetime MDD, but not GAD, was associated with high BMI.

CONCLUSIONS

Intersection of ethnicity and gender may determine how anxiety and depression are associated with BMI among Blacks. Sub-populations of Blacks (e.g. based on ethnicity and gender) may have specific mental health determinants or consequences of obesity. Future research should investigate how and why the additive effects of anxiety and depression on obesity vary across ethnic and gender groups of Blacks.

The association between adiposity, mental well-being, and quality of life in extreme obesity

OBJECTIVES

To explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement.

METHODS

The sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life.

RESULTS

The sample was predominantly female (74.8%) with mean BMI 47.0±7.9 kg/m2. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI -2.86 - -1.00, p<0.001), 1.62 in self-esteem (95% CI -2.67 - -0.57, p<0.05), 2.69 in public distress (95% CI -3.75 - -1.62, p<0.001), 1.33 in work (95% CI -2.63 - -0.02, p<0.05), and 1.79 in total IWQOL-Lite scores (95% CI -2.65 - -0.93, p<0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.47-8.05), and performing usual activities (OR = 2.45, 95% CI 1.10-5.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high.

CONCLUSIONS

We identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental well-being into multi-disciplinary weight management interventions.

Psychological predictors of mental health and health-related quality of life after bariatric surgery: a review of the recent research

BACKGROUND

Improvement of mental health and health-related quality of life (HRQOL) is an important success criterion for bariatric surgery. In general, mental health and HRQOL improve after surgery, but some patients experience negative psychological reactions postoperatively and the influence of pre-surgical psychological factors on mental wellbeing after surgery is unclear. The aim of the current article therefore is to review recent research investigating psychological predictors of mental health and HRQOL outcome.

METHODS

We searched PubMed, PsycInfo and Web of Science for studies investigating psychological predictors of either mental health or HRQOL after bariatric surgery. Original prospective studies published between 2003 and 2012 with a sample size >30 and a minimum of 1 year follow-up were included.

RESULTS

Only 10 eligible studies were identified. The findings suggest that preoperative psychological factors including psychiatric symptoms, body image and self-esteem may be important for mental health postoperatively. Predictors of postoperative HRQOL seem to include personality, severe psychiatric disorder at baseline and improvement of depressive symptoms. In addition, psychiatric symptoms that persist after surgery and inappropriate eating behaviour postoperatively are likely to contribute to poor health-related quality of life outcome.

CONCLUSION

Certain psychological factors appear to be important for mental health and HRQOL after bariatric surgery. However, the literature is extremely sparse and further research is highly needed.

The impact of weight loss on depression status in obese individuals subjected to intragastric balloon treatment

BACKGROUND

Although depression is considered to be significantly related to morbid obesity disorder, no information exists on the evolution of depression status after weight loss, in particular when an intragastric balloon is used. This prospective 6-month study examines both the effect on depression status and the relation of weight loss to depression in morbidly obese patients treated by intragastric balloon.

METHODS

One hundred consecutive females fulfilling criteria for balloon treatment were assessed for depression and divided into two groups (65 depressed, 35 non-depressed). Obesity-related parameters were comparable.

RESULTS

During the treatment period, the depression status of the mildly, moderately, and severely depressed patients improved from 40, 32.3, and 27.7 % to 20, 7.7, and 1.5 %, respectively, with 70.8 % finally exhibiting no depression at all. During the same period, body weight, BMI, body fat, and excess weight loss (EWL) were comparable between all groups, the range of BMI affecting neither the depression score nor the reduction of obesity parameters. However, there was a significant [percentage of EWL >30] weight loss difference in favor of those who were less severely depressed initially.

CONCLUSION

The degree of weight loss observed in obese depressed females-being comparable to that achieved by non-depressed females-after intragastric balloon insertion was found to positively affect their depression status.

The improvement of quality of life in patients treated with bariatric surgery in Korea

PURPOSE

Bariatric surgery is considered an efficient treatment for severe obesity, but postoperative complications and psychosocial problems may impact quality of life (QoL). Although QoL is an important aspect of bariatric surgery, few studies have evaluated the changes in QoL. We examined whether severely obese patients who had undergone bariatric surgery had better QoL compared with severely obese adults who had not undergone bariatric surgery in Korea.

METHODS

Data were obtained from 78 participants in two groups; bariatric surgery group (n = 53) and nonsurgery group (n = 25). EuroQoL-5D (EQ-5D), the impact of weight on quality of life-lite (IWQoL-lite) and the obesity-related psychosocial problem scale (OP-scale) were used to assess the improvement of QoL.

RESULTS

A total of 78 patients completed the QoL forms as part of their surgical consultation. In the EQ-5D, the changes of EQ-5D 3 level and EQ-5D visual analogue scale in the surgery group was 0.174 and 24.6 versus 0.017 and 17.8 in the nonsurgery group (P = 0.197 and P = 0.179). The changes of IWQoL-lite and OP-scale were significantly improved after bariatric surgery. In the IWQoL-lite, the mean changes in the surgery group was 33.4 versus 14.3 points in the nonsurgery group (P = 0.000). In the OP-scale, the mean changes in the surgery group patients scored 39.3 versus 9.0 points in the nonsurgery group (P = 0.000).

CONCLUSION

We demonstrated significant improvement of QoL observed after bariatric surgery compared to nonsurgical procedure. The results of this comparative study favor bariatric surgery for the treatment of severe obesity.

Associations between physical activity and mental health among bariatric surgical candidates

OBJECTIVE

To examine associations between physical activity (PA) and mental health among adults undergoing bariatric surgery.

METHODS

Cross sectional analysis was conducted on pre-operative data of 850 adults with ≥class 2 obesity. PA was measured with a step activity monitor; mean daily steps, active minutes, and high-cadence minutes (proxy for moderate-vigorous intensity PA) were determined. Mental health functioning, depressive symptoms and treatment for depression or anxiety were measured with the medical outcomes study 36-item short form, Beck depression inventory, and a study-specific questionnaire, respectively. Logistic regression analyses tested associations between PA and mental health indicators, controlling for potential confounders. Receiver operative characteristic analysis determined PA thresholds that best differentiated odds of each mental health indicator.

RESULTS

Each PA parameter was significantly (p<.05) associated with a decreased odds of depressive symptoms and/or treatment for depression or anxiety, but not with impaired mental health functioning. After controlling for sociodemographics and physical health, only associations with treatment for depression and anxiety remained statistically significant. PA thresholds that best differentiated those who had vs. had not recently received treatment for depression or anxiety were <191 active minutes/day, <4750 steps/day, and <8 high-cadence minutes/day. Utilizing high-cadence minutes, compared to active minutes or steps, yielded the highest classification accuracy.

CONCLUSION

Adults undergoing bariatric surgery who meet relatively low thresholds of PA (e.g., ≥8 high-cadence minutes/day, representative of approximately 1h/week of moderate-vigorous intensity PA) are less likely to have recently received treatment for depression or anxiety compared to less active counterparts.

Changes in health-related quality of life in people with morbid obesity attending a learning and mastery course. A longitudinal study with 12-months follow-up

BACKGROUND

Severe obesity is a complex condition that is associated with a wide range of serious health complications and reduced health-related quality of life (HRQoL). In addition to physiological factors, activity and participation, environmental factors, and personal factors are related to an individual's overall quality of life HRQoL. In Norway, a course based on cognitive behavioral principles is offered to people seeking medical treatment for weight management. The aim is to assist participants to achieve a healthier lifestyle and thereby improve their HRQoL. We therefore investigated changes in HRQoL in participants after they attended this learning and mastery course, and explored how well sociodemographic variables, paid work, social support, personal factors, and surgery predicted HRQoL at 12-month follow-up.

METHODS

A single-group longitudinal study was conducted. Data were collected by self-reported questionnaires. This article reports on those who had completed the questionnaire at the 12-month (n = 69) follow-up. HRQoL was assessed with the EQ-5D. Other standardized instruments measured employment, social support, self-efficacy, and surgery.

RESULTS

At the 12-month follow-up, participants scored higher on all dimensions of the EQ-5D and on the EQ-VAS. Generalized linear model showed that having paid work, and social support were statistically significant predictors of HRQoL at the 12-month follow-up. Sex, self-efficacy, and surgery were not statistically significant associated with HRQoL.

CONCLUSIONS

Participation in paid work, and receiving social support from persons with whom they had a close relationship were strongly related to HRQoL in obese people 12 months after participating in a learning and mastery course.

TRIAL REGISTRATION

The study is registered in Clinical Trials: NCT01336725.

Understanding the relationship between weight loss, emotional well-being and health-related quality of life in patients attending a specialist obesity weight management service

This study explored predictors of clinically meaningful improvement in health-related quality of life (HRQOL) among obese patients completing a specialist weight management programme. One hundred and ninety-nine adults aged from 20-88 with a BMI >30 with comorbidities or BMI>35 with/without comorbidities were sampled. The results suggested that both weight loss and changes in depression were significant predictors of HRQOL improvement. However, predictors differed between weight loss groups. Clinically meaningful improvement in HRQOL was found to be due to weight loss when participants had lost 5 kg or more in weight. In contrast, among individuals who lost 0.1-4.9 kg, improvement in HRQOL was accounted for by positive changes in depression scores.

Impact of eating disorders and psychological distress on the quality of life of obese people

OBJECTIVE

Quality of life (QoL) is impaired in obesity, but the roles of eating behavior and psychological distress need to be more documented.

METHODS

One hundred thirty consecutive obese patients seeking medical care filled out questionnaires evaluating QoL, the presence of an eating disorder (ED), levels of anxiety and depression, and perception of body image.

RESULTS

Global QoL was poor in 16.4% and intermediate in 61.8% of the patients. EDs were present in 58% of patients who were more (P = 0.05) overweight; 24.2% of patients had binging. EDs impaired significantly the global and specific dimensions of QoL; binging impaired physical and sexual QoLs (both P < 0.02). Anxiety and depression were found in 73.6% and 50.4% of patients, respectively; depression was more frequent in women (P = 0.007) and in patients with EDs. Anxiety and/or depression impaired global (P < 0.001) and specific dimensions of QoL. Body shape concern was marked in 86.4% of women and associated with poor global (P < 0.001) and specific QoL, and with anxiety and depression.

CONCLUSION

The impairment of QoL in obese patients is increased by the presence of an ED, anxiety, and/or depression and marked body shape concern. These psychological factors should be assessed more carefully and taken into account in global strategies aiming to improve the well-being of obese patients.

Psychological assessments of bariatric surgery patients. Development, reliability, and exploratory factor analysis of the PsyBari

BACKGROUND

Bariatric surgery patients are required to receive psychological clearance before they are eligible for surgery. In spite of this, there are no standard assessment practices or tests designed specifically for these evaluations.

OBJECTIVE

The objective of this study is to determine the reliability and construct validity of the PsyBari, a psychological test designed for bariatric surgery patients.

METHODS

The PsyBari was administered to 752 patients. Internal consistency reliability and exploratory factor analyses were conducted.

RESULTS

Items with high percentages of missing data, low communalities, and low item loadings were identified and deleted. Cronbach's α = 0.930 (0.940 for males and 0.927 for females). Six factors were obtained for each gender: for females, awareness of eating habits, early life problems due to weight, dysphoric feelings about weight, weight-related impairment, surgical anxiety, and guilty feelings related to eating; for males, physical impairment with depression, awareness of eating habits, early life problems due to weight, interpersonal support with anxiety about weight, anger, and guilty feelings about eating habits.

CONCLUSIONS

Results indicate that there are unique psychometric parameters when constructing tests for bariatric surgery patients. The PsyBari has good overall reliability, although two of the 11 subscales have poor reliability. Factor analyses revealed six factors for each gender. Some factors were common for both genders, some were unique for each gender, and some consisted of mixed constructs.

Long-term outcome after laparoscopic adjustable gastric banding for morbid obesity

This study was performed to determine the long-term consequences of laparoscopic gastric banding on weight loss, body image, and life quality in morbidly obese patients. After a minimum follow-up of 9 years (mean follow-up 10 years; range 9-12 years) several questionnaires concerning weight loss, body image, and life quality were mailed to 180 morbidly obese patients following laparoscopic adjustable gastric banding. One hundred and twelve (62%) patients (92 females, 20 males) completed and returned the questionnaires. Of the entire sample, 73 (64.9%) patients still had the first band, 17 (15.3%) a second band, and in 22 (19.8%) probands the band had been removed for various reasons. Average weight loss, calculated as change in body mass index, was 13.9 kg/m². Average excess weight loss (EWL) was 30.6%. A total of 10% patients accounted for >50% of EWL. Half of the probands were completely satisfied with their weight loss and about half had reached their planned weight. Lowest post-operative weight was reached at different times, in nearly half of the probands after 2 years, in one-fourth after 4-5 years, and in about 20% at a later time. More than 90% of the probands experienced longer interruptions in weight loss; about half knew why. The findings indicate that overall quality of life was rated good to excellent by two-thirds of the probands, and fair to poor by one-third. A close correlation was seen between extent of weight loss and quality of life and body image. Despite some limitations, laparoscopic adjustable gastric banding is an effective and safe long-term surgical treatment for a majority of morbidly obese individuals, resulting in long-term weight loss and health-related quality of life. However, there is also a minority of morbidly obese subjects who do not benefit enough from this kind of bariatric surgery. Future research should investigate what kind of bariatric surgery is best for the particular obese individual in order to minimize unsatisfying post-operative results.

Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss

BACKGROUND

This retrospective study evaluated long-term weight loss, resolution of comorbidities, quality of life (QoL), and food tolerance after laparoscopic sleeve gastrectomy (LSG).

METHODS

Between January 2003 and July 2008, 102 patients underwent LSG as a sole bariatric operation. A retrospective review of a prospectively collected database was performed. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. Quality of life was measured using Medical Outcomes Survey Short Form 36 (SF-36) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were sent to all patients. The food tolerance score (FTS) was determined and compared with that of nonobese subjects.

RESULTS

A total of 83 patients (81.4%) were eligible for follow-up evaluation. Their mean initial body mass index (BMI) was 39.3 kg/m(2). No major complications occurred. At a median follow-up point of 49 months (range, 17-80 months), the mean %EWL was 72.3% ± 29.3%. For the 23 patients who reached the 6-year follow-up point, the mean %EWL was 55.9% ± 25.55%. The mean BAROS score was 6.5 ± 2.1, and a "good" to "excellent" score was observed for 75 patients (90.4%). In the comparison of patients with a %EWL greater than 50% and those with a %EWL of 50% or less, the SF-36 scores were statistically different only for "physical functioning" and "general health perception." The mean FTS was 23.8, and 95.2% of the patients described their food tolerance as acceptable to excellent.

CONCLUSION

Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure, although a tendency for weight regain is noted after 5 years of follow-up evaluation. Resolution of comorbidity is comparable with that reported in the literature. The LSG procedure results in good to excellent health-related QoL. Food tolerance is lower for patients after LSG than for nonobese patients who had no surgery, but 95.2% described food tolerance as acceptable to excellent.