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De Luca A, Delaye JB, Fauchier G, Bourbao-Tournois C, Champion H, Bourdon G, Dupont J, Froment P, Dufour D, Ducluzeau PH. 3-Month Post-Operative Increase in FGF21 is Predictive of One-Year Weight Loss After Bariatric Surgery. Obes Surg 2023; 33:2468-2474. [PMID: 37391682 DOI: 10.1007/s11695-023-06702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE The association between bariatric surgery outcome and blood levels of fibroblast growth factor 21 (FGF21) remains controversial. Many patients displayed stable or decreased FGF21 one year after bariatric surgery. Nevertheless, there is often an early increase FGF21 concentration in the post-surgery period. The aim of this study was to investigate the relationship between 3-month FGF21 response and percentage total weight loss at one year after bariatric surgery. MATERIALS AND METHODS In this prospective monocentric study, a total of 144 patients with obesity grade 2-3 were included; 61% of them underwent a sleeve gastrectomy and 39% a Roux-en-Y gastric bypass. Data analysis was carried out to determine the relation between 3-month plasma FGF21 response and weight loss one year after bariatric surgery. Multiple adjustments were done including degree of weight loss after 3 months. RESULTS FGF21 significantly increased between baseline and Month 3 (n = 144, p < 10-3), then decreased between Month 3 and Month 6 (n = 142, p = 0.047) and was not different from baseline at Month 12 (n = 142, p = 0.86). The 3-month-FGF21 response adjusted to body weight loss was not different between types of bariatric surgery. The 3-month-FGF21 response was associated to body weight loss at Month 6 (r = -0.19, p = 0.02) and Month 12 (r = -0.34, p < 10-4). After multiple regression analysis, only Month 12 body weight loss remained associated to 3-month FGF21 response (r = -0.3, p = 0.02). CONCLUSION This study showed that the magnitude of changes in FGF21 at 3 months after bariatric surgery emerged as an independent predictor of one-year body weight loss irrespective of the type of surgery.
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Affiliation(s)
- Arnaud De Luca
- Unité d'endocrinologie-Diabétologie-Nutrition, CHRU de Tours, 37044, Tours, France
- INSERM UMR 1069, Nutrition, Croissance Et Cancer, 37000, Tours, France
| | - Jean-Baptiste Delaye
- Laboratoire de Biochimie Et de Biologie Moléculaire, CHRU de Tours, 37044, Tours, France
| | - Grégoire Fauchier
- Unité d'endocrinologie-Diabétologie-Nutrition, CHRU de Tours, 37044, Tours, France
- INRAE, UMR 85 Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
| | | | - Hélène Champion
- Unité d'endocrinologie-Diabétologie-Nutrition, CHRU de Tours, 37044, Tours, France
| | - Guillaume Bourdon
- INRAE, UMR 85 Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
| | - Joëlle Dupont
- INRAE, UMR 85 Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
| | - Pascal Froment
- INRAE, UMR 85 Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
| | - Diane Dufour
- Laboratoire de Biochimie Et de Biologie Moléculaire, CHRU de Tours, 37044, Tours, France
| | - Pierre-Henri Ducluzeau
- Unité d'endocrinologie-Diabétologie-Nutrition, CHRU de Tours, 37044, Tours, France
- INRAE, UMR 85 Physiologie de La Reproduction Et Des Comportements, 37380, Nouzilly, France
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Brunault P, Bourbao-Tournois C, Ballon N, de Luca A. Psychiatric, psychological and addiction management in obesity surgery: Early identification for better support. J Visc Surg 2023; 160:S22-S29. [PMID: 36725454 DOI: 10.1016/j.jviscsurg.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although bariatric surgery results in a significant weight reduction and an improvement in the quality of life in most people who undergo surgery, there are inter-individual differences in terms of postoperative results. Psychological, psychiatric and addictive disorders contribute substantially to these difficulties. Between 20% and 50% of bariatric surgery candidates have a current psychiatric/addictive disorder and approximately 30-75% have a history of a psychiatric/addictive disorder within their lifetime. Surgery is accompanied in the short-term by an improvement in depressive symptoms and binge eating, but these symptoms tend to increase again beyond the 3rd postoperative year. Over the long-term, only the improvement in depression remains durable, whilepostoperative anxiety and disordered eating symptoms do not differ significantly from the preoperative levels. There is a two to four fold increased risk of post-surgical suicide and suicide attempts (from the 1st postoperative year onward), as well as an increased risk of alcohol-abuse (beyond two years after surgery). Psychological support must therefore continue long-term. Several psychotherapeutic and pharmacological treatments have demonstrated their effectiveness in improving the postoperative prognosis of patients with psychological/psychiatric disorders. The early integration of psychological/psychiatric/addiction evaluation and support into multidisciplinary management makes it easier to identify these difficulties and to optimize the postoperative prognosis, both in terms of weight and quality of life. Prior to surgery, patients should be systematically evaluated by a psychologist or psychiatrist in order to identify and to manage disorders that could negatively impact the postoperative prognosis. After surgery, this assessment and support can be carried out in a programmed and systematic way for those patients who were identified preoperatively as the most vulnerable, but support can also be offered during follow-up in the event of specific symptoms (i.e., loss of control over food intake, failure in terms of weight or quality of life, suicidal ideation, loss of control over alcohol use, significant depression or anxiety symptoms).
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Affiliation(s)
- P Brunault
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Université de Tours, QualiPsy, EE 1901, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France.
| | - C Bourbao-Tournois
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; CHRU de Tours, Service de Chirurgie Digestive et Endocrinienne, Tours, France
| | - N Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France
| | - A de Luca
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; Inserm U1069, Université de Tours, Tours, France; CHRU de Tours, Unité Mobile de Nutrition, Tours, France
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El Archi S, Brunault P, De Luca A, Cortese S, Hankard R, Bourbao-Tournois C, Ballon N, Réveillère C, Barrault S. Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates? Front Psychol 2021; 12:745857. [PMID: 34867628 PMCID: PMC8641657 DOI: 10.3389/fpsyg.2021.745857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Addictive-like eating and attention-deficit/hyperactivity disorder (ADHD) are both common among persons seeking treatment for severe obesity. Given that ADHD and addictive-like eating, especially binge eating (BE) and food addiction (FA), are both strongly associated with personality dimensions and emotion dysregulation, it is possible emotional and personality characteristics contribute to the link between addictive-like eating behaviors and ADHD in people with severe obesity. This study aimed to investigate the psychological factors associated with BE and FA in bariatric surgery candidates, and to explore the mediational role of emotional factors (emotion dysregulation and alexithymia) and personality dimensions in the association between ADHD and BE. Method: Two hundred and eighty-two (n = 282) bariatric surgery candidates were recruited during the systematic preoperative psychiatric assessment (University Hospital of Tours, France). We assessed significant BE (Binge Eating Scale), probable adult ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (Yale Food Addiction Scale 2.0, YFAS 2.0), emotion dysregulation (Difficulties in Emotion Regulation Scale-16), alexithymia (Toronto Alexithymia Scale-20) and personality dimensions (Big Five Inventory). Mediation analyses were performed using the PROCESS macro for IBM SPSS Statistics 22. Results: Prevalence of probable adult ADHD, significant BE and FA were 8.2, 19.1, and 26.6%, respectively. Participants who screened positive for addictive-like eating showed higher prevalence of probable adult ADHD, as well as higher scores on adult and childhood ADHD symptoms. They also reported lower conscientiousness, but higher emotion dysregulation, higher alexithymia, and higher neuroticism. Only BE (as opposed to FA) was also associated with lower scores on agreeableness and openness. Analysis of the association between adult ADHD and BE suggests that emotion dysregulation, conscientiousness, agreeableness, and neuroticism are total mediators and alexithymia a partial mediator. Conclusion: Our findings suggest a significant association between ADHD and addictive-like eating among bariatric surgery candidates, and also suggest a significant role of emotion dysregulation and personality dimensions in this association. For individuals with ADHD and obesity, eating may be a way to cope with negative emotions, potentially increasing the risk for addictive-like eating behavior.
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Affiliation(s)
| | - Paul Brunault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | - Arnaud De Luca
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | - Samuele Cortese
- Academic Unit of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Régis Hankard
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | | | - Nicolas Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | | | - Servane Barrault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Centre de Soins d'Accompagnement et de Prévention en Addictologie d'Indre-et-Loire (CSAPA-37), Tours, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France
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Mégier C, Bourbao-Tournois C, Perrotin F, Merle P, Ouaissi M, Diguisto C. Long-term evaluation of the impact of delivery modalities on anal continence in women with Crohn's disease. J Visc Surg 2021; 159:353-361. [PMID: 34799288 DOI: 10.1016/j.jviscsurg.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Crohn's disease (CD) and sphincter injury during childbirth are two risk factors for anal incontinence (AI). The long-term risk of developing AI in women with CD after childbirth has never been studied. GOAL The main objective of the study is to assess the risk of developing severe AI after childbirth in women with CD. METHODS A retrospective study was performed in women with CD who gave birth in a French "Level 3" maternity hospital between 2000 and 2015. The primary endpoint was severe AI as defined by a Wexner score≥9 or a St. Mark's score≥9, at least five years after childbirth. The association between delivery route and occurrence of severe AI was assessed by univariate and multivariate analyses. RESULTS Forty-six women were included, 32 of whom were delivered vaginally and 14 by Caesarean section. Thirty-one percent of the women had severe AI according to the Wexner score, and 41% according to the St. Mark's score. Two factors were associated with severe AI: vaginal delivery and the occurrence of an obstetric perineal injury: (crude OR=8.89, 95% (CI: 1.03-76.57) and crude OR=4.16, 95% (CI: 1.06-16.27) respectively for AI defined by the Wexner score, and crude OR=6.8, 95% (CI: 1.30-35.41) and crude OR=4.3, 95% (CI: 1.23-15.2) for AI defined by the St. Mark's score). After adjusting for confounding factors, only vaginal delivery was associated with severe AI (adjusted OR=22.86, 95% CI: 1.52-931.28 for a Wexner score≥9 and adjusted OR=16. 11 (95% CI: 1.43-533.26) for a St Mark score≥9). CONCLUSION Vaginal birth was associated with the development of severe long-term AI in women with CD.
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Affiliation(s)
- C Mégier
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France.
| | - C Bourbao-Tournois
- François Rabelais University, Tours, France; Department of Digestive, Oncological, Endocrine, Hepatobiliary and Hepatic Transplantation Surgery. Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - F Perrotin
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France
| | - P Merle
- François Rabelais University, Tours, France; Department of Gastroenterology, Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - M Ouaissi
- François Rabelais University, Tours, France; Department of Digestive, Oncological, Endocrine, Hepatobiliary and Hepatic Transplantation Surgery. Trousseau Hospital, Regional University Hospital of Tours, Tours, France
| | - C Diguisto
- Maternity Olympe de Gouges, Regional University Hospital of Tours, 2, Boulevard Tonnellé, 37044 Tours cedex 1, France; François Rabelais University, Tours, France
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Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois C, Laribi S, Flament T, Ferreira-Maldent N, Bruyère F, Stefic K, Gaudy-Graffin C, Grammatico-Guillon L, Bernard L. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2020; 27:258-263. [PMID: 33031948 PMCID: PMC7534895 DOI: 10.1016/j.cmi.2020.09.052] [Citation(s) in RCA: 422] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Abstract
Objectives To describe the clinical evolution and predictors of symptom persistence during 2 months' follow-up in adults with noncritical coronavirus disease 2019 (COVID-19). Methods We performed descriptive clinical follow-up (day (D) 7, D30 and D60) of 150 patients with noncritical COVID-19 confirmed by real-time reverse transcriptase PCR at Tours University Hospital from 17 March to 3 June 2020, including demographic, clinical and laboratory data collected from the electronic medical records and by phone call. Persisting symptoms were defined by the presence at D30 or D60 of at least one of the following: weight loss ≥5%, severe dyspnoea or asthenia, chest pain, palpitations, anosmia/ageusia, headache, cutaneous signs, arthralgia, myalgia, digestive disorders, fever or sick leave. Results At D30, 68% (103/150) of patients had at least one symptom; and at D60, 66% (86/130) had symptoms, mainly anosmia/ageusia: 59% (89/150) at symptom onset, 28% (40/150) at D30 and 23% (29/130) at D60. Dyspnoea concerned 36.7% (55/150) patients at D30 and 30% (39/130) at D60. Half of the patients (74/150) at D30 and 40% (52/130) at D60 reported asthenia. Persistent symptoms at D60 were significantly associated with age 40 to 60 years old, hospital admission and abnormal auscultation at symptom onset. At D30, severe COVID-19 and/or dyspnoea at symptom onset were additional factors associated with persistent symptoms. Conclusions Up to 2 months after symptom onset, two thirds of adults with noncritical COVID-19 had complaints, mainly anosmia/ageusia, dyspnoea or asthenia. A prolonged medical follow-up of patients with COVID-19 seems essential, whatever the initial clinical presentation.
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Affiliation(s)
- Claudia Carvalho-Schneider
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France.
| | - Emeline Laurent
- Epidémiologie des Données cliniques en Centre-Val de Loire (EpiDcliC), Centre Hospitalier Universitaire de Tours, Tours, France; Equipe de Recherche 'Education Ethique Santé' (EE1 EES), Université de Tours, Tours, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France
| | - Emilie Beaufils
- Centre Mémoire Ressources et Recherche (CMRR), Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Saïd Laribi
- Service d'urgences et Faculté de Médecine, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Flament
- Service de Pneumologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | | | - Franck Bruyère
- Service d'urologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Karl Stefic
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Catherine Gaudy-Graffin
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Epidémiologie des Données cliniques en Centre-Val de Loire (EpiDcliC), Centre Hospitalier Universitaire de Tours, Tours, France; Unité INSERM U1259, Université de Tours, Tours, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, France
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Artus A, Tabchouri N, Iskander O, Michot N, Muller O, Giger-Pabst U, Bourlier P, Bourbao-Tournois C, Kraemer-Bucur A, Lecomte T, Salamé E, Ouaissi M. Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer. BMC Cancer 2020; 20:780. [PMID: 32819329 PMCID: PMC7439541 DOI: 10.1186/s12885-020-07109-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection. Methods All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL). Results Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or AAL compared to WAL patients (44.8 and 30% vs 9.3%, p < 0.001). The mean wexner continence grading scale was significantly different between AAL (11,4 ± 3,8), SAL (10,3 ± 0,6) and WAL (6,4 ± 4,7) groups (p = 0.049). The 3 and 5-year overall and disease-free survival rates were similar between the 3 groups (86.6% /84% vs 100%/100% vs 76%/70 and 82.9%/77% vs 100%/100% vs 94.7%/88.3% for patients with SAL, AAL, and WAL, p = 0.480 and p = 0.527). Conclusion The permanent stoma rate was significant higher in patients with SAL or AAL compared to WAL patients. AL did not impair long-term oncological outcome.
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Affiliation(s)
- Alice Artus
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Othman Iskander
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Nicolas Michot
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Olivier Muller
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Urs Giger-Pabst
- Department of General-, Visceral- and Transplant Surgery, University of Münster, Münster, Germany
| | - Pascal Bourlier
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Céline Bourbao-Tournois
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Aurore Kraemer-Bucur
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours, France
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray les Tours, Avenue de la République, Chambray les Tours, France.
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Brunault P, Ducluzeau PH, Courtois R, Bourbao-Tournois C, Delbachian I, Réveillère C, Ballon N. Food Addiction is Associated with Higher Neuroticism, Lower Conscientiousness, Higher Impulsivity, but Lower Extraversion in Obese Patient Candidates for Bariatric Surgery. Subst Use Misuse 2018; 53:1919-1923. [PMID: 29452044 DOI: 10.1080/10826084.2018.1433212] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The "food addiction" phenotype identifies a subpopulation of individuals experiencing substance-dependence symptoms toward specific foods. In the current debate on whether the "food addiction" phenotype should be considered as an addictive disorder, assessment of the personality traits associated with this phenotype would provide arguments for or against the "food addiction" phenotype and its inclusion in the "substance-related and addictive disorder" category. OBJECTIVES To assess the personality characteristics associated with the "food addiction" phenotype in obesity surgery candidates (i.e., big five personality dimensions, alexithymia and impulsivity). METHODS We assessed food addiction (Yale Food Addiction Scale), personality dimensions (Big Fig Inventory), impulsivity (Barratt Impulsiveness Scale-11th version) and alexithymia (Toronto Alexithymia Scale-20 items) in 188 bariatric surgery candidates recruited between July 2013 and November 2015 in the Nutrition Department of the University Hospital of Tours. We used chi-squared tests and Student's tests or Mann-Whitney-U-tests to determine the factors associated with food addiction. RESULTS Prevalence of current food addiction was 16.5%. Patients with (vs. without) food addiction had lower conscientiousness (p = .047), higher neuroticism and lower extraversion (ps < 0.001), but there was no difference in terms of agreeableness (p = 0.42) or openness (p = 0.16). They were more frequently single (p = .021) and reported higher alexithymia (ps < .001) and higher impulsivity sub-scores (ps<.05). Conclusions/Importance: Food addiction shares personality traits with substance-related disorders (regarding neuroticism, conscientiousness, impulsivity, alexithymia), and one distinctive trait (low extraversion). This study provides additional data that enrich the discussion on whether the "food addiction" phenotype should be included or not in the "substance-related and addictive disorder" category.
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Affiliation(s)
- Paul Brunault
- a Équipe de Liaison et de Soins en Addictologie & Clinique Psychiatrique Universitaire , CHRU de Tours , Tours , France.,b Département de Psychologie EA 2114 "Psychologie des Ages de la Vie" , Université de Tours , Tours , France.,c Centre Spécialisé pour la prise en charge de l'Obésité sévère , CHRU de Tours , Tours , France.,d INSERM U1253 iBrain Brain & Imaging , Université de Tours , Tours , France
| | - Pierre-Henri Ducluzeau
- c Centre Spécialisé pour la prise en charge de l'Obésité sévère , CHRU de Tours , Tours , France.,e Service de Médecine Interne-Nutrition , CHRU de Tours , Tours , France.,f INSERM UMR 1069 , Université de Tours , Tours , France
| | - Robert Courtois
- a Équipe de Liaison et de Soins en Addictologie & Clinique Psychiatrique Universitaire , CHRU de Tours , Tours , France.,b Département de Psychologie EA 2114 "Psychologie des Ages de la Vie" , Université de Tours , Tours , France
| | - Céline Bourbao-Tournois
- c Centre Spécialisé pour la prise en charge de l'Obésité sévère , CHRU de Tours , Tours , France.,g Service de Chirurgie Digestive et Endocrinienne , CHRU de Tours , Tours , France
| | - Irène Delbachian
- c Centre Spécialisé pour la prise en charge de l'Obésité sévère , CHRU de Tours , Tours , France.,d INSERM U1253 iBrain Brain & Imaging , Université de Tours , Tours , France
| | - Christian Réveillère
- b Département de Psychologie EA 2114 "Psychologie des Ages de la Vie" , Université de Tours , Tours , France
| | - Nicolas Ballon
- a Équipe de Liaison et de Soins en Addictologie & Clinique Psychiatrique Universitaire , CHRU de Tours , Tours , France.,c Centre Spécialisé pour la prise en charge de l'Obésité sévère , CHRU de Tours , Tours , France.,d INSERM U1253 iBrain Brain & Imaging , Université de Tours , Tours , France
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Benzerouk F, Gierski F, Ducluzeau PH, Bourbao-Tournois C, Gaubil-Kaladjian I, Bertin É, Kaladjian A, Ballon N, Brunault P. Food addiction, in obese patients seeking bariatric surgery, is associated with higher prevalence of current mood and anxiety disorders and past mood disorders. Psychiatry Res 2018; 267:473-479. [PMID: 29980127 DOI: 10.1016/j.psychres.2018.05.087] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/09/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
Abstract
The current cross-sectional study investigates the prevalence of the food addiction (FA) phenotype and its association with psychiatric disorders in bariatric surgery candidates. It also investigates the eating behavior characteristics associated with FA and the association between FA and loss of control over specific foods high in sugar, salt and/or fat. We included 128 bariatric surgery candidates and we assessed FA (YFAS 2.0), mood and anxiety disorders, suicidality, eating disorders (current bulimia nervosa and current anorexia nervosa), alcohol and tobacco use disorders (MINI 5.0.0, beck depression inventory, AUDIT, Fagerström Test for Nicotine Dependence) and eating behavior (DEBQ). Prevalence of FA in our sample was 25%. FA was significantly associated with higher prevalence of current mood and anxiety disorders and past mood disorders, higher current suicidality but not with eating disorders and alcohol use disorder. FA was significantly associated with higher emotional eating, and with loss of control over consumption of foods high in fat, sugar and/or salt, but not of fruits, vegetables or grain products. Our results provide arguments for considering psychiatric disorders and suicidality in FA and for considering FA as an addictive disorder in obese patients, with many risk factors in common with other addictions.
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Affiliation(s)
- Farid Benzerouk
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, avenue du Général Koenig, Reims Cedex 51092, France; CHU de Reims, Service d'Endocrinologie-Diabète-Nutrition, Hôpital Robert-Debré, avenue du Général Koenig, Reims Cedex 51092, France; Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France.
| | - Fabien Gierski
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, avenue du Général Koenig, Reims Cedex 51092, France; Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France
| | - Pierre-Henri Ducluzeau
- CHRU de Tours, Center Spécialisé pour la prise en charge de l'Obésité sévère, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; CHRU de Tours, Service de Médecine Interne-Nutrition, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; Université François Rabelais de Tours, Inserm U1069, 10 boulevard Tonnellé, Tours Cedex 37032, France
| | - Céline Bourbao-Tournois
- CHRU de Tours, Service de Chirurgie Digestive et Endocrinienne, Avenue de la République, Chambray-lès-Tours 37170, France
| | - Isabelle Gaubil-Kaladjian
- CHU de Reims, Service d'Endocrinologie-Diabète-Nutrition, Hôpital Robert-Debré, avenue du Général Koenig, Reims Cedex 51092, France
| | - Éric Bertin
- CHU de Reims, Service d'Endocrinologie-Diabète-Nutrition, Hôpital Robert-Debré, avenue du Général Koenig, Reims Cedex 51092, France
| | - Arthur Kaladjian
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, avenue du Général Koenig, Reims Cedex 51092, France; Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France
| | - Nicolas Ballon
- CHRU de Tours, Center Spécialisé pour la prise en charge de l'Obésité sévère, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; CHRU de Tours, Équipe de Liaison et de Soins en Addictologie & Clinique Psychiatrique Universitaire, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; Université François Rabelais de Tours, UMR INSERM U930 «Imagerie et Cerveau», 2 boulevard Tonnellé, Tours Cedex 9 37044, France
| | - Paul Brunault
- CHRU de Tours, Center Spécialisé pour la prise en charge de l'Obésité sévère, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; CHRU de Tours, Équipe de Liaison et de Soins en Addictologie & Clinique Psychiatrique Universitaire, 2 boulevard Tonnellé, Tours Cedex 9 37044, France; Université François Rabelais de Tours, EA 2114 «Psychologie des Âges de la Vie», 3 rue des Tanneurs, Tours 37000, France.
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Brunault P, Ducluzeau PH, Bourbao-Tournois C, Delbachian I, Couet C, Réveillère C, Ballon N. Food Addiction in Bariatric Surgery Candidates: Prevalence and Risk Factors. Obes Surg 2016; 26:1650-3. [PMID: 27107892 DOI: 10.1007/s11695-016-2189-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barussaud ML, Roussel B, Meurette G, Sulpice L, Meunier B, Regenet N, Bourbao-Tournois C, Huten N, Lhermite E, Paineau J, Durand-Fontanier S, Theraux J, Carretier M, Faure J. French intensive training course in laparoscopic surgery (HUGOFirst) on live porcine models: Validation of a performance assessment scale and residents’ satisfaction in a prospective study. J Visc Surg 2016; 153:15-9. [DOI: 10.1016/j.jviscsurg.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brunault P, Gohier B, Ducluzeau PH, Bourbao-Tournois C, Frammery J, Réveillère C, Ballon N. [The psychiatric, psychological and addiction evaluation in bariatric surgery candidates: What should we assess, why and how?]. Presse Med 2015; 45:29-39. [PMID: 26482489 DOI: 10.1016/j.lpm.2015.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/05/2015] [Accepted: 09/15/2015] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery is indicated in obese patients with a BMI ≥ 40 kg/m(2) or ≥ 35 kg/m(2) with serious comorbidities, in second intention in patients who failed to achieve significant weight loss after a well-managed medical, nutritional and psychotherapeutic treatment for 6 to 12 months, and in patients who are aware of the consequences of bariatric surgery and who agree with a long term medical and surgical follow-up. Such a treatment requires a preoperative multidisciplinary assessment and management, which includes a mandatory consultation with a psychiatrist or a psychologist that should be member of the multidisciplinary staff and participate in these staffs. Although one of this consultation's aim is to screen for the few patients who for which surgery is contra-indicated, in most cases, the main aim of this assessment is to screen for and manage psychiatric and psychopathologic disorders that could be temporary contra-indication, because these disorders could lead to poorer postoperative outcome when untreated. By explaining to the patient how these disorders could affect postoperative outcome and which benefits he could retrieve from their management, the patient will increase his motivation for change and he will be more likely to seek professional help for these disorders. In all cases, a systematic examination of the patient's personality and his/her ability to understand the postoperative instructions is essential before surgery because clinicians should check that the patient is able to be adherent to postoperative instructions. In addition to clinical interview, use of self-administered questionnaires before the consultation might help to determine which psychiatric or psychopathologic factors should be more closely screened during the consultation. Psychiatric disorders and addictions are highly prevalent in this population (e.g., mood and anxiety disorders, binge eating disorder, attention deficit hyperactivity disorder, addictions, personality disorders, pathological personality traits and dimensions), and when untreated, they can lead to poorer postoperative outcome (postoperative occurrence of psychiatric disorders, poorer quality of life, and sometimes to poorer weight loss or excessive weight rebound when the disorder is present during the postoperative period). A complementary training in addiction medicine is helpful given the higher risk for addictions in this population. Given that this evaluation is often the first meeting with a psychiatrist, an empathic and motivational approach is helpful to improve the patient's ability to request for a future psychiatric consultation during the follow-up. Some conditions are required for a high quality assessment: the objectives and expectations of the consultation should be systematically explained to the patient prior to the consultation by the physician who enquires for the assessment; it needs time; the psychiatrist should systematically be member of the multidisciplinary staff and should take part in regular multisciplinary staff meetings; patients should be seen alone to assess his/her readiness to change. After the consultation, a contact with the physician who enquires for the assessment should be systematic (e.g., use of a medical letter that sum up the main conclusions of the consultation; participation in regular multisciplinary staff meetings).
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Affiliation(s)
- Paul Brunault
- CHRU de Tours, équipe de liaison et de soins en addictologie, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, département de psychologie, EA 2114 « psychologie des âges de la vie », 37041 Tours, France; CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37000 Tours, France.
| | - Bénédicte Gohier
- CHU d'Angers, service de psychiatrie et d'addictologie, 49933 Angers, France; Université d'Angers, laboratoire de psychologie des Pays-de-la-Loire, EA 4638, 49045 Angers cedex 1, France
| | - Pierre-Henri Ducluzeau
- CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37000 Tours, France; CHRU de Tours, service de médecine interne-nutrition, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, 37041 Tours, France
| | - Céline Bourbao-Tournois
- CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37000 Tours, France; CHRU de Tours, service de chirurgie digestive et endocrinienne, 37044 Tours cedex 9, France
| | - Julie Frammery
- CHRU de Tours, équipe de liaison et de soins en addictologie, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; Centre hospitalier Louis-Sevestre, 37390 La-Membrolle-sur-Choisille, France
| | - Christian Réveillère
- Université François-Rabelais de Tours, département de psychologie, EA 2114 « psychologie des âges de la vie », 37041 Tours, France
| | - Nicolas Ballon
- CHRU de Tours, équipe de liaison et de soins en addictologie, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37000 Tours, France; UMR Inserm U930 ERL, 37200 Tours, France; Université François-Rabelais de Tours, 37041 Tours, France
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Brunault P, Frammery J, Couet C, Delbachian I, Bourbao-Tournois C, Objois M, Cosson P, Réveillère C, Ballon N. Predictors of changes in physical, psychosocial, sexual quality of life, and comfort with food after obesity surgery: a 12-month follow-up study. Qual Life Res 2014; 24:493-501. [PMID: 25113238 DOI: 10.1007/s11136-014-0775-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Paul Brunault
- Équipe de Liaison et de Soins en Addictologie, CHRU de Tours, Tours, France,
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May A, Cazeneuve N, Bourbao-Tournois C. Acute small bowel obstruction due to internal herniation through the Foramen of Winslow: CT diagnosis and laparoscopic treatment. J Visc Surg 2013; 150:349-51. [PMID: 24138889 DOI: 10.1016/j.jviscsurg.2013.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A May
- Service d'urologie, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnelé, 37000 Tours, France.
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Albeladi B, Bourbao-Tournois C, Huten N. Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity. J Obes 2013; 2013:934653. [PMID: 24078867 PMCID: PMC3775408 DOI: 10.1155/2013/934653] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/01/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. METHODS An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years) were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. RESULTS Thirty-six LRYGB and 34 LSG were included. Mean operative time of LSG was 106 min while LRYGB was 196 min (P < 0.001). Differences in length of stay, early and late complications, and improvement or resolution in comorbidities were not significant (P > 0.05). Eighteen months after surgery, average excess weight loss was 77.6% in LRYGB and 57.1% in LSG (P = 0.003). There was no surgery-related mortality. CONCLUSIONS Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months.
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Affiliation(s)
- Bandar Albeladi
- Department of Digestive and Bariatric Surgery, TOURS University Hospital (Hôpital Trousseau), Avenue de la République, Chambray lès Tours, 37170 Tours, France. dr albeladi
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Brunault P, Jacobi D, Miknius V, Bourbao-Tournois C, Huten N, Gaillard P, Couet C, Camus V, Ballon N. High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study. Psychosomatics 2012; 53:363-70. [PMID: 22458986 DOI: 10.1016/j.psym.2011.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 2006 and February 2010 in a French tertiary referral center. We assessed preoperative depression (using the Beck depression inventory and the SCL-90-R depression subscale), anxiety (using the Hamilton anxiety rating scale and the SCL-90-R anxiety subscales), and binge eating (using the bulimic investigatory test, Edinburgh). The primary outcome was the percentage of excess weight loss at 12 months (PEWL). RESULTS The preoperative mean body mass index (BMI) was 55.3 kg/m2 ± 10.2 kg/m2 and 41.7 kg/m2 ± 8.7 kg/m2 at the 12-month follow-up visit. The mean PEWL was 46.8% ± 15.8%. After adjusting for the preoperative BMI, the PEWL was negatively associated with preoperative scores for depression (β= -0.357; P < 0.05), phobic anxiety (β = -0.340; P < 0.05), interpersonal sensitivity (β = -0.328; P < 0.05), and binge eating (β = -0.315; P = 0.05). Other forms of anxiety were not correlated with the PEWL. CONCLUSIONS Higher preoperative depression, phobic anxiety, interpersonal sensitivity, and binge eating scores are associated with low postoperative weight loss in patients undergoing sleeve gastrectomy. Future studies should assess the preoperative prevalence of syndromal or subsyndromal atypical depression and its relationship to postoperative weight loss in bariatric surgery candidates.
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Affiliation(s)
- Paul Brunault
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France.
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Brunault P, Jacobi D, Léger J, Bourbao-Tournois C, Huten N, Camus V, Ballon N, Couet C. Observations Regarding ‘Quality of Life’ and ‘Comfort with Food’ After Bariatric Surgery: Comparison Between Laparoscopic Adjustable Gastric Banding and Sleeve Gastrectomy. Obes Surg 2011; 21:1225-31. [DOI: 10.1007/s11695-011-0411-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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