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Behavioral Predictors of Weight Regain after Bariatric Surgery
Abstract
After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB).
In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared.
Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p < 0.0001. The mean follow-up after bariatric surgery was 28.1 +/- 18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p = 0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of > or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model.
Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.
... Furthermore, it holds some of the highest associated risks for an obesity intervention (Birkmeyer et al., 2010). Despite its success rates for weight loss, bariatric surgery still holds potential for weight regain (Odom et al., 2010). Low restraint, poor self-monitoring and decreased well-being were associated with post-operative weight relapse (Odom et al., 2010). ...
... Despite its success rates for weight loss, bariatric surgery still holds potential for weight regain (Odom et al., 2010). Low restraint, poor self-monitoring and decreased well-being were associated with post-operative weight relapse (Odom et al., 2010). Bariatric surgery has also been associated with poor psychological outcomes, including depressive symptoms at 24-36 months post-treatment (de Zwann et al., 2011). ...
... In this context, it remains unclear which threshold of WR is clinically significant for morbidities relapse and it hampers the comparison between studies that analyze the impact of WR after bariatric surgery. In our study, we have applied 2 previously defined WR criteria [13,[28][29][30][31][32][33]: > 10% [13,28,33] and > 15% [29][30][31][32] of nadir weight, and the prevalence of WR (37% and 60%) is in line with other studies [27] or lightly higher, probably because of the longer follow-up of our cohort [30]. ...
... In this context, it remains unclear which threshold of WR is clinically significant for morbidities relapse and it hampers the comparison between studies that analyze the impact of WR after bariatric surgery. In our study, we have applied 2 previously defined WR criteria [13,[28][29][30][31][32][33]: > 10% [13,28,33] and > 15% [29][30][31][32] of nadir weight, and the prevalence of WR (37% and 60%) is in line with other studies [27] or lightly higher, probably because of the longer follow-up of our cohort [30]. ...
Background
Obesity-related comorbidities may relapse in patients with weight regain after bariatric surgery. However, HDL cholesterol (HDLc) levels increase after surgery and seem to remain stable despite a gradual increase in BMI. The aim of this study is to analyze the effects of weight regain after bariatric surgery on HDL cholesterol.
Materials and methods
This is a retrospective, observational, cohort study in patients who underwent bariatric surgery in the Hospital de la Santa Creu i Sant Pau (Barcelona) between 2007 and 2015. Patients without at least 5 years of follow-up after surgery, under fibrate treatment, and those who required revisional surgery were excluded from the analysis. Data were collected at baseline, 3 and 6 months after surgery, and then annually until 5 years post-surgery.
Results
One hundred fifty patients were analyzed. 93.3% of patients reached > 20% of total weight loss after surgery. At 5th year, 37% of patients had regained > 15% of nadir weight, 60% had regained > 10%, and 22% had regained < 5% of nadir weight. No differences were found in HDLc levels between the different groups of weight regain, nor in the % of change in HDLc levels between nadir weight and 5 years, or in the proportion of patients with normal HDLc concentrations either.
Conclusion
HDLc remains stable regardless of weight regain after bariatric surgery.
Graphical abstract
... 39 A total of 99.6% of the individuals declared that they did not experience any post-operative body weight gain. Odom et al. (2010) and King et al. (2020), draw attention for the weight regain after bariatric surgery, which poses a risk in terms of comorbidities. 40,41 They pointed to the weight stigma, apart from metabolic complications, after surgery. ...
... Odom et al. (2010) and King et al. (2020), draw attention for the weight regain after bariatric surgery, which poses a risk in terms of comorbidities. 40,41 They pointed to the weight stigma, apart from metabolic complications, after surgery. Accordingly, individuals who had metabolic surgery or weight loss endure self-stigma in the form of internalized weight bias and stigmatizing due to the remarks from family, friends, and healthcare professionals. ...
Objective: Stigma is a mark that defines some people, devalues, and causes them to be distinguished from others in society. Obesity is among the diseases that might cause discrimination and stigmatization. This study aimed to evaluate the relationship between weight stigma, self-esteem, and life satisfaction in people with a bariatric surgery history. Method: This cross-sectional study was evaluated in 250 individuals [147 female (58.8%) and 103 male (41.2%)] with a mean age of 34.35 ± 7.46 years. Descriptive characteristics, the factors leading to bariatric surgery, self-esteem, and life satisfaction scores were collected with a questionnaire. Linear regression models for the life satisfaction scale were analyzed. Statistically, P < 0.05 values were considered significant. Results: The postgraduates had lower life satisfaction than high school and undergraduate students (P=0.001); the non-smokers had higher life satisfaction than smokers or who quit smoking (P=0.036) and also non-alcoholics had higher life satisfaction than the other groups who consume alcohol or quit consuming (P=0.000). The self-esteem of the non-smokers was higher than smokers or who quit smoking (P=0.000). The postoperative body weight loss of the individuals was 93.8 ± 31.3 kg. Accordingly, most of the individuals (98.4%) applied for surgery because of a “fear of health problems”, 98.8% of the individuals were “experiencing exclusion or discrimination at school or work”, 99.2% of the individuals were “feeling insecure about the opinions of others” and “being blamed by people for weight problems”. The self-esteem score of the overweight group was higher than the group with normal BMI values (P=0.012). According to the regression model, weight loss and self-esteem were among the determinants of life satisfaction (P=0.000). Conclusion: The current data suggest that strategies to reduce stigma behavior should be developed in addition to lifestyle interventions, including dietary approaches, in the treatment of obesity. It is necessary to conduct follow-up studies on this subject, which span the time before and after bariatric surgery.
... Furthermore, psychiatric disorders increase the risk of WR during post-operative periods; for instance, Rutledge et al. [62] showed that those individuals presenting two or more psychiatric disorders were six times more likely to develop WR post-MS. Under this framework, depression stands out among the most common disorders in bariatric patients, and although the association between this and WR or failure in post-MS WL has been demonstrated, as well as its presence predisposes individuals to be more prone to develop eating disorders, the results of studies tend to contradict each other since some show that depression is diminished after MS or, failing that, no causal relationships are observed in their analyses [56,[63][64][65][66]. Similarly, patients with WR have high clinical or borderline anxiety and stress levels; however, these were not associated with higher energy consumption [66,67]. ...
... Finally, drug use and alcoholism have been described as influential factors in WR, as post-MS patients may seek relief from other substances through "addiction transfer" to substitute the needs established by the brain reward system for excessive energy consumption prior to MS [60, 68,69]. Odom et al. [65] followed up on 203 post-RYGB patients, showing that decreased post-MS well-being, increased need to eat, and preoccupation with drug or alcohol use (addictive behavior) were independent predictors of WR. Thus, it is clear that bariatric patients need pre-and post-MS psychological assessment to ensure expected outcomes in WL and avoid relapse in maladaptive habits related to WR [70]. ...
Patients undergoing metabolic surgery have factors ranging from anatomo-surgical, endocrine metabolic, eating patterns and physical activity, mental health and psychological factors. Some of the latter can explain the possible pathophysiological neuroendocrine, metabolic, and adaptive mechanisms that cause the high prevalence of weight regain in postbariatric patients. Even metabolic surgery has proven to be effective in reducing excess weight in patients with obesity; some of them regain weight after this intervention. In this vein, several studies have been conducted to search factors and mechanisms involved in weight regain, to stablish strategies to manage this complication by combining metabolic surgery with either lifestyle changes, behavioral therapies, pharmacotherapy, endoscopic interventions, or finally, surgical revision. The aim of this revision is to describe certain aspects and mechanisms behind weight regain after metabolic surgery, along with preventive and therapeutic strategies for this complication.
... These etiologies include five main categories, namely hormonal/metabolic, dietary non-adherence, physical inactivity, psychological factors, and anatomic/surgical failure ( Figure 1) (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). ...
... It has been determined that preoperative psychiatric problems are not strongly associated with WR; however, postoperative psychiatric problems are among the strongest RFs and etiologies (38). Eating psychopathology (38), particularly grazing, loss of control over eating, emotional eating, and food urges (40)(41)(42)(43), were observed to be substantially related to post-BMS WR. In addition, WR was linked to binge eating in both the short and long term following BMS (53). ...
Context
This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS).
Evidence Acquisition
Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR.
Results
Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention.
Conclusions
Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.
... Several maladaptive eating behaviors have been positively associated with weight recurrence including loss of control eating, binge eating, night eating, and grazing [17][18][19][20][21]. Lifestyle factors have also been linked to weight recurrence. For example, while poorer sleep has been associated with an increased likelihood of weight recurrence [15], those who engage in selfmonitoring, regularly weigh themselves, and engage in regular physical activity appear less likely to experience weight recurrence [16,18,22]. ...
... A comprehensive examination may inform which factors should be monitored and targeted for treatment to prevent weight recurrence. Further, much of the work on weight recurrence has been done with Rouxen-Y gastric bypass [15,16,[18][19][20]22]. Those who undergo sleeve gastrectomy appear to be at higher risk for weight recurrence [23], and given this is the most common procedure in the United States, it would be useful to have samples that included patients with sleeve gastrectomy. ...
... However, 30%-40% of patients with obesity who undergo BS are non-responders [8,9]. Pre-operative body mass index (BMI) [10], age [11,12], dietary impulses [13,14], mental health problems [13,14], and endocrine and metabolic alterations [15] are associated with the non-responsive state of patients who have undergone BS. The influence of age on weight loss post-BS remains contentious at present. ...
... However, 30%-40% of patients with obesity who undergo BS are non-responders [8,9]. Pre-operative body mass index (BMI) [10], age [11,12], dietary impulses [13,14], mental health problems [13,14], and endocrine and metabolic alterations [15] are associated with the non-responsive state of patients who have undergone BS. The influence of age on weight loss post-BS remains contentious at present. ...
Objective:
This study aims to explore the relationship between age and whether the percentage of total weight loss (TWL%) is ≥ 25% or not at 1 year after bariatric surgery (BS). We aimed to provide evidence for the stratified treatment of spatients with obesity at different ages.
Methods:
The primary outcome evaluated was whether TWL% was no less than 25% at 1 year after BS. A TWL% ≥ 25% was defined as a satisfied TWL% outcome. Logistic regression analysis and the restricted cubic spline (RCS) function were used to analyze the relationship between age and the satisfied TWL% outcome at 1 year after BS.
Results:
Two hundred and ninety-one patients were included in our study. After adjusting for potential confounders, the odds ratios (ORs) of the corresponding quartiles of age associated with satisfied TWL% outcome were 1.00 (reference), 1.117 [95% confidence interval (95% CI) = 0.540-2.311], 1.378 (95% CI = 0.647-2.935), and 0.406 (95% CI = 0.184-0.895). RCS analysis revealed a non-linear inverted L-shaped association between age and satisfied TWL% outcome at 1 year after BS (non-linear P = 0.033).
Conclusion:
Age was an independent predictor of satisfied TWL% outcome one year following BS, and our study considered 32 years as a potential cut-off point. For Chinese patients over the age of 32 who are eligible for BS, it may be beneficial to do BS earlier as the probability of achieving a satisfied TWL% outcome may decrease with age.
... Later, the study also stated that nutrition counseling was effective in reducing the total body weight and body fat of RYGB patients (2 years post-op) with weight regain as per a study done by Faria et al. (48). Therefore, adherence with self monitoring behaviour decreases likelihood of weight regain (50). ...
... Two important factors that leads to high calorie consumption in beverages are, unawareness about the actual calorie content of that beverage as well as unable to attain satiety after its consumption. Hence, compensation at the next meal does not occur, as a result patients tend to consume more (50). In a study, replacement of caloric beverages with water or calorie-free beverages resulted in a weight loss of 2-2.5% in obese subjects (49). ...
Obesity and its associated co-morbidities is pandemic and with scientific developments, many combating therapies are in prevalence. Bariatric Surgery (BS) is considered most effective treatment for morbid obesity. After the surgery however weight regain can occur in 20-30% cases. It has also been observed that some patients do not achieve successful outcomes of weight loss or even if they do so, they are unable to maintain it. Various factors like food choices, Basal metabolism, energy expenditure, lifestyle modifications and hormonal changes are seen to affect the weight status after surgery. This review study depicts factors as well as the mechanism of weight regain post bariatric surgery. It is imperative that weight gain occurs in patients, therefore, more studies are required towards the prevention and care in these subjects.
... Disordered eating patterns have been reported as highly prevalent in bariatric-metabolic procedure patients both pre-and post-procedure. Prevalent DEPs included grazing (26%), emotional eating (38%), sweet eating (43%), loss of control (61%), binge eating (64%), and food cravings (90%) [11][12][13]. Many patients also suffer complications related to disordered eating, including gastrointestinal symptoms or nutrient deficiencies [14], with prevention and treatment by the MDT hampered by high rates of attrition [15]. ...
... However, the existing literature on disordered eating in bariatric-metabolic procedure patients is limited to the research setting, with each study focused upon select DEPs [11][12][13]. ...
Problem
Disordered eating, such as binge, graze, and emotional eating, has been strongly linked to weight gain. Improved understanding of disordered eating by adults who elect bariatric weight loss procedures in a real‐world setting is required.
Purpose
To determine the association between the number and type of disordered eating patterns (DEPs), as described by healthcare professionals during routine care without standardized assessment, with clinical outcomes in adults who elected a bariatric weight loss procedure.
Method
An observational cohort study recruited laparoscopic sleeve gastrectomy (LSG) and endoscopic sleeve gastroplasty (ESG) patients. DEPs documented in the medical record during routine care were observed and tested for association with events (symptoms, side‐effects, or adverse events), micronutrient deficiencies, weight loss, and attrition. Data were observed up to 12‐month post‐procedure.
Results
215 LSG and 32 ESG patients were recruited. The mean number of DEPs was 6.4 (SD: 2.1) and 6.4 (SD: 2.1) in the LSG and ESG cohorts, respectively. Night eating was associated with a higher number of events ( p < 0.008) in the LSG cohort, and non‐hungry eating was associated with a higher number of events in the ESG cohort ( p < 0.001). ESG patients who had a surgical or medical event by 6‐months post‐procedure had mean 1.78 (95%CI: 0.67, 2.89) more DEPs ( p = 0.004). DEPs were not associated with weight loss, micronutrient deficiencies, nor attrition.
Conclusion
The treating healthcare team believed the LSG and ESG patients experienced a wide variety and high frequency of DEPs requiring multidisciplinary support. Non‐hungry eating and night eating were associated with poorer outcomes following an LSG or ESG.
Trial registration
The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000332729).
... Possibly, other factors of alcohol abuse not related to surgical treatment may help to explain our findings [32,33]. Weight regain after bariatric surgery results from behavioral changes and other factors [40,41], hypothesizing an explanation for our findings. A previous study reported that concerns over alcohol use were predictors of post-surgical weight regain [40]. ...
... Weight regain after bariatric surgery results from behavioral changes and other factors [40,41], hypothesizing an explanation for our findings. A previous study reported that concerns over alcohol use were predictors of post-surgical weight regain [40]. However, alcohol use was not an independent weight-change predictor since the authors also documented increased food urges and decreased post-surgical well-being. ...
Purpose
Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes.
Material and Methods
Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m²) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey.
Results
Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group.
Conclusions
HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
Graphical Abstract
... An estimated 10-20% of post-BS patients regain a significant portion of their lost weight. The weight gain phase is most sensitive about two to five years after BS, when many patients slowly return to old habits and food amounts begin to increase (Odom et al., 2010;Yanos et al., 2015). ...
... Weight loss is an additional and major aetiological factor for sarcopenia (Stegen et al., 2011). However, despite extreme loss of fat mass after BS, there is also significant loss of muscle mass, potentially having a negative effect on muscle strength and physical performance (Carey et al., 2006;Stegen et al., 2011;Zalesin et al., 2010). After a diet-induced weight loss of 8-10%, the reduction in muscle mass could be 2-10% in morbidly obese persons (Cava et al., 2017). ...
... Food cravings are extremely common (experienced by 21-97% of the adult population) [1], and have important health implications. Cravings are linked to greater body mass index [2], predict weight regain after bariatric surgery in patients who are obese [3], and are associated with early attrition from weight loss programs [4]. As rates of global obesity rise [5], it is important to understand why some individuals can exert self-control and maintain healthy dietary choices, while others cannot inhibit hedonic, reward-driven eating. ...
... This may limit the ability to generalize these findings more broadly to other populations. Our study took place in the mornings (10-12 a.m.) and afternoons (3)(4)(5). Cravings for sweet snacks have been reported to be more common in evenings than in the mornings [43]. However, our randomization procedure yielded approximately equal proportions of morning/afternoon participants in the two tDCS conditions, so we do not believe this would lead to any systematic differences in our findings. ...
The ability to regulate the intake of unhealthy foods is critical in modern, calorie dense food environments. Frontal areas of the brain, such as the dorsolateral prefrontal cortex (DLPFC), are thought to play a central role in cognitive control and emotional regulation. Therefore, increasing activity in the DLPFC may enhance these functions which could improve the ability to reappraise and resist consuming highly palatable but unhealthy foods. One technique for modifying brain activity is transcranial direct current stimulation (tDCS), a non-invasive technique for modulating neuronal excitability that can influence performance on a range of cognitive tasks. We tested whether anodal tDCS targeting the right DLPFC would influence how people perceived highly palatable foods. In the present study, 98 participants were randomly assigned to receive a single session of active tDCS (2.0 mA) or sham stimulation. While receiving active or sham stimulation, participants viewed images of highly palatable foods and reported how pleasant it would be to eat each food (liking) and how strong their urge was to eat each food (wanting). We found that participants who received active versus sham tDCS stimulation perceived food as less pleasant, but there was no difference in how strong their urge was to eat the foods. Our findings suggest that modulating excitability in the DLPFC influences “liking” but not “wanting” of highly palatable foods. Non-invasive brain stimulation might be a useful technique for influencing the hedonic experience of eating but more work is needed to understand when and how it influences food cravings.
... También se mencionan causas anatómicas, como un reservorio gástrico grande o dilatado 12 . Varios estudios internacionales, incluso han relacionado algunos factores predictores para la ganancia de peso posterior a la cirugía bariátrica, como la falta de control al comer (OR 5,1), el uso de alcohol y drogas (OR 12,27), los puntajes bajos en la escala de bienestar (OR 2,1) y la falta de seguimiento (OR 2,6) 11,13 . ...
... En cuanto a las características demográficas de nuestros pacientes, los hallazgos son similares a los datos reportados en las revisiones de otros grupos internacionales, con mayor prevalencia de la obesidad en mujeres y estratos socioeconómicos bajos 4,[13][14][15][16][17] . No hubo diferencias evidentes en cuanto escolaridad ni edad, que han sido factores determinantes en el grado de obesidad en otras series publicadas 7,18,19 . ...
Introducción. La cirugía bariátrica es efectiva para inducir una rápida pérdida del exceso de peso, pero existen dudas sobre la duración de este efecto a largo plazo. Este estudio buscaba identificar la proporción de pacientes operados que presentaron una pérdida insuficiente o una ganancia significativa de peso y los posibles factores relacionados.
Métodos. Estudio de cohorte retrospectivo en pacientes adultos sometidos a cirugía bariátrica. Se describieron variables demográficas y clínicas. Se realizó un análisis multivariado para identificar factores relacionados con un peso fuera de metas posterior a la cirugía.
Resultados. Se incluyeron 187 pacientes, 117 con baipás gástrico y 70 con manga gástrica. La mediana de índice de masa corporal preoperatorio fue 41,3 kg/m2 y postoperatorio de 28,8 kg/m2. El 94,7 % de los pacientes en ambos grupos logró una adecuada pérdida del exceso de peso. La ganancia de peso mayor del 20 % se presentó en el 43,5 % de los pacientes, siendo mayor en el grupo de manga gástrica (p
... Middlemore Hospital, Counties Manukau in the south of Auckland, is the leading public hospital conducting bariatric surgical procedures in New Zealand; 1359 surgeries between 2010and 2018(Counties Manukau, 2019. Previous research conducted with patients who received bariatric surgery at this hospital reported a desire for more support from the bariatric service (Lauti, Stevenson, Hill, & MacCormick, 2016). ...
... Several participants (n = 11, 40 %) experienced weight-regain at 21months post-surgery, however, all feared weight-regain. It is well known that with longer time post-surgery, the risk of weight-regain increases, particularly once major physiological and metabolic adaptations have occurred and extreme weight loss begins to plateau around 12-months (Odom et al., 2010). A study including 782 bariatric-surgery participants concluded that weight regain begins to occur two to five years post-surgery, with 50 % of participants experiencing a mean 8 % weight increase at 24-months post-surgery (from the lowest point at 18-months post-surgery) (Magro et al., 2008). ...
Background
Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery.
Methods
Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences.
Results
Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care.
Conclusion
Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.
... The %RWG was calculated by multiplying RWG by 100 and dividing the product by the one-year postoperative weight. A significant RWG was considered a percentage ≥15 [7]. The late results 11 years after surgery were expressed using the classification of Reinhold [8], which correlates preoperative BMI with late BMI after surgery. ...
Purpose
Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years).
Materials and Methods
A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants.
Results
The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients.
Conclusion
After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later.
Graphical Abstract
... While there are psychosocial, behavioral, and physiological changes that may result in weight recurrence after MBS, studies have found that enlargement of the gastric pouch or gastrojejunostomy (GJ), which leads to a decrease in restriction, may play a role in weight recurrence after RYGB. [12][13][14] Although surgical revision of a dilated GJ has been described, it is associated with an increased risk of surgical adverse events and high risk of morbidity. 15 Endoscopic bariatric therapy (EBT) to treat weight recurrence after RYGB was first described in 2004. ...
Transoral outlet reduction (TORe) is an endoscopic intervention for patients who have weight recurrence, dumping syndrome, or post-prandial hypoglycemia following Roux-en-Y gastric bypass (RYGB). TORe offers a minimally invasive alternative to surgical revision, which is often associated with high morbidity rates. This paper will detail the approach to TORe in regard to patient selection, endoscopic technique, and post-TORe outcomes.
... Sisto et al. (47) also showed a relationship between symptoms of anxiety and depression and snack consumption, as well as increased hunger and impulsive eating, as a result of the negative impact of suffering on eating. The state of depression or the worsening of this condition are precursors to weight gain (48). Daniel and collaborators (49) revealed in their study that an increase in uncontrolled eating behavior was a predictor of weight gain during the pandemic. ...
Introduction
University students have been particularly affected during the COVID-19 pandemic, and several sociodemographic and behavioral factors may be associated with the risk of overweight in this population. The aim of this study was to assess the impact of the pandemic on the eating behavior and nutritional status of university students, and the factors associated with these changes, especially the role of intuitive eating in this process.
Methods
This is a repeated measures observational study with data collected in the first and third year of the COVID-19 pandemic in Brazil, from students over the age of 18 in the undergraduate programs of a federal university in southeastern Brazil. The survey was conducted using an online form. Eating behavior was assessed using the “Intuitive Eating Scale–2”.
Results
251 university students took part, most of them female with a median age of 22. There was an increase in body mass index (BMI) and intuitive eating score between the two periods. In the first year of the pandemic, being female and using tobacco reduced the chances of students being overweight. Living in a marital relationship, worrying about weight gain and body dissatisfaction increased the chances of this outcome. In the third year of the pandemic, it was observed that practicing restrictive diets, having inadequate body perception, worrying about weight gain and living in a marital relationship increased the chances of students being overweight. Being female and eating more intuitively, in line with bodily needs, reduced these odds, demonstrating a protective role in this scenario.
Conclusion
There was an increase in BMI and intuitive eating score during the pandemic. Sociodemographic, lifestyle and behavioral variables had both a positive and negative influence on nutritional status. Intuitive eating was shown to be a protective factor during this period, reducing the chances of being overweight in this population. Thus, more intuitive eating may favor greater weight stability, and may, therefore, have helped to reduce the impact of the pandemic on weight gain. In this way, people who ate more intuitively partially resisted the context that favored weight gain (stress, changes in diet and physical inactivity).
... Depression and anxiety-related disorders are highly prevalent in the presurgical bariatric population, with up to 15.6% and 24.0% of patients meeting diagnostic criteria for depression-or anxiety-related disorders, respectively, at the time of PSPE (de Zwaan et al., 2011;Marek et al., 2013). Perhaps surprisingly, most relevant studies have not observed a significant effect of pre-surgical depressive symptomatology on post-surgical outcomes (Dixon et al., 2003;Fisher et al., 2017;Masheb et al., 2007;Scholtz et al., 2007;Thonney et al., 2010;Toussi et al., 2009;Wolfe & Terry, 2006).On the other hand, two studies have reported a positive association between higher pre-surgical depression scores, measured by the Beck Depression Inventory-II (BDI-II), and post-surgical weight loss one year after bariatric surgery (Averbukh et al., 2003;Odom et al., 2010). Notably, neither pre-operative anxiety disorder diagnoses nor anxiety symptoms have consistently been associated with post-operative weight loss at either short-term or long-term post-surgery assessments (Alger-Mayer et al., 2009;Barrash et al., 1987;de Zwaan et al., 2011;Fisher et al., 2017;Marek et al., 2015;Tarescavage et al., 2013;Tsushima et al., 2004;Wolfe & Terry, 2006). ...
Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.
... Weight recurrence after bariatric surgery is currently a significant concern, often attributed to the exaggerated intake of calorie-dense liquids, underlying hormonal disorders and psychiatric conditions and inadequate physical activity [29]. Regular postoperative follow-up meetings provide bariatric patients with opportunities to discuss concerns related to surgical issues, nutritional habits, behaviours and psychological conditions with healthcare professionals [30]. Kim et al. have indicated that long-term postoperative follow-up correlates with increased weight loss and a simultaneous reduction in the risk for weight recurrence [31]. ...
In the context of escalating obesity rates, bariatric surgery holds a crucial role in managing severely obese patients. With a demonstrated effectiveness in weight loss and with the advent of ambulatory surgery, bariatric surgery allows for a streamlined care pathway, ideally suited for postoperative surveillance using digital health applications. The aim of this systematic review and meta-analysis is to evaluate the effect of eHealth-delivered health services or support for adults undergoing bariatric surgery. Five studies, encompassing 2210 patients, were analysed. The intervention group showed a 10% increase in total weight reduction and a 22% reduction in excess weight loss. ED visitation rates also trended towards reduction. Despite the absence of clear statistical superiority for DHA, the findings suggest potential benefits of DHA in postoperative monitoring.
... Bariatric surgery has been demonstrated to be an effective treatment for severe obesity, improving quality of life and decreasing mortality [20]. Yet significant weight loss after surgery is not guaranteed, and there may even be a recurrence of obesity due to (among other things) the existence of binge eating before and, particularly, after surgery [21,22]. To date no studies have examined the associations between interpersonal difficulties and binge eating among individuals seeking bariatric surgery. ...
Background: Preoperative binge eating behavior has been associated with difficulties in weight loss maintenance among patients pursuing bariatric surgery. However, limited data exists on the relationship between interpersonal difficulties and binge eating. Objectives: To identify interpersonal factors linked with binge eating among bariatric surgery candidates. Setting: One hundred and seventeen adult bariatric surgery candidates (BMI = 42.2 ± 5.2) from three different hospitals completed questionnaires on the day of their bariatric committee meeting for operation approval. Methods: Binge eating was assessed using the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) as a dichotomous variable. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and interpersonal characteristics were evaluated using the short version of the Inventory of Interpersonal Problems (IIP-32). Sociodemographic variables (age, gender, income, education) and BMI were considered as confounders. Results: Approximately 25% of bariatric surgery candidates reported experiencing binge eating episodes within the previous three months. Participants with binge eating exhibited significantly lower self-esteem and more interpersonal difficulties, particularly in the domains of aggressiveness and dependence, compared to those without binge eating. Logistic regression analysis revealed that aggressiveness was a significant predictor of binge eating in this sample. Conclusions: This study is the first, to the best of our knowledge, to investigate the relationship between interpersonal difficulties and binge eating among bariatric surgery candidates. The findings highlight the significant contribution of aggressiveness to binge eating and emphasize the importance of clinicians assessing patients’ interpersonal functioning, particularly with regard to aggressiveness, as a factor that may contribute to the maintenance and occurrence of binge eating behaviors.
... However, over the five subsequent years, there is a linear recurrence of 20%-30% of the maximal weight previously lost, thereby increasing risk for the exacerbation or recurrence of weight-associated medical conditions [1][2][3]. The incidence of post-RYGB weight recurrence ranges from 24%-79%, depending on patient characteristics and assessment methodology [4][5][6], and greater than one-third of patients will have a clinically significant weight recurrence surpassing 25% of their initial weight lost [7]. One of the strongest predictors of weight recurrence is time from RYGB, underscoring obesity's chronic, progressive nature, even after one of the most effective weight loss options currently available [8]. ...
Background:
Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting.
Aim:
To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.
Methods:
This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics.
Results:
Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m2) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%).
Conclusion:
When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.
... The numerical variables were tested for normality using the Kolmogorov-Smirnov test, and were expressed as mean or median, minimum-maximum, or interquartile range and standard deviation depending on the results obtained. For statistical analysis, weight recurrence equal to or greater than 15% was considered as used in other studies [14][15][16], with group 1 < 15% and group 2 ≥ 15%. The association between the mean values of the variables was evaluated according to weight recurrence of 15%, and T student and the Mann-Whitney tests were performed for normally distributed data. ...
Background
Eating habits are one of the factors that directly affect weight recurrence after bariatric surgery, and therefore, this study assessed the association between food consumption and weight recurrence in patients who underwent bariatric surgery a minimum of 2 years.MethodsA cross-sectional observational study was conducted with patients who underwent bariatric surgery a minimum of 2 years through SUS, in the city of Palmas, Tocantins. Food consumption was assessed through two 24-h dietary recalls (R24). The foods were classified into groups by degree of processing following the NOVA classification system. Also, macronutrients and fiber contents were quantified. Anthropometric variables were evaluated and weight recurrence (WR) was defined as 15%.ResultsNinety-three (93) patients participated in the study, being 83.9% female, with mean age of 43.5 ± 9.13 years, mean post-surgery time of 4 years, and 58% present WR. A lower total energy consumption was found in patients without WR compared to those with WR (p = 0.05). Among the WR group, calories from processed foods (p = 0.00) and culinary ingredients (p = 0.05) were higher. However, carbohydrate consumption (percentage) was lower in the WR group (p = 0.04). A positive correlation was found between total energy (p = 0.03), processed foods (p = 0.03) and weight recurrence (p = 0.03).Conclusion
Weight recurrence is associated with total daily energy intake, carbohydrates and food groups classified according to NOVA.Graphical Abstract
... Participants shared their experiences of emotional and disordered eating and drinking behaviors. These narratives align with previous studies showing that problematic eating behaviors may contribute to weight regain [43][44][45]. However, binge eating behaviors are often reduced due to anatomic restrictions after bariatric surgery. ...
Purpose
Food quality, energy intake, and various eating-related problems have been highlighted as some of the components influencing weight after bariatric surgery. This study aimed to increase our knowledge of patients’ perspectives on dietary patterns and eating behaviors during weight regain after bariatric surgery.
Materials and Methods
We recruited 4 men and 12 women with obesity and the experience of weight regain after bariatric surgery at an obesity clinic in Stockholm, Sweden. Data were collected during 2018–2019. We conducted a qualitative study, carried out individual semi-structured interviews, and analyzed the recorded and transcribed interview data with thematic analysis.
Results
Participants had regained 12 to 71% from their lowest weight after gastric bypass surgery performed 3 to 15 years before. They perceived their dietary challenges as overwhelming and had not expected weight management, meal patterns, increasing portion sizes, and appealing energy-dense foods to be problematic after surgery. In addition, difficulties with disordered eating patterns, emotional eating, and increased alcohol intake further contributed to the weight management hurdles. Insufficient nutritional knowledge and lack of support limited participants’ ability to avoid weight regain, leading to restrictive eating and dieting without sustained weight loss.
Conclusion
Eating behavior and dietary factors such as lack of nutritional knowledge, emotional eating, or disorganized meal patterns contribute to difficulties with weight management after gastric bypass surgery. Improved counseling may help patients prepare for possible weight regain and remaining challenges with food and eating. The results highlight the importance of regular medical nutrition therapy after gastric bypass surgery.
Graphical Abstract
... Weight loss was recorded at 1 year postop, 3-5 years postop, and > 5 years postop. As there is currently no standardized definition for weight recurrence, two previously used measurements were adapted for this patient population: > 15% increase from nadir postoperative weight and > 15% decrease from nadir %EWL [3,4,24,25]. Although both of these calculations have been used in prior research to define weight recurrence, they represent different levels of weight regain as 15% decrease from nadir %EWL is often a much lower amount of weight regain than > 15% increase from nadir postoperative weight. ...
Background
Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes.
Methods
Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups.
Results
Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41–2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72–1.35).
Conclusions
While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater weight recurrence among this population.
... Thus, increases in patients' non-nutritive, free-and added-sugar intake potentially explain some WR/IWL following MBS [24,25]. So far, there is no consensus on the relation between postoperative weight regain and levels of alcohol intake [26]. ...
Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.
... However, the participants varied in their post-surgery time, ranging from 4-38 months, with a mean of 15.5 so the ideal timing of psychological intervention is unknown [18]. As the mechanisms hypothesized to drive weight gain will take time to express as new obesogenic behaviours to target in therapy [19], therapies targeting post bariatric surgery patients may be more beneficial if given at a later stage. Multiple studies have established that 20-30% of patients regain weight within 24 months of surgery, unfortunately this is also when patients may be discharged from secondary care [20]. ...
Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. To test the feasibility and acceptability of ACT following bariatric surgery a randomised controlled trial of 10 sessions of group ACT or Usual Care Support Group control (SGC) was delivered 15-18 months post bariatric surgery (ISRCTN registry ID: ISRCTN52074801). Participants were compared at baseline, 3, 6 and 12 months using validated questionnaires to assess weight, wellbeing, and healthcare use. A nested, semi-structured interview study was conducted to understand acceptability of the trial and group processes. 80 participants were consented and randomised. Attendance was low for both groups. Only 9 (29%) ACT participants completed > = half of the sessions, this was the case for 13 (35%) SGC participants. Forty-six (57.5%) did not attend the first session. At 12 months, outcome data were available from 19 of the 38 receiving SGC, and from 13 of the 42 receiving ACT. Full datasets were collected for those who remained in the trial. Nine participants from each arm were interviewed. The main barriers to group attendance were travel difficulties and scheduling. Poor initial attendance led to reduced motivation to return. Participants reported a motivation to help others as a reason to join the trial; lack of attendance by peers removed this opportunity and led to further drop out. Participants who attended the ACT groups reported a range of benefits including behaviour change. We conclude that the trial processes were feasible, but that the ACT intervention was not acceptable as delivered. Our data suggest changes to recruitment and intervention delivery that would address this.
... Early adherence to postoperative follow-up was reported to be associated with less weight regain [25,26]. Our results indicated that early adherence is significantly correlated with less 5-year weight regain. ...
Background
Patients with morbid obesity exhibit sustained weight loss after sleeve gastrectomy (SG), but some individuals exhibit subsequent weight regain in the following years. Early weight loss was proven as a predictor of short- and mid-term weight loss and regain. However, the long-term effects of early weight loss have yet to be fully investigated. This study investigated the predictive effects of early weight loss on long-term weight loss and regain after SG.
Methods
Data of patients who underwent SG from November 2011 to July 2016 and followed through July 2021 were collected retrospectively. Weight regain was defined by weight increase more than 25% of their lost weight at the first postoperative year. Linear regression analysis and Cox proportional hazards analysis were performed to evaluate the correlations among early weight loss, weight loss, and weight regain.
Results
Data of 408 patients were included. The percentages of total weight loss (%TWL) at postoperative months 1, 3, 12, and 60 were 10.6%, 18.1%, 29.3%, and 26.6%, respectively. The %TWL at months 1 and 3 were significantly correlated with %TWL after 5 years (P < .01). The weight regain rate was 29.8% at 5 years. The %TWL at months 1 and 3 significantly influenced weight regain (hazard ratio: 0.87 and 0.89, P = .017 and .008).
Conclusion
Early weight loss may be used to predict weight loss and regain 5 years after SG. Patients with poor early weight loss are recommended to receive early interventions to achieve long-term weight loss and prevent weight regain.
Graphical abstract
... Post-operative anatomical changes, such as gastro-jejunal anastomosis (GJA) dilation, have been associated with weight regain after RYGB. In addition, genetic, psychological, nutritional, and behavioral factors play a role, making weight regain a multifactorial process [11,12]. Endoscopic therapy as well as several anti-obesity medications have already been used to manage post-bariatric surgery weight regain [13]. ...
About 1 in every 4 patients who undergo bariatric surgery regains significant amount of weight some time along their journey, posing it as a serious problem that needs to be addressed in a pandemic of obesity. Lifestyle modification, anti-obesity medications, and bariatric endoscopy are multiple therapeutic options that can be used to support any weight loss attempt. A 53-year-old woman with morbid obesity who responded adequately to gastric-bypass regained significant weight 8 years later. We initially approached her post-operative weight regain in a behavioral, pharmacologic non-invasive manner; however, she failed to appropriately respond to several anti-obesity medications. Upper endoscopy revealed a dilated gastric pouch and gastro-jejunal anastomosis (GJA) that was reduced using argon plasma coagulation (APC), but also with a modest response. We then added liraglutide to her APC endo-therapy sessions and subsequentially patient started losing significantly more weight. For selective post-bariatric surgery weight re-gainers, endoscopic and pharmaco-therapy combined may be needed for more effective results.
... However, these findings should be interpreted and discussed with caution since long-term data are not yet available for adults, and studies in adults with obesity who have undergone MBS have shown that many patients gain weight again after 3-10 years, regardless of the surgical method used [22]. ...
Obesity in childhood and adolescence remains a major global health problem, and especially the prevalence of morbid obesity is still rising in this age group. Similar to adults, the excess adipose tissue triggers multiple immunological and metabolic pathways, leading to serious comorbidities such as impaired glucose tolerance or type 2 diabetes (T2DM), dyslipidemia, arterial hypertension, nonalcoholic fatty liver disease (NAFLD), hyperuricemia, orthopedic problems, and psychological disorders (depression, eating disorders). These sequelae frequently start early in life and remain in adulthood. The therapy for childhood obesity should always start with a conservative approach offered by a multidisciplinary team, including a pediatrician, dietitian, psychologist, and physical therapist. Such a standardized lifestyle intervention program remains the most important treatment to reduce body weight and improve comorbidities. Unfortunately, though, even the best intervention programs reveal limited long-term success. Thus, the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee recommends metabolic bariatric surgery (MBS) in morbidly obese adolescents after failed conservative treatment to reduce the long-term risk of severe comorbidities causing end-organ damage. Adolescents with class II obesity [body mass index (BMI) of 120% of the 95th percentile] and one diagnosed comorbidity or with class III obesity (BMI 140% of 95th percentile) may be considered for MBS. Surgery should be performed in specialized centers with long-term follow-up programs. Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures, but laparoscopic sleeve gastrectomy (LSG) has gained wide academic acceptance and is increasingly employed. Available follow-up data reveal that MBS is a safe intervention also for adolescents and may significantly improve or even resolve major preexisting comorbidities. However, results should be interpreted with some caution as long-term results are not available yet. This chapter provides a summary of the current state of the art with respect to obesity in childhood and adolescence as well as available treatment options, including MBS.
... Weight loss < 20% is commonly defined as "surgical weight loss failure", patients with weight loss failure as "non-responders". Identification of relevant clinical risk factors associated with TWL failure and mechanisms underpinning poor response are important areas of research [5][6][7][8][9][10]. ...
Introduction
Parental predisposition and age of onset may be independently associated with 1-year total weight loss (TWL) failure (< 20%) after metabolic–bariatric surgery (MBS).
Methods
This cohort study includes all cases of the German StuDoQ|MBE register (2015–2019) with data on parental predisposition, obesity onset, and at least 1-year follow up after primary MBS procedures (n = 14,404). We provide descriptive statistics of the cohort in terms of the main outcome and 1-year TWL failure, and provide characteristics of surgery type subgroups. Finally, we provide a multivariate logistic regression model of 1-year TWL failure.
Results
58.8% and 45.7% of patients reported maternal and paternal predisposition for obesity, respectively. Average onset of obesity was 15.5 years and duration of disease 28.3 years prior to MBS. SG is the most frequently performed procedure (47.2%) followed by RYGB (39.7%) and OAGB (13.1%). Mean 1-year TWL is 32.7 ± 9.3%, and 7.8% (n = 1,119) of patients show TWL failure (< 20%). Multivariate analysis shows independent association of early onset of obesity (< 18 years), male sex, age at operation, pre-operative BMI, pre-operative weight loss, sleeve gastrectomy (SG), and type 2 diabetes (T2D) with 1-year TWL failure (p < 0.001).
Conclusion
The proportions of MBS patients that report on paternal and maternal predisposition for obesity are 45.7% and 58.8% respectively, and average age at onset is 15.5 years. 7.8% of patients do not meet current target criteria of successful response to surgery at 1 year. Early onset, male sex, age at operation, pre-operative BMI, pre-operative weight loss, SG, and T2D are independently associated with weight loss failure.
Graphical abstract
... Both conditions can be considered long-term complications of bariatric surgery compromising its positive effects and favoring the persistence or recurrence of comorbidities (i.e., diabetes mellitus and hypertension) with negative consequences on the patient's psychological and physical health [4,5]. A poor response following bariatric surgery is multifactorial, including surgical, hormonal, metabolic, mental, and lifestyle conditions that can contribute to its occurrence [6,7]. The management of these conditions is still unclear. ...
Purpose
Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition.
Methods
A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated.
Results
A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected.
Conclusion
Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.
... Another study has shown that blacks but not Hispanics have had a lower %EWL, compared to whites at 6 months after weight loss surgery. An interesting finding is that blacks have had a lower %EWL than Hispanics at every time point during the follow-up of patients [20]. The weight regain among different races varies, and it is evident even from the criteria for Bariatric/Metabolic Surgery in Europe, Asia, and the United States about BMI. ...
Weight regain (WR) after bariatric surgery (BS) is emerging as a common clinical problem due to the increase in the number of procedures performed worldwide. Weight regain is defined as regain of weight that occurs few years after the bariatric procedure and successful achievement of the initial weight loss. Causes of WR following BS are multifactorial and can be categorized into two main groups: patient and surgical-specific causes. Several mechanisms contribute to WR following BS. These include hormonal mechanisms, nutritional non-adherence, physical inactivity, mental health causes, maladaptive eating, surgical techniques, and the selection criteria for the weight loss procedure. Higher preoperative BMI seems to be associated with WR and worse weight loss results in a long term. Patients with baseline BMI ≥ 50 kg/m2 are more likely to have significant WR, while those with BMI < 50 are likely to continue losing weight at 12 months post-surgery. The aim of the chapter is to discuss and reveal all main factors, which may contribute to weight regain after bariatric surgery and emphasize how multifactorial assessment and long-term support/follow-up of patients by key medical professionals can diminish the side effects of weight regain.
... Food cravings may be exacerbated in cases of nutritional deficiencies, whereby the patient desires essential nutrients. Interestingly, food urges has been identified as one of the strongest predictors of weight regain (51) . ...
The clinical effectiveness of bariatric surgery has encouraged the use of bariatric procedures for the treatment of morbid obesity and its comorbidities with sleeve gastrectomy and Roux-en-Y Gastric Bypass being the most common procedures. Notwithstanding its success, bariatric procedures are recognized to predispose the development of nutritional deficiencies. A framework is proposed that provides clarity regarding the immediate role of diet, the gastrointestinal tract and the medical state of the patient in the development of nutritional deficiencies after bariatric surgery, while highlighting different enabling resources that may contribute. Untreated, these nutritional deficiencies can progress in the short term into haematological, muscular and neurological complications and in the long term into skeletal complications. In this review, we explore the development of nutritional deficiencies after bariatric surgery through a newly developed conceptual framework. An in-depth understanding will enable the optimization of the postoperative follow-up including detecting clinical signs of complications, screening for laboratory abnormalities and treatment of nutritional deficiencies.
... years [44]. The small amount of weight regain can also occur after bariatric surgery [45,46], but it can be prevented by pharmacotherapies [47]. The weight regain creates a challenge for healthcare providers' not only to formulate therapeutic recommendations but also to support their patients throughout the treatment process, especially during relapse phases. ...
Obesity is a global health problem with serious consequences such as diabetes, dyslipidemia, cardiovascular disease, infertility, and certain cancers. Excessive body weight, mainly due to its manifestation in the individual's appearance, also harms psychological condition. Therefore health care providers need to make an effort to diagnose and comprehensively threat of obesity. The obesity treatment should be systemic and carried out by a well-communicated therapeutic team consisting of a doctor, nurse, dietitian, psychologist/physiotherapist, and surgeon. The first line of obesity therapy is lifestyle modification and increased physical activity. Pharmacological treatment is recommended in all adult patients with BMI>30 kg/m2or BMI ≥ 27 kg/m2 with at least one obesity-related comorbid. Bariatric surgery should be considered for adults with BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with at least one obesity-related disease. The holistic model of obesity treatment also includes psychological therapy. The EASO recommends psychological assistance for all individuals with previous treatment failures. Adverse or harmful actions towards people with obesity, ascribing negative traits and behaviors to them, and marginalization in the public space are referred to as stigmatization of obesity. Stigmatization of people suffering from obesity is associated with reduced compassion and willingness to help, with feeling dislike and even anger towards this group of patients. The consequence of stigmatization is worse mental health, poorer physical health, avoidance of health care, and the persistence or increase of obesity. Therefore, talking about obesity according to the principles of "people first language", and the patient-centered care model is important.
Bariatric surgery (BS) is the most effective intervention for obesity, with proven significant weight loss, complications prevention, comorbidity remission, and improved survival. However, a substantial proportion of patients experience weight loss failure after BS. This review aims to provide an updated insight into weight loss failure after BS, define it, identify its prevalence, explain its health impact, determine risk factors, and summarize prevention and treatment. Future directives and larger-scale prospective studies should be considered to define weight regain (WR) and insufficient weight loss post bariatric surgery and address measures to resolve gaps and controversies.
Objective
Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post‐operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery.
Methods
PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts ( n = 891) were screened and coded by two raters.
Results
A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post‐operative instructions. Higher self‐efficacy was consistently predictive of better post‐operative adherence to diet and physical activity, while pre‐operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions.
Conclusions
This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.
በ2008 ዓ.ም ጥቅምት ወር መጀመሪያ አካባቢ በአንድ ዕለት ሌሊት ከፍተኛ የውሃ ጥም፣ በተደጋጋሚ ከፍተኛ መጠን ያለው ሽንት መሽናት፣ የሰውነት የድካም ስሜት፣ ብዥ የሚል ዕይታና የትኩረት ማጣት ችግሮች ተከሰቱብኝ፡፡ ዕለቱ እንደጠባ ጧት ሆስፒታል ሄድኩ የደም የስኳር መጠኔን ተመረመርኩ ምግብ ሳልወስድ 280 mg/dl ሆኖ አገኘሁት፡፡ በጣም የገረመኝ ከዚያ በፊት አንድም ቀን እንኳ ስለስኳር በሽታ አስቤ የቅድሚያ ምርመራ አለማድረጌ ነው፡፡ በወቅቱ የሰውነት ክብደቴ 82 ኪ.ግ ነበር፡፡ ቁመቴ 1 ሜትር ከ 65ሳ.ሜ ሲሆን በሰውነት ክብደት መረጃ ጠቋሚ መሰረት 30.12 ነበርኩ ማለት ነው፡፡ ይህም በሰውነት ክብደት ምደባዎች አማካኝነት ከልክ ያለፈ የሰውነት ውፍረት ነበረኝ ማለት ነው፡፡ ከምርመራ በኋላ ሁለት አይነት በአፍ የሚወሰዱ መድሃኒቶችን ማለትም ሜትፎርሚንና ዳይዎኔል የሚባሉትን መድሃኒቶችን እንድወስድ ሀኪሙ አዘዘልኝ፡፡ የታዘዙትን መድሃኒቶች ለ10 ተካታታይ ቀናት ወስጄ አቋረጥኩ፡፡ ምክንያቱም አዕምሮዬ በፍጹም የህይወት ዘመን የስኳር በሽተኛ መሆንን ሊቀበለው አልቻለም፡፡
በምትኩ በሳምንት 4 ቀናት ለአንድ ስዓት ያህል ጠንከር ያለ የአካል ብቃት እንቅስቃሴ ለ7 አመት ያለማቋረጥ መስራት ጀመርኩ፡፡ በተጨማሪም ዝቅተኛ የካሮቦሃይድሬት ይዘት ያላቸውን ምግቦች ብቻ መመገብ ጀመርኩ እንዲሁም አልፎ አልፎ ጧት ላይ ቁርስ መብላቴን አቆምኩ፡፡ ምንም አይነት አልኮሆል መጠጣቴን አቋረጥኩ፡፡ በዚህም ምክንያት የደም ስኳሬ መጠን እየተስተካከለ መጣ ከመነሻው ከ280 mg/dl ወደ 105 mg/dl ወይም 5.3% የሂሞግሎቢን ኤዋንሲ አማካኝ ውጤት ደረሰ፡፡ የሰውነቴ ክብደት በሰባት አመት ጊዜ ውስጥ 15 ኪ.ግ. በመቀነስ 67 ኪ.ግ. ደረሰ፡፡ አሁን የቀነስኩትንም ክብደት ሳይዋዠቅ በዘለቄታው አስጠብቄያለሁ፡፡ በዕየለቱ በውስጤ ደስታና ቀለል የሚል ስሜት እንዲሁም የበለጠ የሰውነት ብርታትና ጥንካሬ ይሰማኛል፡፡
ከዚሁ እንቅስቃሴ ጎን ለጎን ስለ ስኳር በሽታ ከኢንተርኔት ላይ መጽሃፍትን፣ የምርምር ወረቀቶችን፣ ቪዲዮዎችን ማንበብና ማዳመጥ ጀመርኩ፡፡ እነዚህን ሁሉ መረጃዎች ሳገናዝብ የሁለተኛው አይነት የስኳር በሽታ ሊድን የሚችል በሽታ እንደሆነና በርካታ ሰዎችም ከበሽታው እንደተፈወሱ ብዙ መረጃዎችን ለማየት ሞከርኩ፡፡ በዚህ ረገድ አሜሪካን ሀገር በብሪገሀም ያንግ ዩኒቨርሲቲ የባዮኤነርጅቲክስ ፕሮፌሰር የሆኑትን ፕሮፌሰር ቤንጃሚን ቢክማን በኢንሱሊን መቋቋም ላይ በማተኮር የሜታቦሊክ መዛባቶችን እንዴት እንደሚያሰከትል በታዋቂ ጆርናሎች ላይ ያሳተሙትን የምርምር ውጤት እነዲሁም በዚሁ ችግር ዙሪያ የጻፉትን Why We Get Sick የተሰኘውን መጽሃፍ ወደ አማርኛ “ለምን እንታመማለን” በሚል ርዕስ ለመተርጎም ወሰንኩ፡፡ ይህ መጽሃፍ አማዞን በተሰኘው የድረ ገጽ መጽሃፍ መደብር ውሰጥ ከፍተኛ ሽያጭ ያሰገኘ ሲሆን እኔም ለኢትዮጵያዊያን ወገኖቼ በሚረዱት ቋንቋ ቢቀርብላቸው በርካቶች እንደእኔ ሊጠቀሙበት ይችላሉ ብዬ በማሰብ ለመተርጎም ችያለሁ፡፡
መጽሐፉ የኢንሱሊን የመቋቋም ችግር እንደ ሥር የሰደዱ በሽታዎች ዋነኛ መንስኤ መሆኑን ለመረዳት ልዩ የሆነ ጠንካራ አስተዋጽዖ አለው፡፡ የኢንሱሊን መቋቋም ችግር በአጠቃላይ በሰውነት ውስጥ ያሉትን ሁሉንም ስርዓቶች እንዴት እንደሚነካ አጠቃላይ እና በርዕሰ ጉዳዩ ላይ አስፈላጊ የሆነ መረጃ የሚሰጥ መጽሐፍ ነው። በዚህ ረገድ ዶ/ር ቢክማን የኢንሱሊን መቋቋም ችግር እንዴት እና ለምን እንደሚፈጠር ለመረዳት ቀላል መመሪያን ብቻ ሳይሆን በኔ ግንዛቤ የሕክምና መመሪያ የሆነ መጽሃፍ አቅርበዋል። ሳይንቲስቱ ካንሰርን፣ የስኳር በሽታን እና የአልዛይመርን በሽታን ጨምሮ በርካታ ዋና ዋና በሽታዎችን ከአንድ የተለመደ መንስኤ ማለትም የኢንሱሊን መቋቋም ጋር የሚያገናኘውን አስደናቂ ማስረጃ ገልጿል እናም እሱን ለመቀልበስ እና ለመከላከል ቀላል እና ውጤታማ እቅድ አዘጋጅቷል።
ስለሆነም ለኢትዮጵያዊያን ወገኖቼ መግለጽ የምፈልገው ይህ መጽሃፍ የእኔን ተስፋና ህይወት ቀይሮታል በዚህም መሰረት ይህ ችግር ያለባቸውን ሰዎች ህይወት ይቀይራል ብየ በጽኑ አምናለሁ፡፡
ዶ/ር ዘውዱ ወንዲፍራው
There are several psychological and behavioral factors associated with poorer outcomes following bariatric surgery, yet it is unknown whether and how these factors may differ by race. In this cross-sectional study, individuals who underwent bariatric surgery from 2018 to 2021 and up to 4 years post-surgery were invited to complete an online survey. Psychiatric symptoms, maladaptive eating patterns, self-monitoring behaviors, and exercise frequency were examined. Participants (N = 733) were 87% women, 63% White, with a mean age of 44 years. Analyses of covariance demonstrated that White individuals endorsed greater anxiety symptoms (p =.01) and emotional eating due to depression (p = .01), whereas Black individuals endorsed greater depression severity (p = .02). Logistic regression analyses demonstrated that White individuals were more likely to experience loss of control eating (OR= 1.7, p = .002), grazing (OR= 2.53, p <.001), and regular self-weighing (OR= 1.41, p <.001) than Black individuals, and were less likely to skip meals (OR= .61, p = .04), or partake in nighttime eating (OR= .40, p <.001). There were no racial differences in binge eating, emotional eating due to anxiety or frustration, use of a food diary, or exercise. Thus, depressive symptoms, skipping meals, and nighttime eating may be important, modifiable intervention targets to optimize the benefits of bariatric surgery and promote equitable outcomes.
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case‐managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case‐managing interventions, with or without the support of e‐Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse‐led case‐managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient‐centered care models were found to promote adherence to treatment and patient satisfaction. E‐Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long‐term outcomes after surgery remained unclear. Nurse‐led case‐management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient‐centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long‐term effects on weight maintenance.
In recent years, the prevalence of obesity has been increasing. Obese patients can be treated with medication, diet, exercise, and bariatric surgery. Studies on bariatric surgery have mostly focused on the physiological aspect of the surgery, with little attention paid to its psychological effects. There are a limited number of national and international studies that investigate eating behaviors and depression after bariatric surgery together. This descriptive and correlational study aimed to determine the correlation between eating behaviors and depression levels of patients after bariatric surgery. The study was conducted at Fırat University Hospital General Surgery Outpatient Clinic between July 2018 and August 2019. The population of the study was 1,000 adult patients. The sample consisted of 278 patients determined by the power analysis. The Descriptive Characteristics Form was used to determine the descriptive characteristics of the patients, the Dutch Eating Behavior Questionnaire to determine the patients' eating behaviors, and the Beck Depression Inventory to determine their depression levels. Data was gathered through face-to-face interviews at least 1 month after the surgery. The data was assessed using percent distribution, arithmetic mean, and Pearson's correlation analysis. The eating behaviors of the participants were found to be high (104.38 ± 10.29), while their depression levels were low (17.87 ± 7.71). It was determined that there was a positive and weak correlation between the patients' eating behaviors and depression levels, which was statistically significant ( r = 0.190, P = 0.002). Consequently, it was determined that the eating behaviors of the patients improved, and their depression levels were low. Furthermore, as the patients' depression levels increased, so did their eating behaviors. To improve the mental health of patients after bariatric surgery, we must identify mental problems and develop solutions. We suggest that nurses plan training to help patients regulate their eating behaviors and reduce their depression levels. [ Psychiatr Ann . 2023;53(8):374–380.]
የተርጓሚው ማስታወሻ
በ2008 ዓ.ም ጥቅምት ወር መጀመሪያ አካባቢ በአንድ ዕለት ሌሊት ከፍተኛ የውሃ ጥም፣ በተደጋጋሚ ከፍተኛ መጠን ያለው ሽንት መሽናት፣ የሰውነት የድካም ስሜት፣ ብዥ የሚል ዕይታና የትኩረት ማጣት ችግሮች ተከሰቱብኝ፡፡ ዕለቱ እንደጠባ ጧት ሆስፒታል ሄድኩ የደም የስኳር መጠኔን ተመረመርኩ ምግብ ሳልወስድ 280 mg/dl ሆኖ አገኘሁት፡፡ በጣም የገረመኝ ከዚያ በፊት አንድም ቀን እንኳ ስለስኳር በሽታ አስቤ የቅድሚያ ምርመራ አለማድረጌ ነው፡፡ በወቅቱ የሰውነት ክብደቴ 82 ኪ.ግ ነበር፡፡ ቁመቴ 1 ሜትር ከ 65ሳ.ሜ ሲሆን በሰውነት ክብደት መረጃ ጠቋሚ መሰረት 30.12 ነበርኩ ማለት ነው፡፡ ይህም በሰውነት ክብደት ምደባዎች አማካኝነት ከልክ ያለፈ የሰውነት ውፍረት ነበረኝ ማለት ነው፡፡ ከምርመራ በኋላ ሁለት አይነት በአፍ የሚወሰዱ መድሃኒቶችን ማለትም ሜትፎርሚንና ዳይዎኔል የሚባሉትን መድሃኒቶችን እንድወስድ ሀኪሙ አዘዘልኝ፡፡ የታዘዙትን መድሃኒቶች ለ10 ተካታታይ ቀናት ወስጄ አቋረጥኩ፡፡ ምክንያቱም አዕምሮዬ በፍጹም የህይወት ዘመን የስኳር በሽተኛ መሆንን ሊቀበለው አልቻለም፡፡
በምትኩ በሳምንት 4 ቀናት ለአንድ ስዓት ያህል ጠንከር ያለ የአካል ብቃት እንቅስቃሴ ለ7 አመት ያለማቋረጥ መስራት ጀመርኩ፡፡ በተጨማሪም ዝቅተኛ የካሮቦሃይድሬት ይዘት ያላቸውን ምግቦች ብቻ መመገብ ጀመርኩ እንዲሁም አልፎ አልፎ ጧት ላይ ቁርስ መብላቴን አቆምኩ፡፡ ምንም አይነት አልኮሆል መጠጣቴን አቋረጥኩ፡፡ በዚህም ምክንያት የደም ስኳሬ መጠን እየተስተካከለ መጣ ከመነሻው ከ280 mg/dl ወደ 105 mg/dl ወይም 5.3% የሂሞግሎቢን ኤዋንሲ አማካኝ ውጤት ደረሰ፡፡ የሰውነቴ ክብደት በሰባት አመት ጊዜ ውስጥ 15 ኪ.ግ. በመቀነስ 67 ኪ.ግ. ደረሰ፡፡ አሁን የቀነስኩትንም ክብደት ሳይዋዠቅ በዘለቄታው አስጠብቄያለሁ፡፡ በዕየለቱ በውስጤ ደስታና ቀለል የሚል ስሜት እንዲሁም የበለጠ የሰውነት ብርታትና ጥንካሬ ይሰማኛል፡፡
ከዚሁ እንቅስቃሴ ጎን ለጎን ስለ ስኳር በሽታ ከኢንተርኔት ላይ መጽሃፍትን፣ የምርምር ወረቀቶችን፣ ቪዲዮዎችን ማንበብና ማዳመጥ ጀመርኩ፡፡ እነዚህን ሁሉ መረጃዎች ሳገናዝብ የሁለተኛው አይነት የስኳር በሽታ ሊድን የሚችል በሽታ እንደሆነና በርካታ ሰዎችም ከበሽታው እንደተፈወሱ ብዙ መረጃዎችን ለማየት ሞከርኩ፡፡ በዚህ ረገድ አሜሪካን ሀገር በብሪገሀም ያንግ ዩኒቨርሲቲ የባዮኤነርጅቲክስ ፕሮፌሰር የሆኑትን ፕሮፌሰር ቤንጃሚን ቢክማን በኢንሱሊን መቋቋም ላይ በማተኮር የሜታቦሊክ መዛባቶችን እንዴት እንደሚያሰከትል በታዋቂ ጆርናሎች ላይ ያሳተሙትን የምርምር ውጤት እነዲሁም በዚሁ ችግር ዙሪያ የጻፉትን Why We Get Sick የተሰኘውን መጽሃፍ ወደ አማርኛ “ለምን እንታመማለን” በሚል ርዕስ ለመተርጎም ወሰንኩ፡፡ ይህ መጽሃፍ አማዞን በተሰኘው የድረ ገጽ መጽሃፍ መደብር ውሰጥ ከፍተኛ ሽያጭ ያሰገኘ ሲሆን እኔም ለኢትዮጵያዊያን ወገኖቼ በሚረዱት ቋንቋ ቢቀርብላቸው በርካቶች እንደእኔ ሊጠቀሙበት ይችላሉ ብዬ በማሰብ ለመተርጎም ችያለሁ፡፡
መጽሐፉ የኢንሱሊን የመቋቋም ችግር እንደ ሥር የሰደዱ በሽታዎች ዋነኛ መንስኤ መሆኑን ለመረዳት ልዩ የሆነ ጠንካራ አስተዋጽዖ አለው፡፡ የኢንሱሊን መቋቋም ችግር በአጠቃላይ በሰውነት ውስጥ ያሉትን ሁሉንም ስርዓቶች እንዴት እንደሚነካ አጠቃላይ እና በርዕሰ ጉዳዩ ላይ አስፈላጊ የሆነ መረጃ የሚሰጥ መጽሐፍ ነው። በዚህ ረገድ ዶ/ር ቢክማን የኢንሱሊን መቋቋም ችግር እንዴት እና ለምን እንደሚፈጠር ለመረዳት ቀላል መመሪያን ብቻ ሳይሆን በኔ ግንዛቤ የሕክምና መመሪያ የሆነ መጽሃፍ አቅርበዋል። ሳይንቲስቱ ካንሰርን፣ የስኳር በሽታን እና የአልዛይመርን በሽታን ጨምሮ በርካታ ዋና ዋና በሽታዎችን ከአንድ የተለመደ መንስኤ ማለትም የኢንሱሊን መቋቋም ጋር የሚያገናኘውን አስደናቂ ማስረጃ ገልጿል እናም እሱን ለመቀልበስ እና ለመከላከል ቀላል እና ውጤታማ እቅድ አዘጋጅቷል።
ስለሆነም ለኢትዮጵያዊያን ወገኖቼ መግለጽ የምፈልገው ይህ መጽሃፍ የእኔን ተስፋና ህይወት ቀይሮታል በዚህም መሰረት ይህ ችግር ያለባቸውን ሰዎች ህይወት ይቀይራል ብየ በጽኑ አምናለሁ፡፡
ዶ/ር ዘውዱ ወንዲፍራው
Background
Multidisciplinary approaches to weight loss have been shown to improve outcomes in bariatric patients. Few studies have been performed assessing the utility and compliance of fitness tracking devices after bariatric surgery. We aim to determine whether use of an activity tracking device assists bariatric patients in improving postoperative weight loss behaviors.
Methods
A fitness wearable was offered to patients undergoing bariatric surgery from 2019 to 2022. A telephone survey was conducted to elucidate the impact of the device on the patient’s postoperative weight loss efforts 6 to 12 months after surgery. Weight loss outcomes of sleeve gastrectomy (SG) patients receiving the fitness wearable (FW) were compared to those of a group of SG patients who did not receive one (non-FW).
Results
Thirty-seven patients were given a fitness wearable, 20 of whom responded to our telephone survey. Five patients reported not using the device and were excluded. 88.2% reported that using the device had a positive impact on their overall lifestyle. Patients felt that using the fitness wearable to keeping track of their progress helped them both to achieve short-term fitness goals and sustain them in the long run. From the patients that utilized the device, 44.4% of those that discontinued felt like it helped them build a routine that they maintained even after they were no longer using it. Demographic data between FW and non-FW groups (age, sex, CCI, initial BMI, and surgery BMI) did not differ significantly. The FW group trended towards greater %EWL at 1 year post-operation (65.2% versus 52.4%, p = 0.066) and had significantly greater %TWL at 1 year post-operation (30.3% versus 22.3%, p = 0.02).
Conclusion
The use of an activity tracking device enhances a patient’s post-bariatric surgery experience, serving to keep patients informed and motivated, and leading to improved activity that may translate to better weight loss outcomes.
Biliopancreatic diversion with duodenal switch (BPDDS), along with gastric bypass (RYGBP), is among the surgical techniques leading to weight loss and its maintenance over time. As with any surgical technique, BPDDS outcomes are more satisfactory when a patient undergoes regular multidisciplinary follow-up after surgery. Twenty percent of bariatric patients achieve <50% excess weight loss after surgery, largely due to psychological issues regarding general psychopathology (for instance, depression and anxiety); dysfunctional eating behaviors (DEB) like binges, food addictions, and emotional eating; as well as some personality traits where impulsivity is a central phenomenon. Despite that no studies designed specifically to compare the efficacy of different psychotherapeutic approaches for patients undergoing BPDDS are available to date, insights from studies on the behavioral treatment of obesity may shed light on the alternatives available to such patients. The present chapter discusses diverse psychotherapeutic approaches aiming at losing and maintaining weight and/or controlling DEB, which may be helpful to patients undergoing BPDDS. Such approaches comprise cognitive behavioral therapy, interpersonal psychotherapy, mindfulness, and strategies based on emotion regulation, such as dialectical behavior therapy.KeywordsPsychotherapyCognitive behavioral therapyInterpersonal psychotherapyMindfulnessDialectical behavior therapyBiliopancreatic diversion with duodenal switch
Aim:
This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery.
Methods:
This mixed-method study (survey and semi-structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed.
Results:
This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two-thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'.
Conclusion:
This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.
Objectives:
Over the past decades, China has seen a dramatic epidemic of overweight and obesity. However, the optimal period for interventions to prevent overweight/obesity in adulthood remains unclear, and little is known regarding the joint effect of sociodemographic factors on weight gain. We aimed to investigate the associations of weight gain with sociodemographic factors, including age, sex, educational level, and income.
Study design:
This was a longitudinal cohort study.
Methods:
This study included 121,865 participants aged 18-74 years from the Kailuan study who attended health examinations over the period 2006-2019. Multivariate logistic regression and restricted cubic spline were used to evaluate the associations of sociodemographic factors with body mass index (BMI) category transitions over two, six, and 10 years.
Results:
In the analysis of 10-year BMI changes, the youngest age group had the highest risks of shifting to higher BMI categories, with odds ratio of 2.42 (95% confidence interval 2.12-2.77) for a transition from underweight or normal weight to overweight or obesity and 2.85 (95% confidence interval 2.17-3.75) for a transition from overweight to obesity. Compared with baseline age, education level was less related to these changes, whereas gender and income were not significantly associated with these transitions. Restricted cubic spline analyses suggested reverse J-shaped associations of age with these transitions.
Conclusions:
The risk of weight gain in Chinese adults is age dependent, and clear public healthcare messaging is needed for young adults who are at the highest risk of weight gain.
Purpose of Review
Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain.
Recent Findings
Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy.
Summary
Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
Bariatric surgery is an extremely effective treatment for severe and complex obesity. However, changes are dramatic and rapid and therefore, it is a psychologically demanding intervention even for patients who experience very positive outcomes. A person’s weight and eating history, past attempts to lose weight, and self-efficacy will influence the decision to have weight loss surgery. Past dieting “failure” can result in desperation and the belief that weight loss is not possible by any other means. The complex relationship between mental health and obesity also impacts on a person’s ability to make lifestyle changes. There is a wide range of adjustments to be made postoperatively as a result of the significant changes to eating, weight, identity, and coping. Difficulties can occur with each of these issues and therefore, appropriate detection and provision of psychological support is required. Better understanding of factors which previously led to, and maintained, obesity and postoperative issues may help to improve outcome for the significant minority of patients who either regain weight or have other adjustment difficulties. Health professionals need to have a greater understanding of the range of psychological and social factors influencing outcome.
Background:
Data-driven tools can be designed to provide patient-personalized estimates of health outcomes. Clinical calculators are commonly built to assess risk, but potential benefits of treatment should be equally considered. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to create a risk and benefit calculator for adult patients considering primary metabolic and bariatric surgery with multiple prediction features: (1) 30-day risk, (2) 1-year body mass index (BMI) projections, and (3) 1-year co-morbidity remission.
Objective:
To assess the performance of the 1-year BMI projections feature of this tool.
Setting:
Not-for-profit organization, clinical data registry.
Methods:
MBSAQIP data from 596,024 cases across 4.5 years from 882 centers with ∼2.5 million records through 18 months postoperatively were included. A generalized estimating equation model was used to estimate BMI over time for 4 primary procedures: laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch.
Results:
The mean absolute error (MAE) in BMI predictions through postoperative month 12 was 1.68 units; overall correlation of actual and predicted BMI was .94. MAE of postoperative BMI estimates (1-12 mo) was lowest for laparoscopic sleeve gastrectomy (1.64) and highest for biliopancreatic diversion with duodenal switch (1.99). BMI predictions at 12 months showed MAE = 2.99 units.
Conclusions:
Predicted BMI closely aligned with actual BMI values across the 12-month postoperative period. The MBSAQIP Bariatric Surgical Risk/Benefit Calculator is publicly available with the intent to facilitate patient-clinician communication and guide surgical decision making. This tool can aid in evaluating postoperative risk as well as benefits and long-term expectations.
Zusammenfassung
Hintergrund Die Intention dieses Artikels ist, einen Überblick über die Diagnosestellung und Therapiemöglichkeiten bei erneuter Gewichtszunahme (WR) oder unzureichendem Gewichtsverlust (IWL) nach bariatrischer Operation (BS) zu geben. Bei weiter steigenden Zahlen der BS gewinnt WR immer mehr an Relevanz.
Methoden Eine ausgiebige Literaturrecherche wurde mit persönlichen Erfahrungen kombiniert, um eine mögliche Handlungsempfehlung bei WR oder IWL zu geben.
Ergebnisse Im Falle einer anatomischen Ursache für WR ist der chirurgische Therapieansatz derzeit am effektivsten. Bei idiopathischem WR oder IWL ist ein multimodales Therapiekonzept für eine erfolgreiche Therapie notwendig. Abhängig von der vorangegangenen OP ist eine Kombination von Lebensstilinterventionen, medikamentöser und chirurgischer Therapie ein wirksames Vorgehen.
Schlussfolgerungen Eine ausgiebige Diagnostik ist vor Indikationsstellung einer chirurgischen Revision notwendig. Bei idiopathischem WR und IWL nach Roux-Y-Magenbypass (RYGB) schlagen wir die Verlängerung des biliopankreatischen Schenkels bei gleichzeitiger Verkürzung des Common Channels vor. Nach Schlauchmagen (Sleeve-Gastrektomie, SG) sehen wir derzeit die Umwandlung in RYGB bei Patienten mit gleichzeitiger Refluxösophagitis und den SADI-S bei fehlendem Vorliegen eines Refluxes als sinnvollste Therapie an.
The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.
This study identified predictors of weight gain versus continued maintenance among individuals already successful at long-term weight loss. Weight, behavior, and psychological information was collected on entry into the study and 1 year later. Thirty-five percent gained weight over the year of follow-up, and 59% maintained their weight losses. Risk factors for weight regain included more recent weight losses (less than 2 years vs. 2 years or more), larger weight losses (greater than 30% of maximum weight vs. less than 30%), and higher levels of depression, dietary disinhibition, and binge eating levels at entry into the registry. Over the year of follow-up, gainers reported greater decreases in energy expenditure and greater increases in percentage of calories from fat. Gainers also reported greater decreases in restraint and increases in hunger, dietary disinhibition, and binge eating. This study suggests that several years of successful weight maintenance increase the probability of future weight maintenance and that weight regain is due at least in part to failure to maintain behavior changes.
Investigating the validity of the self-reported values of weight allows for the proper assessment of studies using questionnaire-derived data. The study examined the accuracy of gender-specific self-reported weight in a sample of adults. The effects of age, education, race and ethnicity, income, general health and medical status on the degree of discrepancy (the difference between self-reported weight and measured weight) are similarly considered.
The analysis used data from the US Third National Health and Nutrition Examination Survey. Self-reported and measured weights were abstracted and analyzed according to sex, age, measured weight, self-reported weight, and body mass index (BMI). A proportional odds model was applied.
The weight discrepancy was positively associated with age, and negatively associated with measured weight and BMI. Ordered logistic regression modeling showed age, race-ethnicity, education, and BMI to be associated with the degree of discrepancy in both sexes. In men, additional predictors were consumption of more than 100 cigarettes and the desire to change weight. In women, marital status, income, activity level, and the number of months since the last doctor's visit were important.
Predictors of the degree of weight discrepancy are gender-specific, and require careful consideration when examined.
Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
Controversy exists regarding the effectiveness of surgery for weight loss and the resulting improvement in health-related outcomes.
To perform a meta-analysis of effectiveness and adverse events associated with surgical treatment of obesity.
MEDLINE, EMBASE, Cochrane Controlled Trials Register, and systematic reviews.
Randomized, controlled trials; observational studies; and case series reporting on surgical treatment of obesity.
Information about study design, procedure, population, comorbid conditions, and adverse events.
The authors assessed 147 studies. Of these, 89 contributed to the weight loss analysis, 134 contributed to the mortality analysis, and 128 contributed to the complications analysis. The authors identified 1 large, matched cohort analysis that reported greater weight loss with surgery than with medical treatment in individuals with an average body mass index (BMI) of 40 kg/m2 or greater. Surgery resulted in a weight loss of 20 to 30 kg, which was maintained for up to 10 years and was accompanied by improvements in some comorbid conditions. For BMIs of 35 to 39 kg/m2, data from case series strongly support superiority of surgery but cannot be considered conclusive. Gastric bypass procedures result in more weight loss than gastroplasty. Bariatric procedures in current use (gastric bypass, laparoscopic adjustable gastric band, vertical banded gastroplasty, and biliopancreatic diversion and switch) have been performed with an overall mortality rate of less than 1%. Adverse events occur in about 20% of cases. A laparoscopic approach results in fewer wound complications than an open approach.
Only a few controlled trials were available for analysis. Heterogeneity was seen among studies, and publication bias is possible.
Surgery is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with a BMI of 40 kg/m2 or greater. More data are needed to determine the efficacy of surgery relative to nonsurgical therapy for less severely obese people. Procedures differ in efficacy and incidence of complications.
Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality.
The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%).
The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29).
Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.
Social stress resulting from dominant-subordinate relationships is associated with body weight loss and altered body composition in subordinate (SUB) male rats. Here, we extend these findings to determine whether stress-induced changes in energy homeostasis persist when the social stress is removed, and the animal is allowed to recover. We examined body weight (BW), body composition, and relevant endocrine measures after one or two cycles of 14 days of social stress, each followed by 21 days of recovery in each rat's individual home cage. SUB lost significantly more BW during social housing in a visible burrow system (VBS) compared with dominant (DOM) animals. Weight loss during social stress was attributable to a decrease in adipose tissue in DOM and SUB, with an additional loss of lean tissue in SUB. During both 21-day recovery periods, DOM and SUB regained lost BW, but only SUB were hyperphagic. Following recovery, SUB had a relatively larger increase in adipose tissue and plasma leptin compared with DOM, indicating that body composition changes were dependent on social status. Control animals that were weight matched to SUB or male rats exposed to the VBS environment without females, and that did not form a social hierarchy, did not exhibit changes in body composition like SUB in the VBS. Therefore, chronic social stress causes social status-dependent changes in BW, composition and endocrine measures that persist after repeated stress and recovery cycles and that may ultimately lead to metabolic disorders and obesity.
Attending support group meetings has been linked to increased weight loss after gastric bypass surgery. However, the degree to which support group attendance influences weight loss is still unclear. This study quantitatively described the association between support group attendance and weight loss after Roux-en-Y gastric bypass.
The weight loss data and support group attendance of 78 consecutive Roux-en-Y gastric bypass patients were studied retrospectively. The patients were analyzed in 2 groups: those who attended >5 monthly support group meetings (group A) compared with those who went to < or =5 support group meetings (group B). The data from the first 12 months after surgery were analyzed.
Group A achieved a mean percentage of excess weight loss of 10.5% at 2 weeks after surgery, 21.4% at 6 weeks, 30.9% at 3 months, 45.4% at 6 months, 53.6% at 9 months, and 55.5% at 12 months. Group B achieved a mean percentage of excess weight loss of 11.3% at 2 weeks, 21.8% at 6 weeks, 31.8% at 3 months, 41.3% at 6 months, 45.2% at 9 months, and 47.1% at 12 months. The differences between the 2 groups were significant at P <0.05 at 9 and 12 months. The weight loss was nonlinear and slowed as patients approached 1 year after surgery.
Support groups are important for maintaining weight loss throughout the first year after surgery, especially after 6 months when the rate of weight loss from surgery begins to naturally decline. The amount of postoperative weight loss was greater than, or comparable to, the published data. Implementing regular support groups within the postoperative follow-up care may provide patients with the best chances of achieving maximal weight loss.
Severe obesity (ie, at least 100% overweight or body mass index > or =40 kg/m2) is associated with significant morbidity and increased mortality. It is apparently becoming more common in this country. Conventional weight-loss treatments are usually ineffective for severe obesity and bariatric surgery is recommended as a treatment option. However, longitudinal data on the long-term outcome of bariatric surgery are sparse. Available data indicate that the outcome of bariatric surgery, although usually favorable in the short term, is variable and weight regain sometimes occurs at 2 years after surgery. The objective of this study is to present a review of the outcome of bariatric surgery in three areas: weight loss and improvement in health status, changes in eating behavior, and psychosocial adjustment. The study will also review how eating behavior, energy metabolism, and psychosocial functioning may affect the outcome of bariatric surgery. Suggestions for additional research in these areas are made.
Literature review.
On average, most patients lose 60% of excess weight after gastric bypass and 40% after vertical banded gastroplasty. In about 30% of patients, weight regain occurs at 18 months to 2 years after surgery. Binge eating behavior, which is common among the morbidly obese, may recur after surgery and is associated with weight regain. Energy metabolism may affect the outcome of bariatric surgery, but it has not been systematically studied in this population. Presurgery psychosocial functioning does not seem to affect the outcome of surgery, and psychosocial outcome is generally encouraging over the short term, but there are reports of poor adjustment after weight loss, including alcohol abuse and suicide.
Factors leading to poor outcome of bariatric surgery, such as binge eating and lowered energy metabolism, should be studied to improve patient selection and outcome. Long-term outcome data on psychosocial functioning are lacking. Longitudinal studies to examine the long-term outcome of bariatric surgery and the prognostic indicators are needed.
While Roux-en-Y gastric bypass (RYGBP) appears to be the most effective procedure for weight loss in morbidly obese patients, objective outcome data regarding quality of life (QoL) and psychosocial status following surgery are lacking.
The present study examined the effects of RYGBP in 32 morbidly obese subjects on a variety of outcome measures including QoL and psychosocial functioning. Assessments were conducted before surgery, 1 to 3 weeks post-surgery, and at 6-month follow-up.
In addition to weight loss, results show significant improvements in health-related QoL, depression, and self-esteem, as well as a significant reduction in eating pathology following surgery. Results also show that neither the presence of binge-eating disorder nor clinical depression predicted poorer outcome post-surgery.
RYGBP results in a dramatic reduction in weight, and marked improvements in health-related QoL, depression, self-esteem, and eating pathology, including binge-eating in the short term. These findings need to be replicated in a larger cohort of patients and followed for a longer time before we can reach more definitive conclusions regarding the psychosocial outcome in RYGBP.
The effect of gastric bypass on the health-related quality of life (HRQoL) of morbidly obese patients was investigated in a cross-sectional study.
A postoperative group of 78 patients on average 13.8 years after gastric bypass was compared with a preoperative control group of 110 patients. The SF-36 was used to assess HRQoL. In preoperative patients, the SF-36 was self-administered, while in the postoperative group, telephone interviews were conducted. In the postoperative sample, multiple stepwise linear regression analyses were carried out to examine putative predictors of the physical (PCS) and the mental (MCS) composite scores of the SF-36.
Significant differences between the pre-and postoperative group were found for all subscales except Mental Health, in favor of the postoperative group. On average 13.8 years after gastric bypass, most of the sub-scales were similar to the US norm values. However, the Bodily Pain and the overall Physical Composite scale (PCS) scores were lower (more impaired) in the postoperative group compared with the US norms. Female patients, patients who were hospitalized since the surgery, and those who had lost less weight had more impaired values on the PCS and patients who reported binge-eating disorder (BED) at follow-up had more impaired values on the Mental Composite Scale (MCS) of the SF-36.
HRQoL was significantly better in postoperative gastric bypass patients in comparison to a sample of preoperative patients. However, HRQoL, specifically the physical domain of the SF-36, was more impaired in long-term follow-up patients compared with US norm values. The reoccurrence of BED after surgery negatively influenced the mental domain of the SF-36.
Behavioral treatment for obesity seeks to identify and modify eating, activity, and thinking habits that contribute to patients' weight problems. This approach recognizes that body weight is affected by factors other than behavior, which include genetic, metabolic, and hormonal influences. Behavioral treatment helps obese individuals develop a set of skills (eg, a low-fat diet, a high-activity lifestyle, realistic expectations) to regulate weight, even though patients may remain overweight after treatment. This article describes the behavioral treatment of obesity, its short- and long-term results, and methods to improve long-term weight loss.
About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.
To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).
Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.
A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).
A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.
Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.
This article reviews the behavioral treatment of obesity, its short- and long-term results, and methods to improve long-term weight loss. The terms "behavioral treatment," "lifestyle modification," and "behavioral weight control" are often used interchangeably.
Non-compliant patients fail to match their behavior to the clinical prescription. Laparoscopic adjustable gastric banding requires strict compliance with surgical and dietary advice. Failure to attend follow-up appointments and the persistent consumption of calorie-dense liquid foods are associated with poor weight loss and postoperative complications. Prediction of "poor compliers" would enhance candidate selection and enable specific interventions to be targeted.
9 poor compliers were identified and compared with 9 fully compliant controls. Case-notes were analyzed retrospectively.
Cases were found to graze on foods and eat more in response to negative affects. They were reluctant to undergo psychiatric assessment, viewed the band as responsible for weight loss, and aroused caution in the psychiatric evaluator. Poor compliance was not associated with binge eating, purging, impulsivity or psychiatric illness.
Unrealistic expectations and anxiety are known to predict non-adherence. Constant negative affects may be self-modulated by grazing. The results are explored in the context of Self-efficacy Theory, a socio-cognitive account of illness behavior.
Bariatric surgery has become an increasingly popular treatment option for individuals with extreme obesity (defined as a BMI > or = 40 kg/m2) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes. This paper reviews the literature on the preoperative psychosocial status, eating behaviors, and quality of life of patients who seek bariatric surgery. In addition, the paper examines studies that investigated changes in these factors postoperatively. The review concludes with an agenda for future research in this area.
The metabolic syndrome is the fastest growing disease entity in the world. Prevention and effective treatment emphasize lifestyle intervention, including healthful diet, physical activity, and pharmacologic agents to target specific risk factors. Weight loss improves all aspects of the metabolic syndrome and is a primary intervention target. Effective weight management also helps prevent the development of the metabolic syndrome. Lifestyle change strategies--including setting reasonable goals, raising awareness, confronting barriers to change, managing stress, cognitive restructuring, preventing relapse, and providing support--are the keys to long-term success.
The authors investigated the predictive value of various parameters such as age, preoperative weight, eating behavior, psychiatric disorders, adverse childhood experiences and self-efficacy with regard to weight loss after gastric restrictive surgery.
After a minimum follow-up of 30 months (median follow-up 50 months; range 30-84 months), a questionnaire concerning extent of, satisfaction with, and consequences of weight loss was mailed to 220 morbidly obese female patients following laparoscopic Swedish adjustable gastric banding (SAGB).
Questionnaires were completed and returned by 140 patients (63%). Average BMI loss was 14.6 kg/m(2). Most patients (85%) were happy with the extent of weight loss. Satisfaction with weight loss showed a significant correlation with extent of weight loss. BMI loss was greatest in the obese with an atypical eating disorder (20.0 kg/m(2)), and BMI loss was least in the obese with no eating-disordered behavior before surgery (13.4 kg/m(2)). Obese patients with two or more psychiatric disorders showed significantly less weight loss than did obese patients with one or no psychiatric disorder (BMI units 10.8 vs 14.0 vs 16.1; P=.047).
The findings indicate a less successful outcome for obese patients with psychiatric disorders (particularly adjustment disorders, depression and/or personality disorders), compared to patients not mentally ill. An eating disorder preceding surgery, however, was not a negative predictor of success following bariatric surgery. To improve outcome of bariatric surgery in obese patients with psychiatric disorders, more individual psychosocial intervention strategies are necessary.
Loss of follow-up is a concern when tracking long-term clinical outcomes after bariatric surgery. The results of patients who are "lost to follow-up" are not known. After bariatric surgery, the lack of follow-up may result in less weight loss for patients. This study investigated the hypothesis that there are differences between patients who do not automatically return for their annual follow-up and those that do return. Patients who were greater than 14 months postoperative after laparoscopic gastric bypass were contacted if they had not returned for their annual appointment. They were seen in clinic and/or a phone interview was performed for follow-up. These patients (Group A) were compared with patients who returned to see us for their annual appointment (Group B) without us having to notify them. There were 105 consecutive patients, with 48 patients who did not automatically return for their annual appointment. Only six of these patients could not ultimately be contacted. There was no difference in preoperative body mass index between the two groups. Percentage excess body weight loss was greater in Group B (76 vs. 65%; P < 0.003). More patients had successful weight loss (defined as within 50% of ideal body weight) in Group B (50 [88%] vs. 28 [67%]; P < 0.02). We found that a significant number of patients will not comply with regular follow-up care after laparoscopic gastric bypass unless they are prompted to do so by their bariatric clinic. These patients have worse clinical outcome (i.e., less weight loss). Caution should be taken when examining the results of any bariatric study where there is a significant loss to follow-up.
The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years. This review will summarize historic and contemporary bariatric surgical techniques, including gastric bypass (open and laparoscopic), laparoscopic adjustable gastric banding, and biliopancreatic diversion (with or without duodenal switch). Data are presented on bariatric surgery outcomes, focusing on weight loss and obesity-related comorbidities. We also review possible complications from surgery. Bariatric surgery patients undergo many dramatic lifestyle changes, and comprehensive presurgical screening conducted by a multidisciplinary team is important to prepare patients for the numerous changes necessary for successful outcome. In addition, comprehensive presurgical screening can aid the treatment team in identifying patients who would benefit from additional services prior to or following surgery. Further research focused on presurgical variables that predict outcome-especially the longer term outcome-of bariatric surgery is needed. At present, approximately 1% of eligible individuals with morbid obesity receive bariatric surgery. In addition, there appears to be inequity in access to weight loss surgery. Given the accumulating evidence that bariatric surgery is efficacious in producing significant and durable weight loss, improving obesity-related comorbidities, and extending survival, the U.S. healthcare system should examine ways to improve access to this treatment for obesity.
The obesity epidemic has been recognized in the professional and lay public as a major health problem in the United States and many other cultures. The gastroenterology literature has recently paid attention to this problem, focusing primarily on either physiological mechanisms of obesity or surgical remedies for obesity. However, behavioral strategies developed from social learning theory have been the most thoroughly tested interventions for the treatment of obesity, as well as the interventions shown most clearly to have clinical benefit. Nevertheless, descriptions of behavioral techniques and their theoretical underpinnings have been minimal in the gastroenterology literature. Here, a brief history and presentation of the theoretical underpinnings of behavioral strategies for obesity management is summarized, emphasizing some of the key components, treatment effectiveness data, and needed areas for further research. Overall, it is concluded that behavior therapy is both the most studied and most effective therapy for treating obesity at present. Gastroenterologists are encouraged to use it as a first line of treatment for most obese patients, and as a key component of therapies that involve pharmacologic and surgical components.
Relatively few studies have focused on who is at risk for weight regain after weight loss and how to prevent it. The objectives of this study were to determine the prevalence and predictors of weight regain in U.S. adults who had experienced substantial weight loss.
Data were analyzed from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). This study examined U.S. adults aged 20-84 years who were overweight or obese at their maximum weight (body mass index >/=25) and had experienced substantial weight loss (weighed 10% less than their maximum weight 1 year before they were surveyed) (n=1310).
Compared to their weight 1 year ago, 7.6% had continued to lose weight (>5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (>5%). Factors associated with weight regain (vs weight maintenance or loss) included Mexican American ethnicity (versus non-Hispanic white) (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.3-3.1), losing a greater percentage of maximum weight (>/=20% vs 10% to <15%) (OR=2.8; 95% CI=2.0-4.1), having fewer years since reaching maximum weight (2-5 years vs >10 years) (OR=2.1; 95% CI=1.2-3.7), reporting greater daily screen time (>/=4 hours vs 0-1 hour) (OR=2.0; 95% CI=1.3-3.2), and attempting to control weight (OR=1.8; 95% CI=1.1-3.0). Finally, weight regain was higher in those who were sedentary (OR=1.8; 95% CI=1.0-3.0) or not meeting public health recommendations for physical activity (OR=2.0; 95% CI=1.2-3.5).
How to achieve the skills necessary for long-term maintenance of weight loss in the context of an obesogenic environment remains a challenge.
Morbid obesity is the leading public health crisis in the United States, with bariatric surgery as the only effective and enduring treatment for this disease. a concern has been raised, that, postoperatively, alcohol metabolism might be altered in gastric bypass patients. We hypothesized that alcohol metabolism in the postoperative gastric bypass patient would be altered.
Of 36 subjects, 17 control and 19 postgastric bypass subjects each consumed 5 oz of red wine. They underwent an alcohol breath analysis every 5 minutes. The outcomes recorded included symptoms, initial peak alcohol breath level, and the time for alcohol breath levels to normalize.
The gastric bypass group was on average 10 years older and had a greater weight and body mass index than the control group. The average time after gastric bypass was 2 years, with an average body mass index loss of 18 kg/m(2) (51 kg/m(2) before versus 33 kg/m(2) after). The gastric bypass patients had a peak alcohol breath level of 0.08% and the controls had a level of 0.05%. The gastric bypass group needed, on average, 108 minutes to reach an alcohol breath level of 0; the control group reached this level after an average of 72 minutes. Both groups showed a similar postingestion symptom profile.
In this study, alcohol metabolism was significantly different between the postgastric bypass and control subjects. Although the gastric bypass patients' had a greater peak alcohol level and a longer time for the alcohol level to reach 0 than the controls, the gastric bypass group did not experience more symptoms than the control group. These findings provide caution regarding alcohol use by gastric bypass patients.
Support group meetings (SGM) are assumed to be an integral part of success after bariatric surgery. This investigation studies the effect of SGM on weight loss as well as factors associated with attendance of SGM. It is our hypothesis that patients who attend SGM (ASGM) lose more weight than those patients who do not attend SGM (NASGM).
Postoperative bariatric patients completed a questionnaire regarding their opinions of SGM. Change in body mass index (BMI) was computed for each patient. The patients were then divided into two groups: ASGM and NASGM for data comparison.
There were 46 patients in the investigation. Patients in the NASGM group tended to feel that SGM are not needed after bariatric surgery compared to the ASGM group (5.29 vs. 7.06; p = 0.07). Patients in the NASGM group tended to feel that they would lose the same amount of weight with or without attending SGM compared to the ASGM group (5.67 vs. 7.38; p = 0.07). There were no differences in distance to clinic nor in time to clinic between both groups. Gastric bypass patients in the ASGM group had a statistically significantly higher percent decrease in BMI than the patients in the NASGM group (42% vs. 32%; p < 0.03).
Patients in the ASGM group lose more weight than patients in the NASGM group. The importance of attending SGM should be incorporated in preoperative patient counseling and encouraged during postoperative follow-up visits.
Addictions after bariatric surgery retrieved
- P R Schauer
- K Ashton
Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery
- M De Zwaan
- K L Lancaster
- J E Mitchell
- M Zwaan de
Changes in alcohol sensitivity and effects with gastric bypass
- C K Buffington
- D L Daley
- M Warthen
- CK Buffington
Psychosocial predictors of weight loss after bariatric surgery
- J F Kinzl
- M Schrattenecker
- C Traweger
- JF Kinzl
Behavioral assessment of candidates for bariatric surgery: a patient oriented approach
- T A Wadden
- D B Sarwer
- TA Wadden