Rethinking Eligibility Criteria for Bariatric Surgery

JAMA ◽  
2014 ◽  
Vol 312 (9) ◽  
pp. 953 ◽  
Author(s):  
Justin B. Dimick ◽  
Nancy J. Birkmeyer
Keyword(s):  
Bariatric Surgery ◽  
Eligibility Criteria

scholarly journals The Effect of Bariatric Surgery on Weight Loss and Metabolic Changes in Adults with Obesity

2020 ◽  
Vol 17 (15) ◽  
pp. 5342
Author(s):  
Stanisław Głuszek ◽  
Arkadiusz Bociek ◽  
Edyta Suliga ◽  
Jarosław Matykiewicz ◽  
Magdalena Kołomańska ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Metabolic Changes ◽  
Metabolic Parameters ◽  
Lipoprotein Cholesterol ◽  
Excess Body Weight ◽  
Eligibility Criteria

Methods of treating obesity, such as changes in lifestyle, physical activity, restrictive diets, and psychotherapy, are not sufficient. Currently, it is considered that in the case of patients who meet the eligibility criteria for surgery, the treatment of choice should be bariatric surgery. The aim of this study was to assess the weight loss and metabolic changes in a group of adults with obesity undergoing bariatric surgery. The study involved 163 patients whose body mass index (BMI) exceeded 40 or 35 kg/m2, concurrent with at least one metabolic sequelae. In 120 of the cases (74%), sleeve gastrectomy was used; in 35 (21%), gastric banding was used; and in 8 (5%), laparoscopic Roux-en-Y gastric bypass was used. Metabolic parameters such as total cholesterol, LDL-cholesterol (low-density lipoprotein cholesterol), HDL-cholesterol (high-density lipoprotein cholesterol), triglycerides, and glucose were measured preoperatively and postoperatively, as well as the creatinine, creatine kinase (CK-MB), and leptin activity. In patients undergoing bariatric surgery, a significant decrease in excess weight (p < 0.001) was observed at all the analyzed time points, compared to the pre-surgery value. Weight loss after surgery was associated with a significant improvement in glycemia (109.6 ± 48.0 vs. 86.6 ± 7.9 mg/dL >24 months after surgery; p = 0.003), triglycerides (156.9 ± 79.6 vs. 112.7 ± 44.3 mg/dL >24 months after surgery; p = 0.043) and leptin (197.50 ± 257.3 vs. 75.98 ± 117.7 pg/mL 12 months after surgery; p = 0.0116) concentration. The results of the research confirm the thesis on the effectiveness of bariatric surgery in reducing excess body weight and improving metabolic parameters in patients with extreme obesity.

scholarly journals Population estimates and characteristics of Australians potentially eligible for bariatric surgery: findings from the 2011–13 Australian Health Survey

2018 ◽  
Vol 42 (4) ◽  
pp. 429 ◽  
Author(s):  
Melanie J. Sharman ◽  
Monique C. Breslin ◽  
Alexandr Kuzminov ◽  
Andrew J. Palmer ◽  
Leigh Blizzard ◽  
...  
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Population Estimates ◽  
Eligibility Criteria ◽  
The Public ◽  
Australian Health ◽  
Potential Demand ◽  
Patient Prioritisation

Objective The aim of the present study was to determine the potential demand for publicly and privately funded bariatric surgery in Australia. Methods Nationally representative data from the 2011–13 Australian Health Survey were used to estimate the numbers and characteristics of Australians meeting specific eligibility criteria as recommended in National Health and Medical Research Council guidelines for the management of overweight and obesity. Results Of the 3 352 037 adult Australians (aged 18–65 years) estimated to be obese in 2011–13, 882 441 (26.3%; 95% confidence interval (CI) 23.0–29.6) were potentially eligible for bariatric surgery (accounting for 6.2% (95% CI 5.4–7.1) of the adult population aged 18–65 years (n = 14 122 020)). Of these, 396 856 (45.0%; 95% CI 40.4–49.5) had Class 3 obesity (body mass index (BMI) ≥40 kg m–2), 470945 (53.4%; 95% CI 49.0–57.7) had Class 2 obesity (BMI 35–39.9 kg m–2) with obesity-related comorbidities or risk factors and 14 640 (1.7%; 95% CI 0.6–2.7) had Class 1 obesity (BMI 30–34.9 kg m–2) with poorly controlled type 2 diabetes and increased cardiovascular risk; 458 869 (52.0%; 95% CI 46.4–57.6) were female, 404 594 (45.8%; 95% CI 37.3–54.4) had no private health insurance and 309 983 (35.1%; 95% CI 28.8–41.4) resided outside a major city. Conclusion Even if only 5% of Australian adults estimated to be eligible for bariatric surgery sought this intervention, the demand, particularly in the public health system and outside major cities, would far outstrip current capacity. Better guidance on patient prioritisation and greater resourcing of public surgery are needed. What is known about this topic? In the period 2011–13, 4 million Australian adults were estimated to be obese, with obesity disproportionately more prevalent in areas of socioeconomic disadvantage. Bariatric surgery is considered to be cost-effective and the most effective treatment for adults with obesity, but is mainly privately funded in Australia (>90%), with 16 650 primary privately funded procedures performed in 2015. The extent to which the supply of bariatric surgery is falling short of demand in Australia is unknown. What does this paper add? The present study provides important information for health service planners. For the first time, population estimates and characteristics of those potentially eligible for bariatric surgery in Australia have been described based on the best available evidence, using categories that best approximate the national recommended eligibility criteria. What are the implications for practitioners? Even if only 5% of those estimated to be potentially eligible for bariatric surgery in Australia sought a surgical pathway (44 122 of 882 441), the potential demand, particularly in the public health system and outside major cities, would still far outstrip current capacity, underscoring the immediate need for better guidance on patient prioritisation. The findings of the present study provide a strong signal that more funding of public surgery and other effective interventions to assist this population group are necessary.

scholarly journals An unusual case of a completely eroded gastric band and port tubing removed via endoscopy alone

2019 ◽  
Vol 101 (2) ◽  
pp. e48-e51
Author(s):  
G Kourounis ◽  
R Pearson ◽  
D McArthur ◽  
S Gibson
Keyword(s):  
Bariatric Surgery ◽  
Gastric Band ◽  
Multidisciplinary Care ◽  
Band Erosion ◽  
Endoscopic Removal ◽  
Hernia Surgery ◽  
Eligibility Criteria ◽  
First Case ◽  
Management Of Complications ◽  
The Uk

Bariatric surgery is an established intervention providing significant health benefits to patients with obesity. As a result, the National Institute for Health and Care Excellence now recommends bariatric surgery for those that fulfil the eligibility criteria, while emphasising the need for multidisciplinary care before and after surgery. The UK National Bariatric Surgery Registry shows gastric band procedures to be the second most common bariatric procedure performed in the UK. Gastric band erosion is a known potential complication treated primarily by laparoscopic removal of band and repair of stomach. To our knowledge, we present the first case of a partially eroded gastric band with separate gastric fistulation of the port tubing. The band was removed via endoscopy without the need for a cutaneous exploration as the port had previously been removed at incisional hernia surgery. Owing to the fact that the tubing and band were both evident within the lumen of the stomach, complete band erosion was inferred and therefore endoscopic removal thought to be indicated. In actual fact, there was separate erosion of the band and tubing; more specifically, the gastric band clasp had not eroded fully and while endoscopic removal was still possible, it was challenging and required the band to be divided. This case highlights the importance of careful patient selection, involvement of multidisciplinary care prior and after surgery and close follow-up to facilitate timely identification and management of complications.

scholarly journals The Development of Feeding and Eating Disorders after Bariatric Surgery: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2396
Author(s):  
João Victor Taba ◽  
Milena Oliveira Suzuki ◽  
Fernanda Sayuri do Nascimento ◽  
Leandro Ryuchi Iuamoto ◽  
Wu Tu Hsing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Eating Disorders ◽  
Eating Disorder ◽  
Literature Review ◽  
Postoperative Period ◽  
Meta Analysis ◽  
Qualitative Synthesis ◽  
Eligibility Criteria ◽  
Feeding And Eating Disorders

Background: Patients in the postoperative period following bariatric surgery are at risk of developing eating disorders. This study aims to analyze the relation between bariatric surgery and the development and recurrence of eating disorders. Material and methods: A literature review was carried out on 15 November 2020. Fourteen studies that met the eligibility criteria were included for qualitative synthesis, and 7 studies for meta-analysis. Results: The prevalence of eating disorders in the postoperative period was 7.83%, based on the 7 studies in the meta-analysis. Binge eating disorder alone was 3.81%, which was the most significant factor, and addressed in 6 of these studies. Conclusion: The investigated studies have significant methodological limitations in assessing the relation between bariatric surgery and eating disorders, since they mostly present data on prevalence. PROSPERO CRD42019135614.

scholarly journals Cross-Sectional Analysis of Attitudes Towards Bariatric Surgery Tourism of Patients Attending a Weight Management Program: A Qualitative Study

2018 ◽  
Vol 6 (3) ◽  
pp. 100-109
Author(s):  
Paul Joonkoo Choi ◽  
Ryan Terrence Pereira ◽  
Áine Killeen ◽  
Gerard Thomas Flaherty
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Surgical Intervention ◽  
Management Program ◽  
Structured Interviews ◽  
Upward Trend ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Bariatric Patients ◽  
Sectional Analysis

Introduction: The upward trend of seeking bariatric surgery tourism will only grow with the globalization of medical care. We aim to describe the experiences participants of a supervised weight loss program in relation to their pursuit of bariatric tourism. Methods: Semi-structured interviews with an unbiased questionnaire were conducted to obtain a profound understanding of the current Irish bariatric surgery recruitment program and bariatric patients’ perception of it. Results: Analysis of interview data yielded 5 themes. Each theme was elaborated further with selected quotes from the coding process. Participants were asked to suggest potential solutions to current bariatric surgery and tourism support concerns in Ireland. Authors’ recommendations based on a literature review and the analysis of the interview transcripts are also provided. Conclusion: Any patients with morbid obesity and many years of attempted weight loss should receive a bariatric procedure to alleviate not only weight-related metabolic co-morbidities, but also the associated psychiatric burden. The currently available eligibility criteria and the lack of resources render an ideal surgical intervention inaccessible to many. Efforts must be made to scrutinize the efficacy of the existing criteria and the availability of resources. Alternatively, a bariatric tourism scheme that allows uninterrupted patient care should be developed.

scholarly journals The Development of Feeding and Eating Disorders after Bariatric Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
João Victor Taba ◽  
Milena Oliveira Suzuki ◽  
Fernanda Sayuri do Nascimento ◽  
Leandro Ryuchi Iuamoto ◽  
Wu Tu Hsing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Eating Disorders ◽  
Eating Disorder ◽  
Literature Review ◽  
Postoperative Period ◽  
Meta Analysis ◽  
Qualitative Synthesis ◽  
Eligibility Criteria ◽  
Feeding And Eating Disorders

Background: Patients in the postoperative period following bariatric surgery are at risk of developing eating disorders. This study aims to analyse the relation between bariatric surgery and the development and recurrence of eating disorders. Material and methods: Literature review was done on 15th November 2020. Fourteen studies that met the eligibility criteria were included for qualitative synthesis, and 7 studies for meta-analysis. Results: The prevalence of eating disorders in the postoperative period was 7.83%, based on the 7 studies in the meta-analysis. Binge eating disorder alone was 3.81%, which was the most significant factor, and addressed in 6 of these studies. Conclusion: The investigated studies have significant methodological limitations in assessing the relation between bariatric surgery and eating disorders, since they mostly present data on prevalence. PROSPERO CRD42019135614.

scholarly journals Evaluation of Current Eligibility Criteria for Bariatric Surgery: Diabetes prevention and risk factor changes in the Swedish Obese Subjects (SOS) study

Diabetes Care ◽  
2013 ◽  
Vol 36 (5) ◽  
pp. 1335-1340 ◽  
Author(s):  
K. Sjoholm ◽  
A. Anveden ◽  
M. Peltonen ◽  
P. Jacobson ◽  
S. Romeo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Risk Factor ◽  
Diabetes Prevention ◽  
Eligibility Criteria ◽  
Obese Subjects

scholarly journals Metabolomic signatures after bariatric surgery – a systematic review

2021 ◽  
Author(s):  
Matilde Vaz ◽  
Sofia S. Pereira ◽  
Mariana P. Monteiro
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Diabetes Remission ◽  
The Body ◽  
Therapeutic Interventions ◽  
Eligibility Criteria ◽  
Type 2 Diabetes Remission ◽  
Meta Analyses

AbstractMetabolomics emerged as an important tool to gain insights on how the body responds to therapeutic interventions. Bariatric surgery is the most effective treatment for severe obesity and obesity-related co-morbidities. Our aim was to conduct a systematic review of the available data on metabolomics profiles that characterize patients submitted to different bariatric surgery procedures, which could be useful to predict clinical outcomes including weight loss and type 2 diabetes remission. For that, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines were followed. Data from forty-seven original study reports addressing metabolomics profiles induced by bariatric surgery that met eligibility criteria were compiled and summarized. Amino acids, lipids, energy-related and gut microbiota-related were the metabolite classes most influenced by bariatric surgery. Among these, higher pre-operative levels of specific lipids including phospholipids, long-chain fatty acids and bile acids were associated with post-operative T2D remission. As conclusion, metabolite profiling could become a useful tool to predict long term response to different bariatric surgery procedures, allowing more personalized interventions and improved healthcare resources allocation.

scholarly journals Probiotics Can Further Reduce Waist Circumference in Adults with Morbid Obesity after Bariatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Yu Zhang ◽  
Tong Yan ◽  
Chenxin Xu ◽  
Huawu Yang ◽  
Tongtong Zhang ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Waist Circumference ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Eligibility Criteria ◽  
Randomized Controlled ◽  
Central Registry ◽  
Significant Difference

Whether probiotics could be used as an adjunct to bariatric surgery is controversial. This meta-analysis aimed to evaluate the effects of probiotics on body weight, body mass index (BMI), percentage of the excess weight loss (%EWL), waist circumference (WC), and C-reactive protein (CRP) in adults with obesity after bariatric surgery (BS). PUBMED, EMBASE, and the Cochrane Central Registry of Controlled Trials were searched from the earliest record to March 2020. All randomized controlled trials (RCTs) on the effects of probiotics in adults with obesity after bariatric surgery were analyzed according to the eligibility criteria. Four RCTs, including 172 participants, were analyzed. There was a statistically significant difference in probiotics in the reduction of waist circumference at 12 months after bariatric surgery. However, probiotics were not effective in weight, BMI, %EWL, WC, and CRP both within 3 months and at 12 months postoperation. Probiotics aid adults with morbid obesity in achieving further waist circumference improvement after BS, with no significant effect on weight, BMI, %EWL, and CRP. More quality clinical studies are needed to confirm the efficacy and safety of probiotics, and address a number of practical issues before the routine clinical use of probiotics in adults with obesity undergoing BS.

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