Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes

BACKGROUND A patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. Research has focused on implementing digital technologies and measuring their effectiveness in various surgical cohorts, yet there is limited work concerning the desires, suggestions and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patient perspectives on technology features that would support them to change their lifestyle behaviours during the pre- and post-operative periods, to potentially maintain long-term healthy lifestyles following surgery. OBJECTIVE To understand how digital technologies could be used to better support patients across the perioperative pathway to improve weight-loss outcomes and surgical success. Specifically, the objectives concerned: 1) what do patients want from digital technologies, 2) how do they want to use them, and 3) when would they be of most benefit during their surgical journey? METHODS Patients attending bariatric surgery clinics within one hospital in the North of England were invited to take part. Semi-structured interviews were conducted with purposively sampled pre- and post-operative bariatric surgical patients to discuss lifestyle behaviour change and the use of digital technologies to complement their care. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the NHS Health Research Authority. RESULTS Twenty patients were interviewed. Four overarching themes were developed from the data relating to perspectives of optimised technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal-setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs. Interventions that supported the delivery of personalized feedback and post-operative follow-up were perceived as beneficial. Individualized goal- and target-setting could further support a generation of digitally engaged patients with bariatric conditions. Working towards achievable targets was deemed an effective strategy to successfully motivate behaviour change. The creation of digital ‘package of care’ checklists between patients and clinicians was a novel finding from this research. CONCLUSIONS Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made that relate to the design, content and functionality of digital interventions to best address the needs of this patient cohort. These findings have the potential to influence future co-design and integration of person-centered, perioperative technologies within surgical pathways. CLINICALTRIAL N/A

Download Full-text

Abstract #240 Weight Loss Trajectory Following Randomization to Bariatric Surgery on Long-Term Diabetes Outcomes

Endocrine Practice ◽

10.1016/s1530-891x(20)47086-7 ◽

2018 ◽

Vol 24 ◽

pp. 49

Author(s):

Keren Zhou ◽

Kathy Wolski ◽

Ali Aminian ◽

Steven Malin ◽

Philip Schauer ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Diabetes Outcomes ◽

Trajectory Following

Download Full-text

Long-Term Weight Loss and Psychological Functioning in Bariatric Surgery Patients

PsycEXTRA Dataset ◽

10.1037/e659392012-001 ◽

2012 ◽

Author(s):

Leslie M. Schuh ◽

David B. Creel ◽

Joseph Stote ◽

Katharine Hudson ◽

Karen K. Saules ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Psychological Functioning

Download Full-text

Long-Term Iron and Vitamin B12 Deficiency Are Present after Bariatric Surgery, Despite the Widespread Use of Supplements

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094541 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4541

Author(s):

Mauro Lombardo ◽

Arianna Franchi ◽

Roberto Biolcati Rinaldi ◽

Gianluca Rizzo ◽

Monica D’Adamo ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Vitamin B12 ◽

Vitamin B12 Deficiency ◽

Ideal Body Weight ◽

Excess Weight ◽

Nutritional Deficiencies ◽

Average Percentage ◽

Nutritional Studies

There are few long-term nutritional studies in subjects undergoing bariatric surgery that have assessed weight regain and nutritional deficiencies. In this study, we report data 8 years after surgery on weight loss, use of dietary supplements and deficit of micronutrients in a cohort of patients from five centres in central and northern Italy. The study group consisted of 52 subjects (age: 38.1 ± 10.6 y, 42 females): 16 patients had Roux-en-Y gastric bypass (RYGB), 25 patients had sleeve gastrectomy (SG) and 11 subjects had adjustable gastric banding (AGB). All three bariatric procedures led to sustained weight loss: the average percentage excess weight loss, defined as weight loss divided by excess weight based on ideal body weight, was 60.6% ± 32.3. Despite good adherence to prescribed supplements, 80.7% of subjects (72.7%, AGB; 76.7%, SG; 93.8 %, RYGB) reported at least one nutritional deficiency: iron (F 64.3% vs. M 30%), vitamin B12 (F 16.6% vs. M 10%), calcium (F 33.3% vs. M 0%) and vitamin D (F 38.1% vs. M 60%). Long-term nutritional deficiencies were greater than the general population among men for iron and among women for vitamin B12.

Download Full-text

Grazing Behavior Hinders Weight Loss in Long-Term Post Bariatric Surgery: a Cross-Sectional Study

Obesity Surgery ◽

10.1007/s11695-021-05533-4 ◽

2021 ◽

Author(s):

Larissa Cristina Lins Berber ◽

Mariana Silva Melendez-Araújo ◽

Eduardo Yoshio Nakano ◽

Kênia Mara Baiocchi de Carvalho ◽

Eliane Said Dutra

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Grazing Behavior ◽

Post Bariatric Surgery

Download Full-text

Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2012/753472 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Miral Subhani ◽

Kaleem Rizvon ◽

Paul Mustacchia

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Abdominal Pain ◽

Drug Therapy ◽

Upper Gastrointestinal Bleeding ◽

Comorbid Conditions ◽

Endoscopic Evaluation ◽

Number Of Patients ◽

Upper Gastrointestinal

Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

Download Full-text

Abstract P161: Variation in Five-Year Weight Loss Patterns Following Bariatric Surgery by Insurance Status

Circulation ◽

10.1161/circ.135.suppl_1.p161 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Erin Takemoto ◽

Bruce Wolfe ◽

Corey Nagel ◽

Janne Boone-Heinonen

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Parameter Estimates ◽

Similar Amount ◽

Group Model ◽

Specific Patient ◽

Group 6 ◽

Medicaid Beneficiaries ◽

Trajectory Models

In the general population, bariatric surgery facilitates sustained weight loss and remission of comorbidities (e.g., CVD). The effectiveness among Medicaid beneficiaries, a population with a disproportionately high burden of obesity, remains unclear. We sought to determine if patterns of weight change following bariatric surgery differed in patients with Medicaid compared to commercial insurance. Data were obtained from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery (2006-2009) at one of 6 geographically diverse centers. We used group-based trajectory models (PROC TRAJ, SAS) to identify discrete groups of individuals with similar weight trajectories over 5-years; we considered cubic trajectory models with between 1 and 6 groups. We selected the 6-group model based on Bayesian Information Criteria, visual fit and statistical significance of parameter estimates. We tested demographic predictors against trajectory group membership; Medicaid (n=174) vs. Commercial (n=991) was our primary predictor of interest. Medicaid participants had higher mean weight at baseline compared to the commercially insured (307.9 vs. 291.2 lbs), but lost a similar amount of weight over time (74.8 vs 85.0 lbs). All groups experienced the most weight loss in year 1 (Figure). Group 6 was the heaviest at baseline and began to regain weight after year 1; groups 1-5 continued to lose weight through year 2. Group’s 1 & 2 weight remained stable over 5 years while groups 3-6 began to slowly regain weight. Medicaid beneficiaries were more likely to be in group 4 (OR 3.2, 95% CI: 1.2, 8.6), group 5 (OR 5.7, 95% CI: 2.0, 16.1) and group 6 (OR 7.9, 95% CI: 2.5, 25.1) compared to group 1. Medicaid beneficiaries experience substantial long term weight loss. However, they had higher baseline weight and tended to be in groups with less long-term weight loss compared to the commercially insured. Focusing on tailored interventions to specific patient groups could help maintain weight loss.

Download Full-text

Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

Dubai Diabetes and Endocrinology Journal ◽

10.1159/000518856 ◽

2021 ◽

pp. 1-7

Author(s):

Manish Khaitan ◽

Riddhish Gadani ◽

Koshish Nandan Pokharel

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Complete Remission ◽

Predictive Factors ◽

Indian Population ◽

Diabetes Remission ◽

Obese Patients ◽

Sustained Weight Loss

Objectives: The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. Methods: Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s t test and ANOVA and McNemar’s test were applied. Results: Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (n = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (p = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. Conclusion: Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

Download Full-text

Sleeve Gastrectomy vs. Fundus Resection in Bariatric Surgery (Animal Study)

Shiraz E-Medical Journal ◽

10.5812/semj.95198 ◽

2020 ◽

Vol 21 (6) ◽

Author(s):

Alimohammad Bananzadeh ◽

Seyed Vahid Hosseini ◽

Hajar Khazraei ◽

Mohammad Mehdi Lashkarizadeh ◽

Leila Ghahramani ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Sleeve Gastrectomy ◽

Body Weight Loss ◽

Test Results ◽

Significant Difference ◽

Before And After ◽

Total Ghrelin ◽

The Difference ◽

High Level

Background: Bariatric surgery has resulted in body weight loss, which claimed by surgery removal specific parts of the stomach with enzyme or sleeve gastrectomy. Objectives: The aim of this study is to determine weight loss and endocrine changes by 12-week fundus resection and sleeve gastrectomy in rabbits. Methods: Twenty-one rabbits, weighing 2.5 - 3.5 kg, were divided into three groups (n = 7): sleeve gastrectomy, experimental fundus resection, and sham group. The weight of rabbits and total ghrelin and leptin levels in the plasma before and after surgery were measured in 12 weeks. Statistical analyses were performed using the Kruskal-Walis test for comparison of the means between the groups, and the difference after months in one group was assayed by Friedman test. Results: The results showed sleeve gastrectomy had a significant weight loss after one month when compared to fundus resection and sham-operated controls (P = 0.008). There was no significant difference in the ghrelin levels after these surgeries, but leptin levels decreased significantly after the fundectomy (P = 0.025). Conclusions: Sleeve gastrectomy is more efficient than the fundus resection in weight loss. It could be suggested as a new option in metabolic disorders due to the high level of leptin.

Download Full-text