Psychological Diagnoses and Weight Loss among Appalachian Bariatric Surgery Patients

Background. The relationship between presurgical psychopathology and weight loss following bariatric surgery is complex; previous research has yielded mixed results. The current study investigates the relationship among presurgical mental health diagnoses, symptom severity, and weight loss outcomes in an Appalachian population, where obesity-related comorbidities are prominent. Methods. A retrospective chart review was performed on bariatric surgery patients in an accredited Appalachian centered academic hospital in northern West Virginia between 2013 and 2015 (n = 347). Data extraction included basic demographics, anthropometrics (percent excess weight loss (%EWL)) at six-month, one-year, and two-year postoperative visits, and two validated psychological questionnaires (Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI)) from patient’s presurgical psychological evaluation. Results. Average patient population was 92.5% Caucasian, 81.5% female, 45 ± 11.5 years old, and 84.1% who underwent laparoscopic Roux-en-Y gastric bypass surgery with the remaining having laparoscopic sleeve gastrectomy. At baseline, no differences were detected in weight, excess body weight, or body mass index between surgery types. Average baseline BDI-II score was 10.1 ± 8.68 (range 0–41) and BAI score was 6.1 ± 6.7 (range 0–36), and this was not significantly different by surgery at baseline. Both baseline psychological scores were in the “minimal” severity range. BDI-II was positively related to BMI of patients at baseline (p=0.01). Both BDI-II and BAI were not significantly related to %EWL across follow-up. Conclusion. Other than baseline weight, BDI-II and BAI scores were not related to %EWL outcomes in patients receiving bariatric surgery in the Appalachian region. Future work should examine mixed methods approaches to capture prospective and longitudinal data to more thoroughly delve into mental health aspects of our Appalachian patients and improve efforts to recapture postoperative patients who may have been lost to follow-up.

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Outcomes of Bariatric Surgery in Morbidly Obese Patients with Multiple Sclerosis

Journal of Obesity ◽

10.1155/2017/1935204 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Kalman Bencsath ◽

Adham Jammoul ◽

Ali Aminian ◽

Hideharu Shimizu ◽

Carolyn J. Fisher ◽

...

Keyword(s):

Multiple Sclerosis ◽

Bariatric Surgery ◽

Weight Loss ◽

Excess Weight ◽

Control Group ◽

Morbidly Obese ◽

Obese Patients ◽

Percent Excess Weight Loss ◽

Severely Obese

Obesity is common in patients with multiple sclerosis (MS); however, safety and efficacy of bariatric surgery in this population remain unclear. A database of 2,918 was retrospectively reviewed, yielding 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Sixteen surgical patients with complete follow-up data were matched to a nonsurgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up. MS relapse rates and trends in the timed twenty-five foot walk test (T25FW) were compared. In the surgical group (gastric bypass n=19, sleeve gastrectomy n=3), preoperative BMI was 46.5 ± 7.2 Kg/m2 and average excess weight was 60.4 kg. Follow-up data was collected at 59.0 ± 29.8 months. There were two major and four minor complications. Five patients required readmission and there were no mortalities. Percent excess weight loss was 75.5 ± 27.0%. In the 16 patients with follow-up data, patients who underwent bariatric surgery were significantly faster on the T25FW compared to the nonsurgical population. In conclusion, bariatric surgery is relatively safe and effective in achieving weight loss in patients with MS. In addition, surgery may help patients maintain ambulation. Findings support the need for further studies on bariatric surgery and disease-specific outcomes in this population.

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The Bariatric Interprofessional Psychosocial Assessment Of Suitability Scale (BIPASS): Predictive Validity for Outcomes 1 And 2 Years Following Bariatric Surgery

10.32920/ryerson.14643789.v1 ◽

2021 ◽

Author(s):

Molly Atwood

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Bariatric Surgery ◽

Weight Loss ◽

Psychosocial Assessment ◽

Health Related Quality ◽

Related Quality ◽

Health Related

Bariatric surgery is the most effective intervention for severe obesity; however, many patients demonstrate insufficient and/or unsustained weight loss, and unsatisfactory psychosocial functioning in the longer-term. Although it is well established that attendance at postsurgical follow-up appointments is integral to sustained weight loss, nonadherence to follow-up is common. Consequently, presurgical psychosocial evaluations are conducted in order to identify patients at high risk of poor outcomes. Yet, no consensus has been established regarding a standardized protocol for the assessment of variables relevant to surgical outcomes, and bariatric programs vary widely in their interpretation of psychosocial risk. In addition, there is a paucity of research examining the predictive utility of psychosocial evaluations. The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASSTM), a novel psychosocial evaluation tool, was developed to address these issues. The purpose of the present study was to contribute to the validation of the BIPASS tool via two aims: 1) by examining the psychometric properties of the BIPASS, and; 2) by examining the ability of the BIPASS tool to predict outcomes 1 and 2 years following bariatric surgery, including weight loss and weight regain, quality of life, psychiatric symptoms, and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 200 consecutively referred patients of the Toronto Western Hospital Bariatric Surgery Program (TWH-BSP). Factor analysis of BIPASS items revealed a two-factor structure, reflecting “Mental Health” and “Patient Readiness” subscales. Internal consistency for the BIPASS Total and subscale scores ranged from poor to good, and inter-rater reliability was excellent. Higher BIPASS scores significantly predicted higher binge eating symptomatology, and lower physical and mental health-related quality of life at 1 year postsurgery. The BIPASS did not predict any outcome variables at 2 years postsurgery, or adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of problematic eating and poor health-related quality of life early in the postsurgical course, thereby facilitating appropriate interventions.

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Laparoscopic sleeve gastrectomy is an independent predictor of poor follow-up and reaching ≤ 40% excess body weight loss at 1, 2, and 3 years after bariatric surgery

Surgical Endoscopy ◽

10.1007/s00464-019-07023-2 ◽

2019 ◽

Vol 34 (6) ◽

pp. 2572-2584

Author(s):

Anahita Jalilvand ◽

Alecia Blaszczak ◽

Jane Dewire ◽

Andrew Detty ◽

Bradley Needleman ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Independent Predictor ◽

Body Weight Loss ◽

Excess Body Weight

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What Happens to Patients who Do Not Follow-Up after Bariatric Surgery?

The American Surgeon ◽

10.1177/000313480707300219 ◽

2007 ◽

Vol 73 (2) ◽

pp. 181-184 ◽

Cited By ~ 39

Author(s):

Jason Harper ◽

Atul K. Madan ◽

Craig A. Ternovits ◽

David S. Tichansky

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Body Weight ◽

Laparoscopic Gastric Bypass ◽

Excess Body Weight ◽

Preoperative Body Mass Index ◽

Number Of Patients ◽

Group B

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.

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Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

Pain Research and Treatment ◽

10.1155/2012/412174 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Sharlene Wedin ◽

Karl Byrne ◽

Katherine Morgan ◽

Marie LePage ◽

Rachel Goldman ◽

...

Keyword(s):

Bariatric Surgery ◽

Chronic Pain ◽

Weight Loss ◽

Gastric Bypass ◽

Functional Impairment ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

The United States ◽

Walking Ability ◽

The Relationship

Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center () completed the Brief Pain Inventory (BPI), the Center for Epidemiological Studies 10-item Depression scale (CESD-10), and the Beck Anxiety Inventory (BAI). Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

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Personality Psychopathology: Longitudinal Prediction of Change in BMI and Weight Post-Bariatric Surgery

10.31234/osf.io/e2xm9 ◽

2019 ◽

Author(s):

Joshua R. Oltmanns ◽

Jessica Rivera Rivera ◽

Amanda Merchant ◽

Jonathan Cole ◽

Joshua Steiner

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Personality Assessment ◽

Small Sample ◽

Psychological Variables ◽

Percent Excess Weight Loss ◽

Personality Psychopathology ◽

And Gender ◽

Small Sample Sizes

Objective: Bariatric surgery is an effective treatment for obesity, which has been increasing worldwide. However, bariatric surgery causes dramatic physical changes that can cause significant stress. Prior research has found that psychological variables such as personality traits and levels of psychopathology can influence success after bariatric surgery (in terms of body-mass index [BMI] reduction and weight loss). However, most prior studies have been limited by small sample sizes, inconsistent follow-up, and categorical assessment of psychopathology. Methods: The present study examines the predictive utility of the Personality Assessment Inventory (PAI) scales for three bariatric surgery outcomes (BMI reduction, weight loss, and percent excess weight loss [%EWL]) across ten follow-up points five years after surgery. It also examines the largest sample of bariatric surgery-completing patients (N = 2,267) on the PAI to date. Latent growth modeling was used to examine change in the outcome variables. Results: Results indicate that personality and psychopathology variables predicted less BMI reduction, weight loss, and %EWL five years after surgery and also affected the trajectories of change in the outcome variables across time. The PAI scales predicted more variance in the five-year BMI outcomes than did age and gender. The most robust effects were for scales assessing phobias, traumatic stress, identity problems, and negative relationships. Conclusions: The PAI may be useful to clinical health psychologists who conduct recommended psychological evaluations with potential bariatric surgery candidates.

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Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution After Bariatric Surgery

Obesity Surgery ◽

10.1007/s11695-021-05578-5 ◽

2021 ◽

Author(s):

Enzamaria Fidilio ◽

Marta Comas ◽

Miguel Giribés ◽

Guillermo Cárdenas ◽

Ramón Vilallonga ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Energy Expenditure ◽

Severe Obesity ◽

Resting Energy Expenditure ◽

Successful Weight Loss ◽

The Impact ◽

The Relationship ◽

Resting Energy

Abstract Purpose One major determinant of weight loss is resting energy expenditure (REE). However, data regarding REE is scarce in patients with severe obesity (SO)—BMI>50kg/m2. Most studies used equation in order to estimate REE and not indirect calorimetry (IC) (gold standard). Additionally, there is no reliable data on the impact of bariatric surgery (BS) on REE. Objectives (a) To evaluate the REE in patients with SO; (b) to compare REE measured by IC (mREE) to that calculated by Mifflin St-Jeor equation (eREE); (c) to evaluate the impact of BS on REE and the relationship with evolution post-BS. Material and Methods Single-center observational study including consecutive patients with SO between January 2010 and December 2015, candidates for BS. mREE was determined at baseline, and 1 and 12 months post-BS by IC, using a Vmax metabolic monitor. Results Thirty-nine patients were included: mean age 46.5±11.77 years, 64.1%women. Preoperative mREE was 2320.38±750.81 kcal/day. One month post-BS, the mREE significantly decreased (1537.6 ± 117.46 kcal/day, p = 0.023) and remained unchanged at 12 months (1526.00 ± 123.35 kcal/day; p =0.682). Reduction in mREE after the BS was a predictor of reaching successful weight loss (nadir) and weight regain (5 years follow-up) (AUCROC of 0.841 (95%CI [0.655–0.909], p=0.032) and AUCROC of 0.855 (95% CI [0.639–0.901]), p= 0.027, respectively). eREE was not valid to identify these changes. Conclusion In patients with SO, a significant reduction of mREE occurs 1 month post-BS, unchanged at 12 months, representing the major conditioning of successful weight loss and maintenance post-BS. Graphical abstract

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The Bariatric Interprofessional Psychosocial Assessment Of Suitability Scale (BIPASS): Predictive Validity for Outcomes 1 And 2 Years Following Bariatric Surgery

10.32920/ryerson.14643789 ◽

2021 ◽

Author(s):

Molly Atwood

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Bariatric Surgery ◽

Weight Loss ◽

Psychosocial Assessment ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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POS1383 THE ASSOCIATION BETWEEN BARIATRIC SURGERY AND DUPUYTREN DISEASE: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4067 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 974.3-975

Author(s):

T. Burkard ◽

J. Lane ◽

D. Holmberg ◽

A. M. Burden ◽

D. Furniss

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Weight Loss ◽

Cohort Study ◽

Secondary Care ◽

High Body Mass Index ◽

Null Result ◽

Increased Risk ◽

Dupuytren Disease

Background:Dupuytren disease (DD) is multifactorial, with several genetic and environmental risk factors contributing to disease susceptibility. High body mass index, however, was suggested to be protective of DD.1 The impact of weight loss among obese patients on DD has not been assessed to date.Objectives:To assess the association between bariatric surgery and DD in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 30-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery-free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The outcome DD was defined as a diagnosis of DD in secondary care or partial or total fasciotomy of wrist or hand. After a 1-year run-in period, patients were followed in an “as-treated” approach. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of incident DD among bariatric surgery patients when compared to obese unexposed patients overall, and in subgroups of age, sex, bariatric surgery type, and by duration of follow-up.Results:A total of 34 959 bariatric surgery patients were PS-matched to 54 769 obese unexposed patients. A total of 71.6% of bariatric surgery patients were women. Bariatric surgery patients had a mean age of 45.5 years and a mean follow-up of 6.9 years. All patient characteristics in obese unexposed patients were highly similar. We observed 126 and 136 severe DD cases among bariatric surgery and obese unexposed patients, respectively. The risk of DD was significantly increased in bariatric surgery patients compared to obese unexposed patients (HR = 1.30, 95% CI 1.02-1.65). The risk of DD was higher in women (HR = 1.36, 95% CI 1.00-1.84) than in men (HR = 1.05, 95% CI 0.70-1.58). Age did not modify the risk of DD among bariatric surgery patients compared to obese unexposed patients. Malabsorptive bariatric surgery yielded an increased risk of DD when compared to obese unexposed patients (HR = 1.33, 95% CI 1.04-1.71), while restrictive bariatric surgery yielded a null result. The risk of DD increased with duration of follow-up (>5 years of follow-up: HR = 1.63, 95% CI 1.14-2.34, null result in earlier follow-up).Conclusion:Our results suggest that substantial weight loss is associated with a latent increased risk of severe DD in an obese population. This observation further strengthens current evidence that high body mass index is protective against DD. The latency of risk increase of DD after bariatric surgery may suggest that slowly adapting metabolic changes may be part of the mechanism of DD emergence.References:[1]Hacquebord JH, Chiu VY, Harness NG. The Risk of Dupuytren Surgery in Obese Individuals. J Hand Surg Am. 2017, 42: 149–55.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:None declared

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Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Obesity Surgery ◽

10.1007/s11695-021-05499-3 ◽

2021 ◽

Author(s):

Arnaud Liagre ◽

Francesco Martini ◽

Radwan Kassir ◽

Gildas Juglard ◽

Celine Hamid ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Severe Obesity ◽

Postoperative Mortality ◽

One Anastomosis Gastric Bypass ◽

Sustained Weight Loss ◽

Biliopancreatic Limb ◽

Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

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