scholarly journals Fatores de risco para recidiva de peso no pós-operatório tardio de cirurgia bariátrica

2016 ◽  
Vol 26 (4) ◽  
pp. 24224
Author(s):  
Adriane Granato Bardal ◽  
Vanessa Ceccatto ◽  
Thais Regina Mezzomo
Keyword(s):  
Risk Factors ◽  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Emotional Eating ◽  
Weight Regain ◽  
Family Income ◽  
Preoperative Period ◽  
Appointment Attendance ◽  
Cognitive Restraint

Aims: To evaluate risk factors for weight regain in patients undergoing bariatric surgery.Methods: Cross-sectional study using self-administered online questionnaire. The questionnaire asked about factors that can be associated with weight regain after bariatric surgery. Weight, height, sex, age, education, income, and nutrition appointment attendance before and after surgery were registered. Body mass index, weight loss, and loss of excess weight in the immediate postoperative period and at 6, 12, and 24 months postoperatively, as well as at the time of completing the questionnaire, were evaluated. Weight regain was evaluated according to the lowest weight achieved since surgery. The Three Factor Eating Questionnaire-21 was used to classify eating behavior into Emotional Eating, Cognitive Dietary Restraint, or Uncontrolled Eating.Results: The questionnaire was answered by 46 individuals who underwent bariatric surgery, with a mean age of 38±8.78 years and a median of three postoperative years. Forty-three (93.5%) patients were female. The mean loss of excess weight and current weight loss were 78.56±16.12% and 35.24±8.19%, respectively. The current body mass index was 27.35±3.98 kg/m2. Emotional eating was observed in 18 (39.13%), cognitive restraint in 24 (52.17%), and emotional eating associated with cognitive restraint in 4 (8.69%) of the respondents. Eighteen individuals (39%) regained weight, especially after 12 months. A monthly family income greater than 4000 Brazilian Reals and nutrition appointments fewer than three in the preoperative period were associated with a larger probability of weight regain.Conclusions: In this sample, low nutrition appointment attendance in the preoperative period and a high family income were risk factors for weight regain in the late postoperative period of bariatric surgery. 

scholarly journals Use of Pharmacotherapy in Obesity Management

2021 ◽  
Vol 47 (5) ◽  
Author(s):  
Kwang Wei Tham
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Weight Regain ◽  
Energy Homeostasis ◽  
Weight Maintenance ◽  
High Body Mass Index ◽  
Obesity Management ◽  
Behavioural Modification ◽  
Successful Weight Loss

Obesity is a chronic disease which is often relapsing and progressive due in part to the physiology of energy homeostasis in people with obesity, rendering them with the challenge of attaining adequate weight loss and weight maintenance after successful weight loss. Depending on the presence, types and severity of the obesity-related comorbidities (ORCs), some patients will require an amount of weight loss beyond what lifestyle and behavioural modification can achieve. Even after bariatric surgery, patients may not lose the expected amount of weight or experience weight regain. Anti-obesity medications may be required to support them further. Hence, the use of pharmacotherapy in obesity management remains an important adjunct to lifestyle and behavioural modifications and even to bariatric surgery, particularly in those with more severe ORCs and with a high body mass index. This article discusses the general approach to the use of pharmacotherapy in obesity management and the various anti-obesity medications currently approved.

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

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

scholarly journals Dietary and Lifestyle Factors Serve as Predictors of Successful Weight Loss Maintenance Postbariatric Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Afshan Masood ◽  
Lujain Alsheddi ◽  
Loura Alfayadh ◽  
Bushra Bukhari ◽  
Ruba Elawad ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Dietary Habits ◽  
Weight Maintenance ◽  
Dietary Counseling ◽  
Beneficial Effects ◽  
Predicting Factors ◽  
Lifestyle Practices ◽  
Fiber Consumption

Bariatric surgery is considered to be an effective treatment for the resolution of severe obesity; however, in more than half of the bariatric surgery patients, weight reacquisition occurs as early as 18 months postsurgery, compromising the surgery’s beneficial effects. Maintaining weight loss after surgery poses a great challenge, necessitating the identification of predicting factors. In the present study, we explored the association between weight regain and dietary habits and behavioral lifestyle practices in patients following bariatric surgery. Fifty patients who underwent bariatric surgery with ≥18-month postoperative period of follow-up were included. They were classified into two groups: weight maintainers (n = 29) were patients who regained <15% of their weight, and weight regainers (n = 21) were patients who regained ≥15% of their weight compared to their lowest postoperative weight. The mean age of the study participants was 41.4 ± 8.9 years, and twenty-eight patients (56%) of the total, were females. A detailed analysis of dietary and lifestyle habits was performed by questionnaire-based interviews. Significant weight regain was noted in the regainers compared to the maintainers (19.6 ± 8.4 kg vs. 4.5 ± 3.5 kg, respectively, P≤0.001), which was attributed to their following of unhealthy dietary habits and behavioral lifestyle practices. The dietary and behavioral lifestyle practices adopted by the maintainers were higher fiber consumption and water intake, monitored pace of eating, evasion of emotional binge, and distracted eating and following of self-assessment behaviors. Additionally, regular nutritional follow-ups and compliance with postoperative dietary counseling significantly helped to improve weight maintenance. In conclusion, the effectiveness of weight loss postbariatric surgery was compromised by weight regain due to unhealthy dietary and behavioral lifestyle practices stemming from a lack of nutritional guidance and knowledge. The implementation of comprehensive nutritional counseling and advice on behavioral changes before and after surgery will help achieve optimal weight results.

scholarly journals MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Flavio Cadegiani
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Body Weight ◽  
Weight Regain ◽  
Morbidly Obese ◽  
Biochemical Profile ◽  
Initial Weight ◽  
Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of &gt;20% loss of the initial BW loss, and no weight regain (or &lt; 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p &lt; 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

PATIENT PERSPECTIVES ON OBESITY MANAGEMENT: NEED FOR GREATER DISCUSSION OF BMI AND WEIGHT-LOSS OPTIONS BEYOND DIET AND EXERCISE, ESPECIALLY IN PATIENTS WITH DIABETES

2020 ◽  
Vol 26 (5) ◽  
pp. 471-483 ◽  
Author(s):  
Sabrina Huq ◽  
Supriya Todkar ◽  
Sharon W. Lahiri
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Early Death ◽  
Specific Weight ◽  
Obesity Management ◽  
Diet And Exercise ◽  
Patients With Diabetes ◽  
Chi Squared

Objective: To identify perceptions of obesity management in patients with and without diabetes. Methods: A 48-question survey was administered in 2018 to our Endocrinology Clinic's adult patients with a body mass index (BMI) ≥30 kg/m2. Chi-squared or Fisher's exact tests were used to compare variables between groups. Results: Of 146 respondents, 105 had diabetes and 41 did not. Most respondents were female (61.4%), African American (66.4%), and with an income <$50,000 (58.6%). Those with diabetes had significantly greater comorbidities of hypertension, high cholesterol, and arthritis. Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death. Only 48% were aware of their BMI, and only 30.5% with diabetes and 41.5% without diabetes perceived themselves to be obese. Over 60% in each group reported discussion of diet and exercise with their providers, whereas few in both groups reported referral to a formal weight-loss program (18.9%) or to a specialty that manages obesity (4.2%), or discussion of anti-obesity medications (11.2%) or bariatric surgery (8.4%). Reported concerns with anti-obesity medications and bariatric surgery included lack of knowledge and side effects or complications. Conclusion: These findings revealed excellent patient awareness of obesity as a health problem but misperception of obese status and unawareness of BMI. Presence of diabetes and other comorbidities did not result in greater discussion of weight-loss methods beyond diet and exercise. Increased patient education and discussion of specific weight-loss services, anti-obesity medications, and bariatric surgery are needed. Abbreviations: BMI = body mass index; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HCP = healthcare provider

scholarly journals The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

2017 ◽  
Vol 13 (3) ◽  
pp. 491-500 ◽  
Author(s):  
Fatima Cody Stanford ◽  
Nasreen Alfaris ◽  
Gricelda Gomez ◽  
Elizabeth T. Ricks ◽  
Alpana P. Shukla ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Weight Loss Medications ◽  
Multi Center Study ◽  
Inadequate Weight Loss ◽  
Center Study

Revisional Bariatric Surgery

2018 ◽  
Author(s):  
Catherine Frenkel ◽  
Aurora Pryor
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Gastric Band ◽  
Surgical Techniques ◽  
Jejunoileal Bypass ◽  
Revisional Bariatric Surgery ◽  
Laparoscopic Gastric Band ◽  
Ensure Patient Safety ◽  
Failed Weight Loss

The annual volume of bariatric surgery is growing, giving rise to an increase in complications requiring complex management, including revision. Bariatric revision procedures are also becoming increasingly necessary for weight-loss recidivism and patients at the extreme of obesity. This chapter outlines clinical management pathways used to address secondary bariatric surgery. It summarizes reasons for, and outcomes with, revision of a laparoscopic gastric band, vertical banded gastroplasty, sleeve gastrectomy, or Roux-en-Y gastric bypass. Surgical techniques used to manage weight regain or failed weight loss after bariatric surgery are also discussed. Finally, surgical solutions for bariatric surgery-induced malnutrition are described, particularly in the setting of biliopancreatic diversion, duodenal switch, or jejunoileal bypass. Overall, the chapter concludes that standardization of revisional procedures can have a significant patient impact, and guidelines must be evidence-based in order to ensure patient safety and success.

scholarly journals Association of endocrine active environmental compounds with body mass index and weight loss following bariatric surgery

2020 ◽  
Vol 93 (3) ◽  
pp. 280-287 ◽  
Author(s):  
Harshal Deshmukh ◽  
Lesa L. Aylward ◽  
Martin Rose ◽  
Alwyn Fernandes ◽  
Peter Sedman ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass
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