Morbid Obesity and Motivation for Bariatric Surgery/Obesidad Mórbida y Motivación para la Cirugía Bariátrica

Morbid obesity is a disease affecting the health of thousands of people around the world, representing a great economic burden for health services. One of the most effective methods of weight reduction is bariatric surgery; however this procedure is commonly used only after other weight reduction methods have failed. This study explores the importance of certain elements as pre- and post-surgery motivators, as well as their relevance in the evolution of the bariatric patient. In this qualitative study we analyzed the discourse of 9 morbid obese people who had gone through bariatric surgery to lose weight, to identify their motivation to do the bariatric procedure, as well as doing and keeping changes to their lifestyle after surgery. We found that the most important motivating factors in pre-surgery period are fear of suffering diseases derived from their morbid obesity, and failure of other weight reduction methods; in post-surgery period, the main motivators to do and keep lifestyle changes are family support and desire to be able to do physical activities. We conclude that motivation should be considered in the treatment of bariatric patients, and treated by a psychologist as part of a multidisciplinary team of health experts.

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Associations between Pre-Bariatric High-Sensitivity C-Reactive Protein and Post-Surgery Outcomes

Diagnostics ◽

10.3390/diagnostics11040721 ◽

2021 ◽

Vol 11 (4) ◽

pp. 721

Author(s):

Tannaz Jamialahmadi ◽

Mohsen Nematy ◽

Simona Bo ◽

Valentina Ponzo ◽

Ali Jangjoo ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Success Rate ◽

Liver Stiffness ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

Post Surgery ◽

Hs Crp

Background: Obesity is a chronic inflammatory condition associated with increased circulating levels of C-reactive protein (CRP). Bariatric surgery has been reported to be effective in improving both inflammatory and liver status. Our aims were to elucidate the relationships between pre-surgery high sensitivity-CRP (hs-CRP) values and post-surgery weight loss and liver steatosis and fibrosis in patients with severe obesity undergoing Roux-en-Y gastric bypass. Methods: We conducted an observational prospective study on 90 individuals with morbid obesity, who underwent gastric bypass. Anthropometric indices, laboratory assessment (lipid panel, glycemic status, liver enzymes, and hs-CRP), liver stiffness and steatosis were evaluated at baseline and 6-months after surgery. Results: There was a significant post-surgery reduction in all the anthropometric variables, with an average weight loss of 33.93 ± 11.79 kg; the mean percentage of total weight loss (TWL) was 27.96 ± 6.43%. Liver elasticity was significantly reduced (from 6.1 ± 1.25 to 5.42 ± 1.52 kPa; p = 0.002), as well as liver aminotransferases, nonalcoholic fatty liver disease fibrosis score (NFS) and the grade of steatosis. Serum hs-CRP levels significantly reduced (from 9.26 ± 8.45 to 3.29 ± 4.41 mg/L; p < 0.001). The correlations between hs-CRP levels and liver fibrosis (elastography), steatosis (ultrasonography), fibrosis-4 index, NFS, and surgery success rate were not significant. Regression analyses showed that serum hs-CRP levels were not predictive of liver status and success rate after surgery in both unadjusted and adjusted models. Conclusions: In patients with morbid obesity, bariatric surgery caused a significant decrease in hs-CRP levels, liver stiffness and steatosis. Baseline hs-CRP values did not predict the weight-loss success rate and post-surgery liver status.

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Interfaces between bariatric surgery and oral health: a longitudinal survey

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000800015 ◽

2011 ◽

Vol 26 (suppl 2) ◽

pp. 79-83 ◽

Cited By ~ 20

Author(s):

Juliane Avansini Marsicano ◽

Patrícia Garcia de Moura Grec ◽

Lídia Barbieri Belarmino ◽

Reginaldo Ceneviva ◽

Sílvia Helena de Carvalho Sales Peres

Keyword(s):

Quality Of Life ◽

Bariatric Surgery ◽

Oral Health ◽

Tooth Wear ◽

Salivary Flow ◽

Lifestyle Changes ◽

Dental Wear ◽

Bariatric Patients ◽

The Impact

PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p<0.05). RESULTS: DMFT was 17.6±5.7, 18.4±4.1 and 18.3±5.5 (P>0.05), presence of periodontal pockets in 50%, 58% and 50% of patients (p>0.05), tooth wear in dentin present in 81.5%, 87.5% and 87.5% before, 3 and 6 months after surgical treatment respectively. There were differences between the three periods for prevalence and severity of dental wear (p = 0.012). Salivary flow was 0.8±0.5 ml/min before surgery, 0.9±0.5 ml/min for 3 months and 1.1±0.5m/min for 6 months (p>0.05). The impact of oral health on quality of life decreased with time after bariatric surgery (p= 0.029). CONCLUSION: The lifestyle changes after bariatric surgery and these changes may increase the severity of pre-existing dental problems. However, these alterations in oral health did not influence the quality of life.

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A Retrospective Study about the Differences in Cardiometabolic Risk Indicators and Level of Physical Activity in Bariatric Surgery Patients from Private vs. Public Units

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234751 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4751 ◽

Cited By ~ 2

Author(s):

Rebeca Rocha de Almeida ◽

Márcia Cândido de Souza ◽

Dihogo Gama de Matos ◽

Larissa Monteiro Costa Pereira ◽

Victor Batista Oliveira ◽

...

Keyword(s):

Physical Activity ◽

Bariatric Surgery ◽

Retrospective Study ◽

Healthcare System ◽

Cardiometabolic Risk ◽

Risk Indicators ◽

Public Healthcare ◽

Post Surgery ◽

Bariatric Patients ◽

One Year

Background: Obesity is a pathology with a growing incidence in developing countries. Objective: To evaluate the evolution of cardiometabolic, anthropometrics, and physical activity parameters in individuals undergoing bariatric surgery (BS) in the public healthcare system (PUS) and private healthcare system (PHS). Methods: A longitudinal, observational, and retrospective study was conducted with 111 bariatric patients on two different health systems, with 60 patients from the PUS and 51 from the PHS. Cardiometabolic risk (CR) was analyzed by the assessment of obesity-related comorbidities (AORC) on admission and 3, 6, and 12 months after BS, and the International Physical Activity Questionnaire (IPAQ) was surveyed before and 12 months after BS. In addition, cardiometabolic risk was also assessed by biochemical (fasting glucose and complete lipidogram) and anthropometric (weight, weight loss, waist circumference, and waist-to-height ratio) parameters. Results: On admission, the parameters of severe obesity, systemic arterial hypertension (SAH), Diabetes mellitus (DM), and waiting time to BS were higher in the PUS. Additionally, in the PUS, AORC was reduced only in the SAH parameter. However, in the post-surgery moment, AORC reduced, and there was no difference between the two groups after BS. Regarding physical activity, the IPAQ showed a higher level of activity in the PHS before and one year after BS. Conclusion: At the PUS, BS is performed in patients with a higher degree of comorbidities, but BS improved the reduction of the CR at a similar level to those observed in the PHS.

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The relationship between specialized pro-resolving lipid mediators, morbid obesity and weight loss after bariatric surgery

Scientific Reports ◽

10.1038/s41598-020-75353-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Fabian Schulte ◽

Abdul Aziz Asbeutah ◽

Peter N. Benotti ◽

G. Craig Wood ◽

Christopher Still ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

White Blood Cells ◽

Diabetes Remission ◽

Lipid Mediators ◽

Morbidly Obese ◽

Post Surgery ◽

Obesity And Diabetes ◽

Obese Subjects

AbstractObesity and diabetes are associated with chronic inflammation. Specialized pro-resolving lipid mediators (SPMs)—resolvins (Rv), protectins (PD) and maresins (MaR)—actively resolve inflammation. Bariatric surgery achieves remission of diabetes, but mechanisms are unclear. We measured SPMs and proinflammatory eicosanoid levels using liquid chromatography-tandem mass spectrometry in 29 morbidly obese subjects (13 with diabetes) and 15 nondiabetic, mildly obese subjects. Compared to the mildly obese, the morbidly obese had higher levels of SPMs—RvD3, RvD4 and PD1—and white blood cells (WBC) and platelets. Post-surgery, SPM and platelet levels decreased in morbidly obese nondiabetic subjects but not in diabetic subjects, suggesting continued inflammation. Despite similar weight reductions 1 year after surgery (44.6% vs. 46.6%), 8 diabetes remitters had significant reductions in WBC and platelet counts whereas five non-remitters did not. Remitters had a 58.2% decrease (p = 0.03) in 14-HDHA, a maresin pathway marker; non-remitters had an 875.7% increase in 14-HDHA but a 36.9% decrease in MaR1 to a median of 0. In conclusion, higher levels of RvD3, PD1 and their pathway marker, 17-HDHA, are markers of leukocyte activation and inflammation in morbid obesity and diabetes and diminish with weight loss in nondiabetic but not diabetic subjects, possibly representing sustained inflammation in the latter. Lack of diabetes remission after surgically-induced weight loss may be associated with reduced ability to produce MaR1 and sustained inflammation.

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Your patient and weight-loss surgery

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.111.008938 ◽

2012 ◽

Vol 18 (6) ◽

pp. 418-425 ◽

Cited By ~ 5

Author(s):

Tom Stevens ◽

Samantha Spavin ◽

Samantha Scholtz ◽

Lisa McClelland

Keyword(s):

Mental Health ◽

Bariatric Surgery ◽

Mental Illness ◽

Weight Loss ◽

Mental Health Professionals ◽

Weight Loss Surgery ◽

Psychological Impact ◽

Lifestyle Changes ◽

Morbidly Obese ◽

Reduction Methods

SummaryObesity is common in patients with mental illness. Weight-loss surgery, known as bariatric surgery, is becoming a familiar intervention for treating people who are morbidly obese and for whom other weight-reduction methods have failed. This article offers guidance for mental health professionals on the assessment and management of patients with mental illness undergoing such treatment. Assessment is of the patient's suitability for surgery, taking into account their mental health diagnosis, expectations, knowledge and insight into the psychological impact of surgery, and ability to address and cope with lifestyle changes before and after surgery. The patient's capacity and ability to cooperate and engage with services are also assessed. Potential risks and complications of bariatric surgery and how the weight-loss procedures may affect patients' mental health and management of their medication are addressed.

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VOCAL COMPLAINT, AUDITORY-PERCEPTUAL ASSESSMENT OF VOICE AND VOCAL SELF-ASSESSMENT IN WOMEN WITH MORBID OBESITY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201500s100008 ◽

2015 ◽

Vol 28 (suppl 1) ◽

pp. 23-25 ◽

Cited By ~ 4

Author(s):

Lourdes Bernadete Rocha de SOUZA ◽

Leandro de Araujo PERNAMBUCO ◽

Marquiony Marques dos SANTOS ◽

Joana Cristina Vasconcelos da SILVA

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Morbidly Obese ◽

Self Assessment ◽

Obese People ◽

Voice Production ◽

Perceptual Evaluation ◽

Before And After ◽

Perceptual Assessment ◽

The Voice

Background : Obese people often have altered breathing patterns and therefore may experience difficulties in voice production. Aim : To verify the presence of vocal complaints and the correlation between the auditory-perceptual analysis of voice and vocal self-assessment of a group of women with morbid obesity before and after bariatric surgery. Methods : A longitudinal, exploratory, descriptive study of 21 morbidly obese women aged between 28 and 68 years, assessed before and after bariatric surgery, was performed. The women filled out a form containing identification data and type of vocal complaint. Perceptual evaluation of voice and vocal self-assessment were performed using a visual analog scale. For perceptual assessment of voice the women were asked to say three sentences from the Consensus Auditory-Perceptual Evaluation of Voice. Results : Of the 21 patients, 14 (66.6%) reported vocal complaints, of which 10 (71%) vocal fatigue, eight (57.14%) voice failures and seven (50%) vocal effort. All participants reported improvements in the voice after surgery, irrespective of having reported vocal complaints before surgery. There was no correlation between vocal self-assessment and auditory-perceptual assessment of the voice before or after the procedure. There was no correlation between vocal self-assessment and perceptual evaluation of the voice before surgery. Conclusion : Obesity interfered with voice production and influenced negative perception and therefore vocal complaints. Complaints about vocal production cannot be perceived by a speech therapist with the same impact as by patients, as both employ different criteria for vocal evaluation. Vocal self-assessment is an important tool in voice evaluation.

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Chew and spit (CHSP) in bariatric patients: a case series

Journal of Eating Disorders ◽

10.1186/s40337-021-00441-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Phillip Aouad ◽

Kristin Stedal ◽

Gro Walø-Syversen ◽

Phillipa Hay ◽

Camilla Lindvall Dahlgren

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Disordered Eating ◽

Weight Loss Surgery ◽

Eating Pathology ◽

Post Surgery ◽

Significant Depression ◽

Bariatric Patients ◽

Clinically Significant

Abstract Background Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. Case presentation The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology—including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. Conclusions The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.

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Is Insulin Resistance at Baseline a Predictor of Weight Loss After Bariatric Surgery?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.034 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A18-A19

Author(s):

Marta Borges-Canha ◽

João Sérgio Neves ◽

Fernando Mendonça ◽

Maria Manuel Silva ◽

Cláudia Costa ◽

...

Keyword(s):

Insulin Resistance ◽

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Cell Function ◽

First Year ◽

Model Assessment ◽

Post Surgery ◽

Homeostatic Model Assessment ◽

Homeostatic Model

Abstract Background: Obesity is a multifactorial disease that is strongly associated to other metabolic disorders, such as insulin resistance and type 2 diabetes. Bariatric surgery is nowadays considered the most effective treatment of morbid obesity. The role of insulin resistance (IR) in weight loss after bariatric surgery is highly unknown. Aim: To evaluate the association between Insulin Resistance (IR) and percentage of excess weight loss (EWL%) one, two, three and four years after bariatric surgery in patients with morbid obesity. Methods: Retrospective longitudinal study in patients with morbid obesity followed in our centre between January 2010 and July 2018 were included. Patients were excluded if they had diabetes. We evaluated baseline Homeostatic Model Assessment of IR (HOMA-IR), Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index (QUICKI) and Matsuda and DeFronzo index, and performed a linear regression concerning each year’s EWL%. Results: After applying the exclusion criteria, 1723 patients were included in this analysis. The logarithm of HOMA-beta was negatively associated with EWL% at second-, third- and fourth-years post-surgery (β=-1.04 [-1.82 to -0.26], p<0.01; β=-1.16 [-2.13 to -0.19], p=0.02; β=-1.29 [-2.64 to 0.06], p=0.061, respectively), adjusting for age, sex, body mass index and type of surgery. This was not observed in the first-year post-surgery nor for the other indexes. Glycaemia at baseline was also positively associated to EWL% at second- and third-years post-surgery. Conclusion: IR at baseline seems to be associated to long term weight loss, explicitly after the first year post bariatric surgery.

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Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery

Frontiers in Endocrinology ◽

10.3389/fendo.2021.714173 ◽

2021 ◽

Vol 12 ◽

Author(s):

Marta Borges-Canha ◽

João Sérgio Neves ◽

Fernando Mendonça ◽

Maria Manuel Silva ◽

Cláudia Costa ◽

...

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Beta Cell ◽

Beta Cell Function ◽

Cell Function ◽

Model Assessment ◽

Post Surgery ◽

Homeostatic Model Assessment ◽

Β Cell Function

BackgroundObesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain.AimTo evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity.MethodsRetrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery).ResultsThere were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = −1.04 [−1.82 to −0.26], p<0.01; β = −1.16 [−2.13 to −0.19], p=0.02; β = −1.29 [−2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery.Conclusionβ-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.

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Atherogenic Index of Plasma (AIP) a Tool to Assess Changes in Cardiovascular Disease Risk Post Laparoscopic Sleeve Gastrectomy

Journal of Diabetes Research ◽

10.1155/2020/2091341 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Eman Al Shawaf ◽

Ebaa Al-Ozairi ◽

Fahad Al-Asfar ◽

Anwar Mohammad ◽

Shaima Al-Beloushi ◽

...

Keyword(s):

Cardiovascular Disease ◽

Morbid Obesity ◽

Sleeve Gastrectomy ◽

Atherogenic Index ◽

Cvd Risk ◽

Obese People ◽

Atherogenic Index Of Plasma ◽

History Of ◽

Vascular Age ◽

Morbid Obese

Predictive indices like the atherogenic index of plasma (AIP) have been developed to estimate the risk of cardiovascular disease (CVD). Metabolic surgery is the most effective treatment for a rapid improvement of morbid obesity and its comorbidities such as type 2 diabetes (T2D) and CVD. A decreased reoccurrence of CVD after metabolic surgery has been reported by several studies. However, studies utilizing predictive indices for CVD risk in CVD-free morbid-obese patients who undertook laparoscopic sleeve gastrectomy (LSG) are lacking. Here, we use AIP as a tool to evaluate the improvement in CVD risk post-LSG in morbid-obese people who had no history of CVD. Method. We compared baseline, 6- and 12-month post-LSG score of AIP, vascular age, circulating biochemical markers related to CVD in two groups of BMI and age-matched morbid-obese participants with and without T2D. Results. At baseline, people with T2D had significantly higher AIP both, with morbid obesity (0.23±0.06, p<0.001) and normal weight (0.022±0.05, p<0.001) compared to their BMI-matched without T2D group. People with morbid obesity had low AIP (−0.083±0.06). Vascular age was significantly higher in people with morbid obesity and T2D (65.8±3.7year, p<0.0001) compared to morbid obesity (37.9±2.6 year). After one year, AIP was significantly reduced compared to baseline score in people with morbid obesity with/without T2D, respectively (−0.135±0.07, p=0.003; and −0.36±0.04, p=0.0002). Conclusion. Our data illuminates AIP as a reliable predictive index for CVD risk in morbid-obese people who had no history of CVD. Moreover, AIP accurately distinguishes between morbid obesity with T2D and morbid obesity and showed a rapid and significant reduction in CVD risk after LSG in people who had no history of CVD. This is a ClinicalTrials.gov registered trial (Reference NCT03038373).

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