Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

This systematic literature review aims to point out sex-specific special features that are important in the bariatric treatment of women suffering from severe obesity. A systematic literature search was carried out according to Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guidelines. After the literature selection, the following categories were determined: sexuality and sexual function; contraception; fertility; sex hormones and polycystic ovary syndrome; menopause and osteoporosis; pregnancy and breastfeeding; pelvic floor disorders and urinary incontinence; female-specific cancer; and metabolism, outcome, and quality of life. For each category, the current status of research is illuminated and implications for bariatric treatment are determined. A summary that includes key messages is given for each subsection. An overall result of this paper is an understanding that sex-specific risks that follow or result from bariatric surgery should be considered more in aftercare. In order to increase the evidence, further research focusing on sex-specific differences in the outcome of bariatric surgery and promising treatment approaches to female-specific diseases is needed. Nevertheless, bariatric surgery shows good potential in the treatment of sex-specific aspects for severely obese women that goes far beyond mere weight loss and reduction of metabolic risks.

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Comment on: Effects of Bariatric Surgery on the Menstruation and Reproductive Related Hormones of Obese Women without Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2021.11.007 ◽

2021 ◽

Author(s):

Judy Y. Chen

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Meta Analysis ◽

Obese Women ◽

Ovary Syndrome

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Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis

Obesity Surgery ◽

10.1007/s11695-021-05360-7 ◽

2021 ◽

Author(s):

Fardowsa Mohamed ◽

Megna Jeram ◽

Christin Coomarasamy ◽

Melanie Lauti ◽

Don Wilson ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Bariatric Surgery ◽

Gastric Bypass ◽

Faecal Incontinence ◽

Meta Analysis ◽

One Anastomosis Gastric Bypass ◽

Significant Difference ◽

Post Bariatric Surgery

Abstract Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract

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Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome

Fertility and Sterility ◽

10.1016/j.fertnstert.2009.11.001 ◽

2010 ◽

Vol 94 (5) ◽

pp. 1812-1816 ◽

Cited By ~ 97

Author(s):

Rebecca L. Thomson ◽

Jonathan D. Buckley ◽

Siew S. Lim ◽

Manny Noakes ◽

Peter M. Clifton ◽

...

Keyword(s):

Quality Of Life ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Obese Women ◽

Ovary Syndrome ◽

Lifestyle Management

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Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa439 ◽

2020 ◽

Vol 105 (9) ◽

pp. e3384-e3391

Author(s):

Estela Benito ◽

Jesús M Gómez-Martin ◽

Belén Vega-Piñero ◽

Pablo Priego ◽

Julio Galindo ◽

...

Keyword(s):

Bariatric Surgery ◽

Birth Weight ◽

Polycystic Ovary Syndrome ◽

Live Birth ◽

Polycystic Ovary ◽

Premenopausal Women ◽

Obese Women ◽

Ovary Syndrome ◽

Birth Rates ◽

Live Birth Rates

Abstract Context Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. Objective To study fertility and gestational outcomes in women with PCOS after bariatric surgery. Design Unicenter cohort study. Setting Academic hospital. Patients Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. Interventions All participants underwent bariatric surgery from 2005 to 2015. Main outcome measures Pregnancy and live birth rates in the PCOS and control groups. Results In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ± 28 months in women with PCOS and 32 ± 25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ± 618 g) compared with those from controls (3155 ± 586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. Conclusions Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.

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Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis

Psychodynamic Psychiatry ◽

10.1521/pdps.2020.48.4.437 ◽

2020 ◽

Vol 48 (4) ◽

pp. 437-454

Author(s):

Tomas Lindegaard ◽

Matilda Berg ◽

Gerhard Andersson

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Psychodynamic Therapy ◽

Significant Heterogeneity ◽

Psychodynamic Treatment ◽

Literature Searches ◽

Treatment Models ◽

Promising Treatment

Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32–0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.

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