Impact of Bariatric Surgery on Pulmonary Function and Nitric Oxide in Asthmatic and Non-Asthmatic Obese Patients

Background. Asthma is an important co-morbidity of obesity. This study evaluated the impact of bariatric surgery on respiratory function in obese patients and compared the outcomes in asthmatic and non-asthmatic subjects. Methods. The study was observational and prospective and included subjects on waiting list for bariatric surgery. Pulmonary function, symptoms, and exhaled nitric oxide were assessed before surgery and 1 year after. Results. Twenty-nine severe obese subjects (age range: 25–66 years) with a mean body mass index of 44.8 ± 4.7 kg/m² were included. Fourteen of them had also intermittent to moderate asthma. In the whole population, the body mass index decreased from 44.8 ± 4.7 to 41.1 ± 3.9 kg/m² (p = .0001) and the forced vital capacity increased from 3.05 ± 0.83 to 3.50 ± 0.81 L (p = .043). No change was seen in forced expiratory volume and oxygen saturation. These results remained valid also analyzing asthmatics and non-asthmatics separately. Concerning nitric oxide, the decrease at 1 year was significantly different between the two populations, since in asthma patients exhaled nitric oxide decreased by 4.86 ppb after bariatric surgery and increased by 0.27 ppb in non-asthmatics (p = .04). Conclusions. Bariatric surgery significantly reduces the intake of inhaled corticosteroids and the levels of exhaled nitric oxide, thus bronchial inflammation, in asthmatics.     

Factor Structure and Item Analysis of the Yale Food Addiction Scale in Obese Candidates for Bariatric Surgery

Converging research suggests phenomenological and neurobiological similarities between excessive food consumption and addictive behaviour in substance dependence. Recently, the Yale Food Addiction Scale (YFAS) has been proposed for the assessment of addictive eating behaviour. The German version of the YFAS was administered to obese individuals seeking bariatric surgery (N = 96). Factor structure, internal consistency, and item statistics were analysed. Forty participants (41.70%) received a food addiction diagnosis. The one‐factorial structure of the YFAS, which has been found in non‐clinical samples, could be confirmed. All but three items had factor loadings >.50. Internal consistency was α = .82. Item analysis revealed that items related to unsuccessful attempts to cut down and consumption despite physical and emotional problems were endorsed by the majority of participants. Findings support the use of the YFAS in clinical populations, while applicability of some items differs between clinical and non‐clinical samples. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Weight Loss Trajectories in Bariatric Surgery Patients and Psychopathological Correlates

This study aimed to explore the empirical trajectories of body mass index (BMI) 1 year following bariatric surgery (BS) and to identify the risk factors for each trajectory. The study included 115 patients with severe obesity who underwent BS. Assessment included metabolic variables, psychopathological and personality measures. Growth mixture modelling identified four separated trajectories for the percentage of total weight loss course shape (namely, T1 ‘good‐fast’, T2 ‘good’, T3 ‘low’ and T4 ‘low‐slow’). After adjusting for BS subtype and metabolic baseline state, T1 and T2 registered less eating and general psychopathology. T1 was characterized by the lowest scores in novelty seeking and self‐transcendence, whereas T4 was defined by the highest scores in novelty seeking and the lowest scores in persistence. Our findings suggest that psychological state prior to BS is predictive of BMI trajectories during the 12 months following BS. These results could be useful in developing more efficient interventions for these patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge Eating and Temperament in Morbidly Obese Prebariatric Surgery Patients

The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Obese African-American Women’s Perspectives on Weight Loss and Bariatric Surgery

Background African-American (AA) women have higher rates of obesity and obesity-related diseases but are less likely than other women to undergo bariatric surgery or have success with conventional weight loss methods. Objective To explore obese AA women’s perceptions regarding barriers to weight loss and bariatric surgery. Design Focus groups to stimulate interactive dialogue about beliefs and attitudes concerning weight management. Participants and Approach We partnered with a community organization to recruit women who were AA, were ≥18 years old, and had a body mass index (BMI) of ≥30 kg/m². We audiotaped the 90-minute focus groups and used content analysis for generating and coding recurring themes. Results In our sample of 41 participants, the mean age was 48.8 years and mean BMI was 36.3. Most participants were unmarried, had some postsecondary education, and reported good or fair health. About 85% knew someone who had undergone bariatric surgery. Qualitative analysis of 6 focus group sessions revealed that the most common barriers to weight loss were lack of time and access to resources; issues regarding self-control and extrinsic control; and identification with a larger body size. Common barriers to bariatric surgery were fears and concerns about treatment effects and perceptions that surgery was too extreme or was a method of last resort. Conclusions Only through the elimination of barriers can AA women receive the care needed to eliminate excess weight and prevent obesity-related morbidity and mortality.     

Prevalence of Dyslipidemia and Associated Factors in Obese Children and Adolescents

Objective:Childhood-onset obesity is associated with increased mortality and morbidity related to cardiovascular diseases (CVD) during adulthood. Dyslipidemia has a fundamental role in the pathogenesis of CVD. This study aimed to evaluate the prevalence of dyslipidemia and related factors among obese children and adolescents.Methods:Obese patients aged between 2 and 18 years were included in the study. Serum concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), fasting glucose levels, insulin, thyroid-stimulating hormone (TSH), free thyroxine (fT4), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and liver ultrasound findings were evaluated retrospectively.Results:Among 823 obese patients, 353 (42.9%) met the dyslipidemia criteria: 21.7% had hypertriglyceridemia, 19.7% had low levels of HDL-C, 18.6% had hypercholesterolemia, and 13.7% had high levels of LDL-C. Older age and/or high body mass index (BMI) were related to increased prevalence of dyslipidemia. Hepatosteatosis was more common among dyslipidemic patients. The frequency of insulin resistance (IR) and of higher levels of ALT and TSH were also detected in dyslipidemic patients. Patients with both dyslipidemia and grade 2-3 hepatosteatosis had higher levels of ALT, AST and TSH and lower levels of fT4.Conclusion:Prevalence of dyslipidemia is high in obese children, and hypertriglyceridemia is in the foreground. Higher levels of IR and more apparent abnormal liver function test results are observed in the context of dyslipidemia and hepatosteatosis coexistence. Metabolic and hormonal alterations related with thyroid functions may also be associated with dyslipidemia and hepatosteatosis in obese patients.     

Impulse Control Disorders in Obese Patients

The aim of this study was to determine the prevalence of impulse control disorders (ICDs) in morbidly obese individuals. One hundred bariatric surgery candidates were examined using a module of the Structured Clinical Interview for DSM‐IV that has been developed for ICDs. Nineteen per cent suffered from at least one current ICD and 27% met the criteria for any lifetime ICD, most frequently skin picking (current, 8%; lifetime, 9%), compulsive buying (current 6%, lifetime 8%), and intermittent explosive disorder (current, 5%; lifetime, 10%). Patients with regular binge eating (N = 25) reported significantly more often a history of at least one ICD compared with those without binge eating. The results indicate a high prevalence of ICDs among morbidly obese prebariatric surgery patients that are related to regular binge eating. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Snoring and Sleep Apnea in Obese Adolescents: Effect of Long-term Weight Loss-Rehabilitation

Objective: To test the effect of a long-term weight loss rehabilitation program in extremely obese adolescents on breathing parameters during sleep. Methods: Thirty-eight extremely obese [mean body mass index (BMI) 45.3 ± 7.9kg/m²] adolescents participated during a three- to nine-month period in an inpatient weight loss rehabilitation in a specialized long-term rehabilitation center. Breathing parameters were registered via a seven-channel portable screening device. Body weight and arterial blood pressure were measured before and after the long-term treatment. Results: Mean BMI decreased from 45.3 to 35.8 (p < 0.001), mean diastolic blood pressure decreased from 89 mmHg to 81 mmHg (p = 0,002). Nine patients had a RDI of 5 and 30 patients a RDI of <5; the mean RDI decreased from 4.08 to 3.27 (n.s.). Within the group, the RDI was 5 and the mean RDI decreased from 10.3/h to 5.2/h (p = 0.02). The mean SaO₂ increased from 93.65 to 95.35% (p = 0.003), lowest SaO₂ increased from 72.14 to 73.19% (n.s.) and snoring frequency decreased from 37.56% of total sleep time (TST) to 32.86% of TST (n.s.). Conclusion: A long-term inpatient weight loss program has a positive effect on breathing parameters during sleep in extremely obese adolescents. However, the effect on apneic events and snoring is relatively minor compared to the effect on arterial oxygen saturation. The role of obesity in the origin of respiratory events and snoring in adolescents might be overestimated.     

Bariatric surgery: A primer for eating disorder professionals

Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non‐surgical long‐term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non‐surgical approaches. Pre‐operative evaluation followed by post‐operative, longitudinal follow‐up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow‐up for bariatric surgery patients to prevent and detect post‐operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Bariatric surgery for obese children and adolescents: a systematic review and meta‐analysis

The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric‐adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta‐analyse change in body mass index (BMI) 1‐year post‐surgery and (iii) report complications, co‐morbidity resolution and health‐related quality of life (HRQoL). A systematic literature search (1955–2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux‐en‐Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta‐analysed using a random effects model. In total, 637 patients from 23 studies were included in the meta‐analysis. There were significant decreases in BMI at 1 year (average weighted mean BMI difference: ?13.5 kg m^?2; 95% confidence interval [CI] ?14.1 to ?11.9). Complications were inconsistently reported. There was some evidence of co‐morbidity resolution and improvements in HRQol post‐surgery. Bariatric surgery leads to significant short‐term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long‐term, prospectively designed studies, with clear reporting of complications and co‐morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents.     

Design as a Critical Tool in Bariatric Patient Care

Both men and women in the United States are roughly an inch taller and 25 pounds heavier than they were in 1960, says the National Center for Health Statistics at the Centers for Disease Control and Prevention. An increasing number are also overweight or obese. In fact, obesity has become an alarming epidemic with enormous implications for our health care system. A critical concern is the ability to care physically and emotionally for this segment of the patient population. Respecting patient dignity and delivering optimum clinical care are primary issues, as are establishing procedures for safeguarding the health and well-being of these patients and their caregivers. Design is a critical tool in the care of and the improved long-term clinical outcomes for bariatric patients; success mandates a three-prong approach to the design process: appropriate facilities and space, proper equipment and furnishings, and training and standardized care protocols. Together, these components ensure the ability of a health care provider to adequately care for all patients—including this newest and rapidly growing patient segment—with equality and dignity.