Background Extremely obese bariatric surgery candidates report numerous episodes of both successful and unsuccessful dieting attempts,
but little is known about the clinical significance of frequent dieting attempts in this patient group.
Methods The current study examined psychological and weight-related correlates of self-reported dieting frequency in 219 bariatric
surgery candidates (29 men and 190 women). Prior to surgery, patients completed a battery of established self-report assessments.
Patients were dichotomized into chronic dieters (n = 109) and intermittent dieters (n = 110) based on a median split of self-reported percent time spent dieting during adulthood. The two dieting groups were
compared on demographics, eating and weight history, eating disorder psychopathology, and global functioning.
Results Chronic dieters had significantly lower pre-operative body mass indexes (BMIs), lower highest-ever BMIs, more episodes of
weight cycling, and earlier ages of onset for overweight and dieting than intermittent dieters. After controlling for differences
in BMI, chronic dieters were found to have statistically but not clinically significant elevations in eating concerns, dietary
restraint, and body dissatisfaction than infrequent dieters. The two groups, however, did not differ significantly on depressive
symptoms, self-esteem, or health-related quality of life; nor did they differ in binge-eating status.
Conclusions Chronic dieting is commonly reported among extremely obese bariatric candidates and is not associated with poorer psychological
functioning or binge eating and may be beneficial in attenuating even greater weight gain. Our findings provide preliminary
data to suggest that requiring additional presurgical weight loss attempts may not be warranted for the vast majority of extremely
obese bariatric candidates.
Background: This study investigated the psychiatric diagnoses and psychiatric treatment histories of 90 bariatric surgery
candidates. Methods: Prior to surgery, all participants completed the Weight and Lifestyle Inventory, the Questionnaire on
Eating and Weight Patterns, and the Beck Depression Inventory-II. Participants also underwent a behavioral/psychological evaluation
with a psychologist, which reviewed responses to the measures and provided further assessment of participants' psychiatric
status. The evaluation also was used to produce a recommendation on the patients' psychological appropriateness for surgery.
Results: Almost two-thirds of patients received a psychiatric diagnosis, the most common of which was major depressive disorder.
Nearly two-fifths of all participants, and more than half of those given a psychiatric diagnosis, were engaged in some form
of psychiatric treatment at the time of the evaluation. Nevertheless, 64% of patients were unconditionally approved for surgery;
31% were recommended for additional psychiatric or nutritional counseling prior to surgery. Three patients were not recommended
for surgery. Conclusion: Results of this study provide important information on the preoperative psychiatric status and treatment
histories of bariatric surgery candidates. Given the increasing population of bariatric surgery patients, evaluation of patients'
preoperative psychiatric status may play an important role in maximizing successful postoperative outcomes. 相似文献
Carcinoid is a rare gastrointestinal tumor. We have noticed a high incidence of carcinoid in our patient population during
the gastric reduction-duodenal switch operation.Further studies are needed to identify any potential correlation between morbid
obesity and carcinoid tumors. 相似文献
Psychological factors are considered potential contraindicators to bariatric surgery, but inconsistently predict surgical
outcomes. We examined biomedical and psychosocial predictors of future bariatric candidacy in a population of veterans enrolling
in a multidisciplinary weight management program. 相似文献
Morbid obesity has multiple negative consequences for psychological health. These patients are described as depressed, anxious,
and impulsive, with low self-esteem and impaired quality of life. The severity of these psychological disorders has been related
to the degree of obesity. The aim of this study was to analyze the psychopathological characteristics of obese candidates
for bariatric surgery, determining differences and similarities in general and specific psychopathologic symptoms among patients
with different degrees of obesity and normal-weight individuals. 相似文献
Carcinoids of the appendix are rare in children and
are usually diagnosed incidentally on histologic investigation
following appendectomy for appendicitis. To investigate the
significance of the diagnosis of appendiceal carcinoid in children, we
conducted a retrospective study of the treatment and follow-up of 36
children with histologically confirmed carcinoid tumors of the
appendix. Between 1970 and 2000 a total of 36 patients (25 girls,
11 boys) were diagnosed with appendiceal carcinoid. The median age of
the patients at diagnosis was 12.3 years (range 6–16 years). The
indication for appendectomy was acute lower right quadrant pain in 27
cases and chronic right lower quadrant pain in 9 patients. In 27
specimens the tumor was localized at the apex, in 7 at the midportion,
and in 2 at the base of the appendix. The median tumor diameter was 6
mm (range 3–17 mm). Concomitant severe appendicitis was diagnosed
in 14 patients 2 with a perforated appendicitis. In only one tumor were
mucin-producing cells detectable. After a median follow-up of 10 years
(range 2 months to 30 years) all patients were tumor-free. None of the
patients had a synchronous or metachronous noncarcinoid malignant
tumor. Appendiceal carcinoids are usually asymptomatic, and the
indication for surgical intervention is acute or chronic abdominal
pains in the right lower quadrant. For most patients the prognosis is
excellent after appendectomy. As in adults, appendectomy is the
appropriate treatment. 相似文献
Background This study used standardized assessments to evaluate the association between childhood maltreatment (i.e., emotional, physical,
and sexual abuse and emotional and physical neglect) and Axis I and II psychiatric disorders in patients presenting for bariatric
surgery.
Methods Participants (N = 230) provided demographic information and completed the Childhood Trauma Questionnaire, short form. The Structured Clinical
Interview for the DSM-IV was used to assess Axis I clinical disorders and Axis II personality disorders.
Results Approximately 66% of participants had a history of childhood maltreatment. Individuals reporting childhood maltreatment had
a greater number of lifetime Axis I diagnoses than did those without, although the effect for physical neglect was no longer
significant after controlling for multiple comparisons. With respect to specific Axis I diagnoses, a history of emotional
or sexual abuse was associated with increased rates of lifetime mood and anxiety disorder diagnoses. Emotional neglect also
was associated with increased rates of mood disorder diagnoses, and physical abuse was associated with increased rates of
substance use disorders. There was no significant association between childhood maltreatment and personality psychopathology.
Conclusion This study confirms high rates of childhood maltreatment in patients presenting for bariatric surgery that are associated
with increased prevalence of lifetime mood, anxiety, and substance use disorders. Future prospective studies should include
evaluation of a broad range of mental health and childhood experiences to tease apart the nature of the relationships between
these factors and their potential impact on post-surgical outcomes. 相似文献
Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS.
Methods
An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1–2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records.
Results
Data for paired study questionnaires scores were available for 128 patients (n?=?69 and n?=?59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3?±?11.4 years and 41.3?±?4.9 kg/m2, respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P?≤?0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P?=?0.030). No within or between-group differences were found for the trait anxiety items score. The “dream” and “realistic” weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P?<?0.001 for all).
Conclusion
Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.
Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS, based on our clinical experience and current scientific literature in both nutrition fields.
Methods
Cross-sectional analysis of a prospectively maintained database of all primary laparoscopic sleeve gastrectomies (LSG) performed at a bariatric center of excellence between January 2014 and November 2016 was carried out querying patients who declared a vegetarian or vegan lifestyle before surgery. Preoperative data collected included demographics, anthropometrics, dietary patterns, supplementation use, physical activity, smoking habits, co-morbidities, and blood tests. Each vegetarian was matched to five different omnivores based on age, gender, and BMI.
Results
During the study period, 1470 patients underwent primary LSG surgery (63.7% females). Twenty-one declared a vegetarian or vegan lifestyle (1.4%) pre-surgery. Most were classified as lacto-ovo (57.1%) and were driven from ethical reasons (85.7%). No differences were found between vegetarian and omnivore LSG candidates regarding co-morbidities and nutritional deficiencies, except for lower prevalence of impaired fasting glucose (14.3 vs. 47.1%;P = 0.007), lower ferritin levels (54.3 ± 50.5 vs. 96.8 ± 121.8 ng/ml; P = 0.052) and higher transferrin levels (313.9 ± 42.7 vs. 278.4 ± 40.4 mg/dl; P = 0.009) among the vegetarian cohort. Preoperative use of vitamin B12 and iron supplementation was higher among vegetarian LSG candidates than their omnivore counterparts (57.1 vs. 6.7%;P < 0.001 and 23.8 vs. 6.7%; P = 0.015, respectively).
Conclusions
Vegetarians have comparable health status and nutritional deficiencies, lower iron stores, and higher supplementation use before surgery compared to omnivore LSG candidates.
This study used a qualitative approach to comprehend how the morbid obese conceptualize and deal with obesity and obesity treatment, with the particular aim of exploring the expectations and beliefs about the exigencies and the impact of bariatric surgery.
Methods
The study population included 30 morbid obese patients (20 women and 10 men) with a mean age of 39.17?years (SD?=?8.81) and a mean body mass index of 47.5 (SD?=?8.2) (reviewer #2, comment #9) interviewed individually before surgery using open-ended questions. The interviews were audiotaped, transcribed, and then coded according to grounded analysis methodology.
Results
Three main thematic areas emerged from the data: obesity, eating behavior, and treatment. Obesity is described as a stable and hereditary trait. Although participants recognize that personal eating behavior exacerbates this condition, patients see their eating behavior as difficult to change and control. Food seems to be an ever-present dimension and a coping strategy, and to follow an adequate diet plan is described as a huge sacrifice. Bariatric surgery emerges as the only treatment for obesity, and participants highlight this moment as the beginning of a new life where health professionals have the main role. Bariatric surgery candidates see their eating behavior as out of their control, and to commit to its demands is seen as a big sacrifice. For these patients, surgery is understood as a miracle moment that will change their lives without requiring an active role or their participation.
Conclusion
According to these results, it is necessary to validate them with qualitative and quantitative studies (reviewer #2, comment #3); it is necessary to promote a new awareness of the weight loss process and to empower patients before and after bariatric surgery. 相似文献
Severe obesity and metabolic syndrome have been implicated in the development of nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic value of liver stiffness measurement (LSM), by transient elastography (FibroScan®) in bariatric surgery candidates with suspected NAFLD.
Methods
A total of 100 prospectively included consecutive severely obese subjects underwent bariatric surgery with liver needle biopsy. LSM was performed in the 15 days preceding liver biopsy.
Results
According to Kleiner’s classification, 28 patients had no fibrosis, 50 had stage F1 fibrosis, 13 had stage F2 fibrosis, and nine had stage F3 fibrosis. LSMs were higher in patients with fibrosis stage F ≥2, than in patients with a fibrosis stage below F2 (p?p?p?p?p?=?0.027) were independently correlated with LSM. Homeostasis model assessment (HOMA) index was also significantly and independently correlated with LSM (p?r?=?0.43, p?=?0.01), but not with changes in BMI or weight.
Conclusion
FibroScan® allows the early diagnosis of fibrosis in severely obese patients. Our results also suggest that FibroScan® could identify a subgroup of NAFLD patients at high risk of progressive liver disease and that LSM could be used as a surrogate marker of insulin resistance. Further studies are required to evaluate the prognostic value of FibroScan®. 相似文献
In the USA, less than 1% of eligible patients who qualify for bariatric surgery ultimately undergo surgery. Perceptions of endoscopic bariatric therapies (EBTs) for weight management remain unknown.
Methods
A 22-question survey was distributed to primary care physicians (PCPs) across the Mayo Clinic healthcare system. Survey invitations were sent via email, and all surveys were unanimously conducted electronically.
Results
A total of 130 PCPs participated in the survey (40% response rate). Twenty-four PCPs were between 20 and 24 years out of training (18.5%), and 71 (54.6%) were female. Most providers had a body mass index (BMI) between 18.5 and 24.9 kg/m2 (n?=?62, 47.7%). Among the weight loss options discussed during clinic visits, PCPs discussed lifestyle modification including diet and exercise (n?=?129; 99.2%), and 68 PCPs (52.3%) were not aware of EBTs as weight loss interventions. While 46.2% of the PCPs agreed that a bariatric endoscopy is an effective option for weight loss, only 24.6% of PCPs were familiar with the indications for EBTs. Most of the cohort (n?=?69, 53.1%) experienced barriers in referring their patients. Moreover, most of the patients referred to bariatric clinics were from PCPs who had a BMI between 18.5 and 24.9 kg/m2 (n?=?62, 47.7%) as compared to PCPs with a BMI of 40 kg/m2 and greater (n?=?5, 3.8%).
Conclusions
Due to the rise of bariatric therapies in recent years, PCPs are increasingly involved in the referral and management of patients with obesity and obesity-related comorbidities. However, knowledge gaps regarding weight loss options, including EBTs, could limit optimal care to patients desiring medically monitored weight loss.
Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown.
Methods
Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed.
Materials
The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n?=?405), Three-Factor Eating Questionnaire (TFEQ; n?=?405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n?=?204), Clinical Impairment Assessment (CIA; n?=?204) and the Eating Disorder Examination clinical interview (EDE; n?=?131).
Results
CFA revealed adequate fit for only the CIA in its current form (CFI?=?0.925, RMSEA?=?0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α?=?0.43–0.82; revised scales α?=?0.67–0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures.
Conclusions
Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.
Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient ?0.2, P?相似文献
