Background
Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates. 相似文献Megan RoehrigEmail: |
Background
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Background
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Introduction
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.Background
The present study aimed to identify the implications for the mother and the newborn in pregnancies occurring after the bariatric surgery. 相似文献Introduction
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.Background
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Background
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?0.001). Fibrosis stage (p?0.002), amount of steatosis (%) (p?0.001), BMI (p?0.02), and activity score (p?=?0.027) were independently correlated with LSM. Homeostasis model assessment (HOMA) index was also significantly and independently correlated with LSM (p?0.01). The area under the receiver operating characteristic curve (AUROC) generated by FibroScan® was 0.81?±?0.05 for predicting fibrosis stage F ≥2 and 0.85?±?0.04 for predicting F3 fibrosis. The decrease in LSM 1 year after bariatric surgery was significantly correlated with changes in HOMA index (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.
MethodsA 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.
ResultsA 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%).
ConclusionsDue 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.
Graphical abstract